American Thyroid Association Design and Feasibility of a Prospective Randomized Controlled Trial of Prophylactic Central Lymph Node Dissection for Papillary Thyroid Carcinoma

Carling, Tobias; Carty, Sally E.; Ciarleglio, Maria; Cooper, David S.; Doherty, Gerard M.; Kim, Lawrence T.; Kloos, Richard T.; Mazzaferri, Ernest L.; Peduzzi, Peter; Roman, Sanziana A.; Sippel, Rebecca S.; Sosa, Julie Ann; Stack, Brendan C.; Steward, David L.; Tufano, Ralph P.; Tuttle, R. Michael; Udelsman, for the American Thyroid Robert

doi:10.1089/thy.2011.0317

Cited by 197 publications

(121 citation statements)

References 24 publications

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“…Carling et al assessed that it would be necessary to enroll almost 6,000 patients in the prospective analysis in order to demonstrate the benefit of prophylactic central lymphadenectomy (50).…”

Section: Disease Recurrence and Ln Metastasesmentioning

confidence: 99%

BRAF V600E mutation in prognostication of papillary thyroid cancer (PTC) recurrence

Czarniecka¹,

Oczko-Wojciechowska²,

Barczyński³

2016

Gland Surg.

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Papillary thyroid cancer (PTC) offers excellent prognosis, however relapse risk or persistent disease is related to ~30%. Currently, attention is paid to the possibility of patient group selection of different risk of unfavorable outcome to match a particular therapeutic approach. Therefore, interest in new prognostic and predictive markers known preoperatively is observed. BRAF V600E mutation is such a marker. Many studies analyzing the prevalence of the mutation and its relationship with other clinicopathological risk factors were reported but with controversial conclusions. The prognostic significance of BRAF mutation was confirmed by some single centre studies, a few meta-analyses and a large multicenter retrospective international study. They confirmed a correlation between the mutation and the risk of recurrence. The strongest argument against using BRAF mutation as an independent prognostic and predictive factor in PTC is its high prevalence (30-80%). At present it seems that BRAF mutation is one of the factors influencing the prognosis and it should be analyzed in correlation with other prognostic factors.The most recent ATA recommendations do not indicate a routine application of BRAF status for initial risk stratification in differentiated thyroid cancer due to a lack of evident confirmation of a direct influence of mutation on the increase in relapse risk. However, ATA demonstrates the continuous risk scale for the relapse risk assessment, considering BRAF and/or TERT status. At present, researchers are working on determining the role of BRAF mutation in patients from a low-risk group and its correlations with others molecular events. Currently, BRAF mutation cannot be used as a single, independent predictive factor. However, its usefulness in the context of other molecular and clinico-pathological risk factors cannot be excluded. They may be used to make modern prognostic scales of relapse risk and be applied to individualized diagnostic and therapeutic strategy for PTC patients.

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Section: Disease Recurrence and Ln Metastasesmentioning

confidence: 99%

BRAF V600E mutation in prognostication of papillary thyroid cancer (PTC) recurrence

Czarniecka¹,

Oczko-Wojciechowska²,

Barczyński³

2016

Gland Surg.

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“…If standard surgical approaches are maintained, a percentage of complications is low even in bigger scale primary interventions (5,12), contrariwise long term complications after the reoperation can be twice as high as after the primary intervention (5, 13). When Lymphangioinvasionundet.,pN0 1 1 0 n-numberofpatients,%-relativepercentage,N-numberofpatientsintheevaluatedgroup,MTS-metastaticinvolvement,pN+-histologicallyverifiedmetastasesinregionallymphnodes,pN0-histologicallyverifiedstatuswithoutmetastasesinregionallymphnodes making a decision regarding treatment strategy it is important to remember that a proper surgical intervention is still the most important treatment and treatment with radioiodine, TSH suppression, and external radiotherapy have adjuvant roles (1).…”

Section: Discussionmentioning

confidence: 99%

Papillary Thyroid Carcinoma: Analysis of the Central Compartmentʼs Lymph Nodes Metastases

Sojak

Obtulovičová

Kališ

et al. 2017

Acta Med. (Hradec Kralove, Czech Repub.)

