Significance and management of thyroid lesions in lymph nodes as an incidental finding during neck dissection

Background. The incidental discovery of thyroid lesions In lymph nodes duri ng a lymph node dissection performed for a separate primary head and neck t umor is an unusual clinical entity. Its discovery has led to controversy re garding its significance and management. Methods. We identified five patients over the years 1991-1999 with this fin ding. All five patients were subsequently treated with a total thyroidectom y and a level VI lymph node dissection. Results. Pathological examination revealed three papillary carcinomas and l evel VI lymph node metastases in the two patients who had carcinoma in thei r thyroid glands. All five patients are presently free of their primary and thyroid disease on followup examinations. Conclusions. These patients should be addressed with additional work-up and surgery if metastatic thyroid cancer is documented in the lymph node. We o ffer a diagnostic algorithm that may aid in further work-up and treatment i n these unusual cases. (C) 2001 John Wiley & Sons, Inc.