Modified neck dissection (MND) is not recommended for surgery of thyroid carcinoma (TC) in the absence of grossly involved nodes, except for medullary thyroid carcinoma, and clinical node recurrence in uncommon at follow-up (3% for us). But several authors report metastatic cancer in non-palpable nodes up to 70% on MND specimens. The fear of overlooking occult metastatic nodes prompted us to sample even normal appearing nodes and to rely on frozen sections (FS) to make a decision whether or not a MND should be done.
Patients and methods: 130 among 300 consecutive patients operated for TC were submitted to supraclavicular node sampling with FS. All pathological varieties were covered. In 170 cases, sampling was not done purposely (lack of intraoperative diagnosis of carcinoma: 75) or for other reasons (absence of obvious nodes: 77; unavailable pathologist: 14; miscellaneous: 4). All specimens were reviewed by paraffin sections (PS).
Results: Among the 130 patients; 25 had gross metastatic node involvement, confirmed by FS+ and PS+; 1 had grossly equivocal nodes with FS- and PS+; 104 had grossly normal nodes. In 101 (97%) this was confirmed by FS- and PS-. In 3 (3%) FS was +, leading to MND, and PS confirmed metastatic involvement in 2. All 32 specimens of routine node sampling done in 1988 have been reviewed by serial cross sections, one each millimeter (331 sections). One only disclosed one occult metastatic invasion.
Conclusion: No more than 3% of the grossly normal supraclavicular nodes are metastatic at the time of surgery.(ABSTRACT TRUNCATED AT 250 WORDS)