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Background: Papillary thyroid carcinoma is typical by regional lymph nodes metastases. Therefore we decided to analyse associated risk factors. Objective: In this retrospective study we focused on the incidence of metastatic involvement of the central compartment’s lymph nodes correlated with age, size of the primary tumour, infiltration of thyroid gland capsule, positive lymphangioinvasion in order to assess risk factors. Method: We analysed group of 156 patients with papillary carcinoma, who have undergone total thyroidectomy and bilateral elective central compartment neck dissection. We evaluated the occurrence of metastases, size, infiltration and lymphangioinvasion based on definitive histology of the whole group and separately for subgroups of patients under and over 45 years. Result: We found metastatic involvement in 88 (56.4%) patients. When comparing the subgroups of patients under (73 patients) and over 45 years (83 patients), we found metastases in 56 vs. 32 (76.7% vs. 38.6%) patients. In the subgroup of younger patients we found significant higher incidence of metastases compared with the group of over 45 years, P < 0.001 (P = 0.000027). We found significant higher incidence of metastases in patients with positive capsule infiltration in the whole group, P < 0.001 (P = 0.00049); in the subgroup of under 45 years, P < 0.001 (P = 0.00091) and in patients with positive lymphangioinvasion in the whole group, P < 0.01 (P = 0.00177); in the subgroup of over 45 years, P < 0.001 (P = 0.0002). In patients with metastases we found tumour size ≥1cm more frequently in all groups. Conclusion: We recorded higher incidence of regional metastases in patients under 45 years, positive capsule infiltration, lymphangioinvasion. Age under 45 years itself does not correlate with less aggressive disease, to the contrary some of other analysed risk factors correlate with more aggressive disease.

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“…Indeed, currently available data on the prognostic influence of central node dissection are controversial [23][24][25][26][27][28][29][30][31]. Carling T et al reported that a prospective randomized controlled trial of prophylactic central lymph node dissection in cN0 PTC is not readily feasible [32]. The JSTS/JAES guidelines indicate that currently, there is insufficient evidence to support the contention that prognosis is improved by central node dissection.…”

Section: Treatment For Low-risk Follicular Carcinomamentioning

confidence: 99%

Therapeutic strategy for low-risk thyroid cancer in Kanaji Thyroid Hospital [Review]

et al. 2014

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Abstract. It is well-known that differentiated thyroid carcinoma (DTC) has a generally indolent character and shows a favorable prognosis in comparison with many other carcinomas. The therapeutic strategy for patients with DTC in Japan has differed from that in Western countries. Total thyroidectomy followed by radioactive iodine (RAI) ablation has been standard in Western countries, whereas limited hemi-thyroidectomy and subtotal thyroidectomy has been extensively accepted in Japan. Papillary thyroid carcinoma (PTC) accounts for over 90% of all thyroid cancers in Japan. The majority of patients with PTC are categorized into a low-risk group on the basis of the recent risk-group classification schemes, and they show excellent outcomes. Several management guidelines for thyroid cancers have been published in Western countries. However, the optimal therapeutic options for PTC remain controversial, and high-level clinical evidence aimed at resolving these issues is lacking. Moreover, as socioeconomic differences in medical care exist, conventional policies for the treatment of PTC have differed between Japan and other countries. This review focuses on the special features of treatment in Japan for patients with low-risk DTC involving subtotal thyroidectomy without adjuvant therapies, rather than total thyroidectomy with RAI, with the aim of preserving quality of life. At our institution in Japan, we have had extensive experience with RAI treatment for high-risk DTC patients, and this represents a very rare situation. Here we introduce the therapeutic strategy for low-risk thyroid cancer in Japan, including the measures adopted at our institution.

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American Thyroid Association Design and Feasibility of a Prospective Randomized Controlled Trial of Prophylactic Central Lymph Node Dissection for Papillary Thyroid Carcinoma

Cited by 197 publications

References 24 publications

BRAF V600E mutation in prognostication of papillary thyroid cancer (PTC) recurrence

BRAF V600E mutation in prognostication of papillary thyroid cancer (PTC) recurrence

Papillary Thyroid Carcinoma: Analysis of the Central Compartmentʼs Lymph Nodes Metastases

Therapeutic strategy for low-risk thyroid cancer in Kanaji Thyroid Hospital [Review]

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