Requirement of Central and Lateral Neck Dissection in the Surgical Treatment of Thyroid Cancer Nodules in Children

MN Azılı¹, SA Bostancı¹, MN Gürel², EE Erten³, VS Çayhan³, A Ertürk¹, Cİ Öztorun¹, AN Abay³, S Demir³, E Karakuş⁴, Ç Damar⁵, N Gülaldı⁶, N Sarı⁷, M Boyraz⁸, E Şenel¹, C Azılı⁹

¹Ankara Yildirim Beyazit University Medical Faculty, Department of Pediatric Surgery
²Ankara Bilkent City Hospital Department of Pediatric Surgery
³Ankara Bilkent City Hospital Department of Pediatric Surgery, Ankara
⁴Ankara Bilkent City Hospital Department of Pathology, Ankara
⁵Ankara Bilkent City Hospital, Department of Pediatric Radiology
⁶Ankara Bilkent City Hospital, Department of Nuclear Medicine, Ankara
⁷Ankara Bilkent City Hospital, Department of Pediatric Oncology
⁸Ankara Bilkent City Hospital, Department of Pediatric Endocrinology
⁹Department of Surgical Oncology, Ankara Education and Research Hospital, Ankara, Turkey

Objective

This study aims to evaluate the necessity of central and lateral cervical lymph node dissection (CLND and LLND) in the surgical management of thyroid nodules suspected to be malignant in pediatric patients.

Methods

A single-center retrospective analysis was conducted on patients under 18 years of age who underwent total thyroidectomy (TT) and/or CLND or LLND between January 2020 and June 2025. Preoperative decisions regarding LLND were made based on thyroglobulin washout (TGWO) and pathological findings indicating lateral neck lymph node metastases. CLND was performed intraoperatively in cases of confirmed central lymph node metastases or when lateral metastases were identified. Data on demographics, imaging, fine needle aspiration biopsy (FNAB), thyroglobulin washout, and surgical procedures were reviewed.

Results

The cohort included 67 patients with a median age of 14.1 years, of whom 67.1% (n=45) were female. The mean nodule size was 21 mm, and the malignancy rate was 64.1% (43/67), with a mean malignant nodule size of 18.5 mm. CLND was performed in 7.4% (5/67) of patients, while concurrent CLND and LLND were required in 25.3% (17/67). FNAB findings were statistically significant in predicting malignancy (p < 0.05), and TGWO positivity was strongly associated with metastatic lateral lymphadenopathy (p = 0.001). The classical variant of papillary thyroid carcinoma accounted for 76.7% (33/43) of malignancies. Additionally, prior neck radiotherapy and microcalcifications were significantly associated with malignancy (p < 0.05).

Conclusion

Metastasis to the central lymph node was observed in 7.4% of cases, while metastasis to both central and lateral neck regions occurred in 25.3%. Positive TGWO serves as a reliable preoperative predictor for lateral lymph node metastases. Surgeons managing pediatric thyroid surgery should be skilled in CLND to address the elevated risk of lymph node involvement in this population.

Keywords: pediatric tyroid cancer, neck dissection, thyroglobulin washout

MN Azılı¹, SA Bostancı¹, MN Gürel², EE Erten³, VS Çayhan³, A Ertürk¹, Cİ Öztorun¹, AN Abay³, S Demir³, E Karakuş⁴, Ç Damar⁵, N Gülaldı⁶, N Sarı⁷, M Boyraz⁸, E Şenel¹, C Azılı⁹

¹Ankara Yıldırım Beyazıt Üniversitesi, Tıp Fakültesi, Çocuk Cerrahisi Ana Bilim Dalı, Ankara, Türkiye.
²Ankara Bilkent Şehir Hastanesi Çocuk Cerrahisi Kliniği
³Ankara Bilkent Şehir Hastanesi Çocuk Cerrahisi Kliniği, Ankara
⁴Ankara Bilkent Şehir Hastanesi, Patoloji Kliniği
⁵Ankara Bilkent Şehir Hastanesi, Çocuk Radyoloji Kliniği
⁶Ankara Bilkent Şehir Hastanesi, Nükleer Tıp Kliniği, Ankara
⁷Ankara Bilkent Şehir Hastanesi, Çocuk Onkoloji Kliniği
⁸Ankara Bilkent Şehir Hastanesi, Çocuk Endokrinoloji Kliniği
⁹Ankara Eğitim ve Araştırma Hastanesi, Ankara

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