{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T07:17:45Z","timestamp":1785827865314,"version":"3.56.0"},"reference-count":81,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: The optimal extent of lateral lymph node dissection in cN1b differentiated thyroid cancer remains controversial. This systematic review aimed to assess the frequency of lymph node involvement across neck levels I to V. Materials and Methods: A systematic review was conducted following PRISMA guidelines. PubMed was searched for studies on lateral neck dissection in differentiated thyroid cancer. Included studies reported level-specified metastatic rates. Data on patient numbers and metastatic events were extracted. A random-effects meta-analysis with Freeman\u2013Tukey double arcsine transformation was performed for each neck level to calculate pooled prevalence proportions and 95% confidence intervals. Heterogeneity was assessed using the I2 statistic. Results: Meta-analysis of 57 studies revealed that level III (68%, 95% CI: 63\u201373) and level IV (66%, 95% CI: 61\u201370) had the highest metastatic prevalence, followed by level IIA (46%, 95% CI: 37\u201356). Level V demonstrated an overall prevalence of 22% (95% CI: 18\u201326), with sublevel VB (19%, 95% CI: 11\u201328) significantly higher than VA (4%, 95% CI: 1\u20139). Level I (6%, 95% CI: 2\u201311) and sublevel IIB (14%, 95% CI: 9\u201320) showed the lowest risk. Significant heterogeneity (I2 71\u201394%) was observed across all levels. Conclusions: Our findings support sparing level I, and sublevels IIB and VA during lateral neck dissection. Current guidelines recommend systematic dissection of IIA, III, IV, and VB, although VB involvement was found to be only 19% in our study. Future personalization of the extent of neck dissection, based on individual risk factors, may be key to optimizing oncologic and functional outcomes.<\/jats:p>","DOI":"10.3390\/diagnostics15202613","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T16:33:22Z","timestamp":1760632402000},"page":"2613","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Patterns of Lateral Lymph Node Involvement by Neck Level in cNIb Differentiated Thyroid Carcinoma: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1161-5628","authenticated-orcid":false,"given":"Dana M.","family":"Hartl","sequence":"first","affiliation":[{"name":"Division of Surgery and Anesthesiology, Head and Neck Oncology Service, Thyroid Surgery Unit, Gustave Roussy Cancer Campus Grand Paris, 94800 Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1420-7366","authenticated-orcid":false,"given":"Karthik N.","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Oncology, Sri Shankara Cancer Foundation, Bangalore 560004, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1363-8559","authenticated-orcid":false,"given":"Andr\u00e9s","family":"Coca Pelaz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Hospital Universitario Central de Asturias, ISPA, IUOPA, CIBERONC, University of Oviedo, 33003 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7956-6709","authenticated-orcid":false,"given":"Alessandra","family":"Rinaldo","sequence":"additional","affiliation":[{"name":"ENT Unit, Policlinico Citt\u00e0 di Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7918-9739","authenticated-orcid":false,"given":"Mark E.","family":"Zafereo","sequence":"additional","affiliation":[{"name":"Head and Neck Endocrine Surgery, MD Anderson Cancer Center, The University of Texas, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5373-9181","authenticated-orcid":false,"given":"Greg W.","family":"Randolph","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8919-8783","authenticated-orcid":false,"given":"Iain J.","family":"Nixon","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, University of Edinburgh, Edinburgh EH8 9YL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8547-2768","authenticated-orcid":false,"given":"Marc","family":"Hamoir","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Institute de Recherche Exp\u00e9rimentale, 1200 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Thomas","family":"Robbins","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 62702, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0481-156X","authenticated-orcid":false,"given":"Luiz P.","family":"Kowalski","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, S\u00e3o Paulo 01509-010, Brazil"},{"name":"Department of Head and Neck Surgery, University of S\u00e3o Paulo Medical School, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia Pace","family":"Asciak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, St. Joseph\u2019s