Cervical Lymph Node Dissection for Papillary Thyroid Cancers: A Decade Experience of a Single Surgical Team

Abstract

Premize: Pacienţii cu operaţii tiroidiene trebuie evaluaţi ecografic preoperator iar în cazul leziunilor suspecte puncţia aspirativă cu ac fin (FNA) trebuie să completeze investigaţiile. În ţările vestice, chirurgii endocrini efectuează de rutină ecografii cervicale. Rolul limfadenectomiei profilactice de compartiment central (LPCC) în cazul carcinoamelor papilare tiroidiene (CPT) rămâne controversat. În anul 2014 am efectuat o schimbare de strategie în tratamentul CPT: introducerea LPCC efectuată pe baza criteriilor European Society of Endocrine Surgeons (ESES) şi ecografia preoperatorie efectuată de către chirurg (S-US). Material şi Metodă: Pentru înţelegerea rolului jucat de cele două metode nou introduse am efectuat un studiu retrospectiv a două periode succesive de 5 ani, din baza noastră de date menţinută prospectiv. Rezultate: Cele două grupuri analizate au fost similare din punct de vedere epidemiologic şi clinic. FNA s-a efectuat la doar 21,66% dintre pacienţi. Diagnosticul de CPT a fost stabilit la majoritatea cazurilor prin examen histopatologic extemporaneu (EHE). S-US au ghidat limfadenectomia laterocervicală selectivă ducând astfel la îndepărtarea unui număr mai mare de ganglioni metastazaţi, având în plus şi o valoare predictivă pozitivă superioară celor efectuate de către endocrinologi. Rata de complicaţii a LPCC a fost semnificativ mai mare doar pe seama hipoparatiroidismului tranzitor.

The Effect of Prophylactic Central Neck Dissection during Total Thyroidectomy on Locoregional Recurrence in Patients with Papillary Thyroid Carcinoma: An Updated Meta-Analysis

“…The outcomes of the included studies are shown in Table 2. Only two studies did not report the incidence of LRR [27], [30]. Only nine studies reported the incidence of central and lateral locoregional recurrence, with zero incidences reported in four of these studies.…”

Diagnostic role of FNA cytology in the evaluation of cervical lymph nodes in thyroid cancers: Combined evaluation of thyroglobulin in eluate from FNA cytology

“…Therefore, the detection of thyroid malignancies, including small malignant cancers, has also increased significantly in these last decades. Thyroid cancers and especially papillary thyroid carcinoma (PTC) are the most common endocrine malignancies, with an indolent course in more than 90% of cases 1–5 . Long‐term prognosis for well‐differentiated thyroid cancer, including PTC, is excellent, with survival rates in adults at approximately 92%–98% after 10‐year follow‐up.…”

“…Thyroid cancers and especially papillary thyroid carcinoma (PTC) are the most common endocrine malignancies, with an indolent course in more than 90% of cases. [1][2][3][4][5] Long-term prognosis for well-differentiated thyroid cancer, including PTC, is excellent, with survival rates in adults at approximately 92%-98% after 10-year follow-up. Nonetheless, 5%-10% of these cancers develop local recurrences and nodal metastases, which require further treatment and impair the quality of life.…”

A Risk Stratification Model for Metastatic Lymph Nodes of Papillary Thyroid Cancer: A Retrospective Study Based on Sonographic Features

“…Although the prognosis of PTC is good, it is prone to present lymph node (LN) metastases (1)(2)(3). The metastasis rate of central LN is 20-50%, and the rate of lateral LN is 10-30% (4). Ultrasonography (US) is the most widely used tool for detecting metastatic LNs, which can also effectively guide fine-needle aspiration (FNA) for suspicious LNs (5).…”