Hindawi Publishing Corporation Journal of Thyroid Research Volume 2012, Article ID 436243, 7 pages doi:10.1155/2012/436243 Clinical Study Pattern and Risk Factors of Central Compartment Lymph Node Metastasis in Papillary Thyroid Cancer: A Prospective Study from an Endocrine Surgery Centre Sudhi Agarwal, 1 Gyan Chand, 1 Sushila Jaiswal, 2 Anjali Mishra, 1 Gaurav Agarwal, 1 Amit Agarwal, 1 A. K. Verma, 1 and S. K. Mishra 1 1 Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India 2 Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India Correspondence should be addressed to Gyan Chand, gyan133@sgpgi.ac.in Received 27 June 2011; Revised 4 August 2011; Accepted 4 August 2011 Academic Editor: Yasuhiro Ito Copyright © 2012 Sudhi Agarwal et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Lymphatic metastasis in papillary thyroid cancer (PTC) is eminent; however, the extent of central compartment lymph nodes dissection (CCD) is controversial and requires the knowledge of pattern and risk factors for central compartment lymph nodes metastasis (CCM). We did a prospective study of 47 cases with PTC who underwent total thyroidectomy (TT) with CCD with/without lateral lymph nodes dissection (LND). Clinicopathological profile including CCM as ipsilateral and contralateral was documented. On histopathology, the mean tumour size was 3.57 ± 2.42 cm 59.6% had CCM, which was bilateral in the majority (60.72%). The tumour-size was the most important predictor for lymph nodes metastasis-(P = 0.018) whereas multicentricity- (P = 0.002) and ipsilateral CCM-(P = 0.001) were the predictors for contralateral CCM. The long-term morbidity of CCD done in primary setting is comparable with TT-alone. Bilateral CCD should be done with thyroidectomy in PTC, otherwise the risk of residual diseases and subsequent recurrence is high. The long-term morbidity is comparable in experienced hands. 1. Introduction Papillary thyroid cancer (PTC) is the most common thyroid malignancy with the predilection for lymphatic spread [1]. Like any other head and neck malignancy, the lymphatic spread of PTC is supposed to follow a sequential pattern with the central compartment or level VI lymph nodes being first to involve [2–4], which besides containing the pre- and paratracheal lymph nodes, also contains the parathyroid glands and recurrent laryngeal nerves on either side, which are prone to injury while dissecting the central compartment lymph nodes [4]. The central compartment lymph nodes dissection (CCD) in PTC has the advantages of complete clearance of the disease, thereby reducing the chances of recurrence and the subsequent morbidity of reoperation, also it provides the nodes for exact nodal staging to plan further adjuvant therapy and prognosticate the patient [5, 6]. However, it is associated with increased risk of hypoparathy- roidism and recurrent laryngeal nerve palsy [7]. Therefore for high-risk with clinically involved nodes the routine CCD is acceptable; however, it is controversial for low-risk, clinically uninvolved nodes [8], with some advocating for [9, 10] and some against [11] routine bilateral clearance while a third group of surgeons adopted a midway, by dissecting the ipsilateral side only, thus sparing the contralateral parathy- roid glands and recurrent laryngeal nerve [12–14]. The extent of lymphadenectomy in PTC is still controversial and requires the knowledge of pattern of central compartment lymph nodes metastasis. Therefore, we aim our study to find out the pattern and risk factors of central compartment lymph node metastasis (CCM), and the morbidity of CCD. 2. Material and Method We did a prospective study of all patients with papillary thyroid cancer, who underwent total thyroidectomy (TT) with CCD as a primary surgery from September 2008 till November 2010 at Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. The study was approved by department review board,