Health Centre, University of Toronto, Toronto, ON M5S 1A1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Badr","family":"Soudi","sequence":"additional","affiliation":[{"name":"Division of Surgery and Anesthesiology, Head and Neck Oncology Service, Thyroid Surgery Unit, Gustave Roussy Cancer Campus Grand Paris, 94800 Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3063-0890","authenticated-orcid":false,"given":"Juan P.","family":"Rodrigo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Hospital Universitario Central de Asturias, ISPA, IUOPA, CIBERONC, University of Oviedo, 33003 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8247-8002","authenticated-orcid":false,"given":"Alfio","family":"Ferlito","sequence":"additional","affiliation":[{"name":"Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1089\/thy.2011.0312","article-title":"American thyroid association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer","volume":"22","author":"Stack","year":"2012","journal-title":"Thyroid"},{"key":"ref_2","first-page":"841","article-title":"2025 american thyroid association management guidelines for adult patients with differentiated thyroid cancer","volume":"35","author":"Ringel","year":"2025","journal-title":"Thyroid"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/thy.2015.0020","article-title":"2015 american thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer","volume":"26","author":"Haugen","year":"2016","journal-title":"Thyroid"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1001\/archotol.134.5.536","article-title":"Consensus statement on the classification and terminology of neck dissection","volume":"134","author":"Robbins","year":"2008","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"American Thyroid Association Surgery Working Group, American Association of Endocrine Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Carty, S.E., Cooper, D.S., Doherty, G.M., Duh, Q.-Y., Kloos, R.T., and Mandel, S.J. (2009). Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid, 19, 1153\u20131158.","DOI":"10.1089\/thy.2009.0159"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Abdulmajeed, J., Chivese, T., and Doi, S.A.R. (2025). Overcoming challenges in prevalence meta-analysis: The case for the Freeman-Tukey transform. BMC Med. Res. Methodol., 25.","DOI":"10.1186\/s12874-025-02527-z"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1136\/bmj.39343.408449.80","article-title":"Uncertainty in heterogeneity estimates in meta-analyses","volume":"335","author":"Ioannidis","year":"2007","journal-title":"BMJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1111\/biom.12817","article-title":"Quantifying publication bias in meta-analysis","volume":"74","author":"Lin","year":"2018","journal-title":"Biometrics"},{"key":"ref_10","unstructured":"Schwarzer, G. (2025, September 26). Meta: General Package for Meta-Analysis. Available online: https:\/\/cran.r-project.org\/web\/packages\/meta\/index.html."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1002\/hed.22903","article-title":"Pattern and predictive factors of regional lymph node metastasis in papillary thyroid carcinoma: A prospective study","volume":"35","author":"Nam","year":"2013","journal-title":"Head Neck"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1007\/s00405-016-4423-5","article-title":"Level I lymph node involvement in patients with N1b papillary thyroid carcinoma: A prospective study","volume":"274","author":"Eweida","year":"2017","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1046\/j.0007-1323.2001.01843.x","article-title":"Pattern of cervical lymph node metastases from papillary carcinoma of the thyroid","volume":"88","author":"Sivanandan","year":"2001","journal-title":"Br. J. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1001\/archotol.128.11.1275","article-title":"Tumor above the spinal accessory nerve in papillary thyroid cancer that involves lateral neck nodes: A common occurrence","volume":"128","author":"Pingpank","year":"2002","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1001\/archotol.130.7.857","article-title":"Patterns of lateral neck metastasis in papillary thyroid carcinoma","volume":"130","author":"Kupferman","year":"2004","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1245\/s10434-006-9202-x","article-title":"Review of distribution of nodal disease in differentiated thyroid cancers in an oncosurgical center in Sri Lanka","volume":"14","author":"Amarasinghe","year":"2007","journal-title":"Ann. