Central compartment management in patients with papillary thyroid cancer presenting with metastatic disease to the lateral neck: Anatomic pathways of lymphatic spread

Background: Papillary thyroid cancer (PTC) occasionally presents with metastases to the lateral neck, without clinically evident disease in the central neck. These cases may ultimately manifest as either skip metastases to the lateral compartment or as occult metastases in the central compartment. Methods: This is a retrospective review of 80 patients with PTC with metastases to the lateral cervical lymph nodes treated from 2006 to 2015. Photographs of the cadaveric dissections were used with permission from the author. Schematic illustrations were created to highlight lymphatic drainage pathways. Results: The rate of skip metastasis in this cohort was 5%. Clinical evidence of central neck disease did not predict the pathologic status of the compartment. Conclusion: PTC rarely spreads to the lateral neck without depositing metastases within the central neck. This finding is supported by the anatomic pathways for lymphatic spread, not previously highlighted in the English literature.