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1245\/s10434-008-9813-5","article-title":"Lateral cervical lymph node metastases from papillary thyroid carcinoma: Pattern of nodal metastases and optimal strategy for neck dissection","volume":"15","author":"Roh","year":"2008","journal-title":"Ann. Surg. Oncol."},{"key":"ref_18","first-page":"312","article-title":"Pattern of regional metastases and prognostic factors in differentiated thyroid carcinoma","volume":"29","author":"Spriano","year":"2009","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"735678","DOI":"10.1155\/2011\/735678","article-title":"Patterns of cervical lymph node metastases in primary and recurrent papillary thyroid cancer","volume":"2011","author":"Ahmadi","year":"2011","journal-title":"J. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1001\/archotol.133.10.1028","article-title":"Level IIb lymph node metastasis in neck dissection for papillary thyroid carcinoma","volume":"133","author":"Lee","year":"2007","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1007\/s00268-008-9588-7","article-title":"Diagnostic accuracy of CT and ultrasonography for evaluating metastatic cervical lymph nodes in patients with thyroid cancer","volume":"32","author":"Ahn","year":"2008","journal-title":"World J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1007\/s00268-007-9381-z","article-title":"Is level IIb lymph node dissection always necessary in N1b papillary thyroid carcinoma patients?","volume":"32","author":"Lee","year":"2008","journal-title":"World J. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1245\/s10434-009-0367-y","article-title":"Predictive factors of level IIb lymph node metastasis in patients with papillary thyroid carcinoma","volume":"16","author":"Koo","year":"2009","journal-title":"Ann. Surg. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1007\/s00268-009-0071-x","article-title":"Is routine dissection of level II-B and V-A necessary in patients with papillary thyroid cancer undergoing lateral neck dissection for FNA-confirmed metastases in other levels","volume":"33","author":"Farrag","year":"2009","journal-title":"World J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1186\/1477-7819-10-221","article-title":"Optimal surgical extent of lateral and central neck dissection for papillary thyroid carcinoma located in one lobe with clinical lateral lymph node metastasis","volume":"10","author":"Keum","year":"2012","journal-title":"World J. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1001\/2013.jamaoto.393","article-title":"Predictors of level II and Vb neck disease in metastatic papillary thyroid cancer","volume":"138","author":"Merdad","year":"2012","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1007\/s00268-012-1476-5","article-title":"Skip lateral neck node metastases in papillary thyroid carcinoma","volume":"36","author":"Park","year":"2012","journal-title":"World J. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1002\/hed.21937","article-title":"Determining the extent of lateral neck dissection necessary to establish regional disease control and avoid reoperation after previous total thyroidectomy and radioactive iodine for papillary thyroid cancer","volume":"34","author":"Wu","year":"2012","journal-title":"Head Neck"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1186\/1477-7819-11-304","article-title":"Should level v be included in lateral neck dissection in treating papillary thyroid carcinoma?","volume":"11","author":"Zhang","year":"2013","journal-title":"World J. Surg. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1002\/bjs.9024","article-title":"Preoperative detection and predictors of level V lymph node metastasis in patients with papillary thyroid carcinoma","volume":"100","author":"Shim","year":"2013","journal-title":"Br. J. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1007\/s00268-013-2361-6","article-title":"Candidates for limited lateral neck dissection among patients with metastatic papillary thyroid carcinoma","volume":"38","author":"Kang","year":"2014","journal-title":"World J. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1111\/ans.12045","article-title":"Disease outcomes and nodal recurrence in patients with papillary thyroid cancer and lateral neck nodal metastases","volume":"84","author":"Coorough","year":"2014","journal-title":"ANZ J. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/j.jamcollsurg.2016.02.006","article-title":"Dissection of levels ii through v is required for optimal outcomes in patients with lateral neck lymph node metastasis from papillary thyroid carcinoma","volume":"222","author":"Javid","year":"2016","journal-title":"J. Am. Coll. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1002\/cam4.792","article-title":"Risk factors for level v lymph node metastases in solitary papillary thyroid carcinoma with clinically lateral lymph node metastases","volume":"5","author":"Yang","year":"2016","journal-title":"Cancer Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1002\/bjs.10514","article-title":"Patterns, predictive factors and prognostic impact of multilevel metastasis in N1b papillary thyroid carcinoma","volume":"104","author":"Kim","year":"2017","journal-title":"Br. J. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1002\/hed.24936","article-title":"Therapeutic lateral neck dissection in well-differentiated thyroid cancer: Analysis on factors predicting distribution of positive nodes and prognosis","volume":"40","author":"Lombardi","year":"2018","journal-title":"Head Neck"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e12263","DOI":"10.1097\/MD.0000000000012263","article-title":"Pattern of and clinicopathologic risk factors for lateral lymph node metastases in papillary thyroid carcinoma patients with lateral cervical lymphadenopathy","volume":"97","author":"Gong","year":"2018","journal-title":"Medicine"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Liu, C., Xiao, C., Chen, J., Li, X., Feng, Z., Gao, Q., and Liu, Z. (2019). Risk factor analysis for predicting cervical lymph node metastasis in papillary thyroid carcinoma: A study of 966 patients. BMC Cancer, 19.","DOI":"10.1186\/s12885-019-5835-6"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3371","DOI":"10.2147\/CMAR.S247914","article-title":"Predictive factors for level v lymph node metastases in papillary thyroid carcinoma with brafv600e mutation and clinicopathological features","volume":"12","author":"Li","year":"2020","journal-title":"Cancer Manag. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1177\/01945998211038318","article-title":"Indications of superselective neck dissection in patients with lateral node metastasis of papillary thyroid carcinoma","volume":"166","author":"Song","year":"2022","journal-title":"Otolaryngol.-Head Neck Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"101705","DOI":"10.1016\/j.suronc.2021.101705","article-title":"Level IIb neck dissection guided by fine-needle aspiration for N1b papillary thyroid carcinoma","volume":"40","author":"Song","year":"2022","journal-title":"Surg. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2576","DOI":"10.1245\/s10434-008-0017-9","article-title":"Chyle leakage in patients undergoing thyroidectomy plus central neck dissection for differentiated papillary thyroid carcinoma","volume":"15","author":"Roh","year":"2008","journal-title":"Ann. Surg. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1007\/s00405-009-1185-3","article-title":"Level IIb lymph node metastasis in thyroid papillary carcinoma","volume":"267","author":"Vayisoglu","year":"2010","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1177\/014556131109000814","article-title":"Management of lateral cervical metastases in papillary thyroid cancer: Patterns of lymph node distribution","volume":"90","author":"King","year":"2011","journal-title":"Ear Nose Throat J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.oraloncology.2011.10.006","article-title":"Predictive factors of skip metastases to lateral neck compartment leaping central neck compartment in papillary thyroid carcinoma","volume":"48","author":"Lim","year":"2012","journal-title":"Oral Oncol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1177\/0194599812439277","article-title":"Patterns and predictive factors of lateral lymph node metastasis in papillary thyroid microcarcinoma","volume":"147","author":"Kim","year":"2012","journal-title":"Otolaryngol.\u2013Head Neck Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1245\/s10434-016-5521-8","article-title":"Routine level 2b dissection may be recommended only in n1b papillary thyroid carcinoma with three- or four-level lateral lymph node metastasis","volume":"23","author":"Kim","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1111\/coa.13562","article-title":"Metastasis predictors for neck sublevel IIb in papillary thyroid carcinoma","volume":"45","author":"Bumber","year":"2020","journal-title":"Clin. Otolaryngol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1016\/j.surg.2020.02.003","article-title":"Level IIb lymph node metastasis characteristics and predictive factors for patients with cN1b papillary thyroid carcinoma","volume":"167","author":"Liu","year":"2020","journal-title":"Surgery"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Liu, W.-Q., Yang, J.-Y., Wang, X.-H., Cai, W., and Li, F. (2022). Analysis of factors influencing cervical lymph node metastasis of papillary thyroid carcinoma at each lateral level. BMC Surg., 22.","DOI":"10.1186\/s12893-022-01678-w"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1097\/MLG.0b013e31815ae3e4","article-title":"Regional metastases in well-differentiated thyroid carcinoma: Pattern of spread","volume":"118","author":"Yanir","year":"2008","journal-title":"Laryngoscope"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"4619","DOI":"10.7314\/APJCP.2012.13.9.4619","article-title":"Is level v dissection necessary for low-risk patients with papillary thyroid cancer metastasis in lateral neck levels ii, iii, and iv","volume":"13","author":"Yu","year":"2012","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1017\/S0022215121000499","article-title":"Relevance of level IIb neck dissection in patients with papillary thyroid carcinoma","volume":"135","author":"Hosokawa","year":"2021","journal-title":"J. Laryngol. Otol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/0002-9610(85)90163-1","article-title":"Modified radical neck dissection for metastatic carcinoma of the thyroid: A reappraisal","volume":"150","author":"Sako","year":"1985","journal-title":"Am. J. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1007\/s00268-005-0358-5","article-title":"Selective modified radical neck dissection for papillary thyroid cancer\u2014Is level I, II and V dissection always necessary?","volume":"30","author":"Caron","year":"2006","journal-title":"World J. Surg."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1001\/archotol.133.12.1258","article-title":"Impact of preoperative ultrasonographic staging of the neck in papillary thyroid carcinoma","volume":"133","author":"Cruz","year":"2007","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1002\/hed.20696","article-title":"Elective paratracheal neck dissection for lateral metastases from papillary carcinoma of the thyroid: Is it indicated?","volume":"30","author":"Khafif","year":"2008","journal-title":"Head Neck"},{"key":"ref_58","first-page":"104","article-title":"Pattern of anterolateral cervical lymph nodes involvement in papillary thyroid carcinoma","volume":"19","author":"Iqbal","year":"2009","journal-title":"J. Coll. Physicians Surg.-Pak."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s00405-009-1032-6","article-title":"Regional metastatic pattern of papillary thyroid carcinoma","volume":"267","author":"Bayram","year":"2010","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/j.ejso.2010.06.015","article-title":"Lymph node management in clinically node-negative patients with papillary thyroid carcinoma","volume":"36","author":"Vergez","year":"2010","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"772","DOI":"10.7150\/jca.28527","article-title":"Nomogram for predicting level v lymph node metastases in papillary thyroid carcinoma with clinically lateral lymph node metastases: A large retrospective cohort study of 1037 patients from fduscc","volume":"10","author":"Wang","year":"2019","journal-title":"J. Cancer"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"12801","DOI":"10.2147\/CMAR.S273316","article-title":"The extent of therapeutic central compartment neck dissection in unilateral ct1n1a or ct2n1a papillary thyroid carcinoma","volume":"12","author":"Liu","year":"2020","journal-title":"Cancer Manag. Res."},{"key":"ref_63","first-page":"5562065","article-title":"Analysis of risk factors of level v lymphatic metastasis for papillary thyroid carcinoma with pn1b","volume":"2021","author":"Li","year":"2021","journal-title":"J. Oncol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2550","DOI":"10.1245\/s10434-021-11085-9","article-title":"Patterns of occult metastasis to level va and vb in clinically lateral node-positive papillary thyroid carcinoma","volume":"29","author":"Song","year":"2022","journal-title":"Ann. Surg. Oncol."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Huang, C., Hu, D., Zhuang, Y., and Su, X. (2022). Risk factors and prediction model of level II lymph node metastasis in papillary thyroid carcinoma. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.984038"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"3587","DOI":"10.1245\/s10434-016-5254-8","article-title":"Incidence and risk factors for occult level 3 lymph node metastases in papillary thyroid cancer","volume":"23","author":"Fraser","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Eun, N.L., Kim, J.-A., Lee, Y., Youk, J.H., Yun, H.J., Chang, H., Kim, S.-M., Lee, Y.S., Chang, H.-S., and Yang, H. (2024). Preoperative ultrasonography predicts level ii lymph node metastasis in n1b papillary thyroid carcinoma: Implications for surgical planning. Biomedicines, 12.","DOI":"10.3390\/biomedicines12071588"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Wu, S., Liu, Y., Ruan, X., and Zheng, X. (2024). Predictive factors for lymph node metastasis in papillary thyroid cancer patients undergoing neck dissection: Insights from a large cohort study. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1447903"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"512","DOI":"10.21037\/gs-20-368","article-title":"Risk factors of suprasternal lymph node metastasis in papillary thyroid carcinoma with clinical lateral cervical lymph node metastasis","volume":"10","author":"Kwon","year":"2021","journal-title":"Gland Surg."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Zhai, Y., and Ruan, L. (2022). The necessity of lymph node dissection between sternocleidomastoid and sternohyoid muscles in pn1b papillary thyroid carcinoma. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.865621"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Xue, S., Wang, P., Zhang, Q., Yin, Y., Guo, L., Wang, M., Jin, M., and Chen, G. (2019). Routine lateral level v dissection may not be necessary for papillary thyroid microcarcinoma with lateral lymph node metastasis: A retrospective study of 252 cases. Front. Endocrinol., 10.","DOI":"10.3389\/fendo.2019.00558"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/cen.12515","article-title":"Guidelines for the management of thyroid cancer","volume":"81","author":"Perros","year":"2014","journal-title":"Clin. Endocrinol."},{"key":"ref_73","first-page":"e250033","article-title":"Nccn guidelines\u00ae insights: Thyroid carcinoma, version 1.2025","volume":"23","author":"Haddad","year":"2025","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1856","DOI":"10.1093\/annonc\/mdz400","article-title":"Thyroid cancer: Esmo clinical practice guidelines for diagnosis, treatment and follow-up","volume":"30","author":"Filetti","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1507\/endocrj.EJ20-0025","article-title":"The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer","volume":"67","author":"Ito","year":"2020","journal-title":"Endocr. J."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"S79","DOI":"10.1016\/j.jviscsurg.2023.04.012","article-title":"Extent of cervical lymph node dissection: Recommendations from the Francophone Association for Endocrine Surgery, the French Society of Endocrinology and the French Society of Nuclear Medicine","volume":"160","author":"Gaujoux","year":"2023","journal-title":"J. Visc. Surg."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2429","DOI":"10.1002\/lary.26433","article-title":"A novel thyroid cancer nodal map classification system to facilitate nodal localization and surgical management: The A to D map","volume":"127","author":"Cunnane","year":"2017","journal-title":"Laryngoscope"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1002\/hed.23277","article-title":"Papillary thyroid carcinoma nodal surgery directed by a preoperative radiographic map utilizing CT scan and ultrasound in all primary and reoperative patients","volume":"36","author":"Lesnik","year":"2014","journal-title":"Head Neck"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1002\/hed.27451","article-title":"A combination of computed tomography scan and ultrasound provides optimal detection of cervical lymph node metastasis in papillary thyroid carcinomas: A systematic review and meta-analysis","volume":"45","author":"Albuck","year":"2023","journal-title":"Head Neck"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.1002\/lary.26495","article-title":"Mapping the distribution of nodal metastases in papillary thyroid carcinoma: Where exactly are the nodes?","volume":"127","author":"Goyal","year":"2017","journal-title":"Laryngoscope"},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Hartl, D.M., Lombardi, D., Simo, R., Mihai, R., Rovira, A., Ofo, E., and Nixon, I.J. (2025). Super-superselective level vb neck dissection for papillary thyroid cancer. Cancers, 17.","DOI":"10.3390\/cancers17091497"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/20\/2613\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T14:37:23Z","timestamp":1761057443000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/20\/2613"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,16]]},"references-count":81,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["diagnostics15202613"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15202613","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,16]]}}}