Cervical lymph node dissection in papillary thyroid cancer: Current trends, persisting controversies, and unclarified uncertainties

Sakorafas, George H.; Sampanis, Dimitrios; Safioleas, Michael

doi:10.1016/j.suronc.2009.04.002

Cited by 92 publications

(68 citation statements)

References 113 publications

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“…Historically, the location of cervical lymphadenopathies has been described in terms of chains and triangles, but currently, the most used system of nodal mapping anatomically classifies lymph nodes into levels (Sakorafas et al, 2010). Fig.…”

Section: The Anatomymentioning

confidence: 99%

“…The upper poles, along with the pyramidal lobe and isthmus also drain superiorly toward lymph node levels II/III while the lateral aspect of each lobe drain towards lymph node levels III/IV. The lower pole of the gland drains initially into level VI then goes on to levels IV and VII (Roh & Koch, 2010;Sakorafas et al, 2010).…”

Section: The Anatomymentioning

confidence: 99%

“…To eliminate the probability of leaving behind residual disease, routine total thyroidectomy with cervical lymph node dissection (CLND) would be theoretically the ideal operation. However, such an aggressive surgical approach will represent over-treatment in a large percentage of patients, associated with longer surgical time and an unjustified increase of surgical morbidity (Sakorafas et al, 2010). Balancing the risk of increased morbidity from CLND with the benefit of removing a source of potential recurrence creates a controversial and difficult management decision.…”

Section: Cervical Neck Dissection In Well-differentiated Thyroid Cancermentioning

confidence: 99%

“…Besides lower recurrence rates, prophylactic CLND has also the advantage of adequate staging, enhancing the effects of radioactive iodine by removing potentially positive lymph nodes while also lowering the postoperative thyroglobulin levels thereby facilitating followup (Grodski et al, 2007;Sakorafas et al, 2010).…”

Section: In Favor Of Prophylactic Cervical Lymph Node Dissectionmentioning

confidence: 99%

“…Reoperation for recurrence in the lateral compartment can be performed more easily than that for recurrence in the central compartment, where more critical structures (i.e., trachea, great vessels, etc) are located. Therefore, since metastases in the central compartment are very common, recurrences in the area are sometimes difficult to demonstrate, especially in males with a short and thick neck (Henry et al, 1998) and given that surgery for recurrence in the central compartment may be a complicated procedure, www.intechopen.com prophylactic central CLND during the initial thyroid surgery (usually through the same incision) seems for many to be a reasonable management option (Sakorafas et al, 2010).…”

Section: In Favor Of Prophylactic Cervical Lymph Node Dissectionmentioning

confidence: 99%

See 4 more Smart Citations

Sentinel Lymph Node Biopsy in Well Differentiated Thyroid Cancer

Mijović¹,

Richardson²,

Payne³

et al. 2012

Updates in the Understanding and Management of Thyroid Cancer

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Section: The Anatomymentioning

confidence: 99%

Section: The Anatomymentioning

confidence: 99%

Section: Cervical Neck Dissection In Well-differentiated Thyroid Cancermentioning

confidence: 99%

Section: In Favor Of Prophylactic Cervical Lymph Node Dissectionmentioning

confidence: 99%

Section: In Favor Of Prophylactic Cervical Lymph Node Dissectionmentioning

confidence: 99%

See 3 more Smart Citations

Sentinel Lymph Node Biopsy in Well Differentiated Thyroid Cancer

Mijović¹,

Richardson²,

Payne³

et al. 2012

Updates in the Understanding and Management of Thyroid Cancer

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Thyroid Cancer

Carr¹

2019

Cancer

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

Tralongo

Bruno

Policardo

et al. 2023

Cancer Cytopathology

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BackgroundThe presurgical evaluation of cervical lymph nodes (CLNs) in the management of thyroid malignant lesions is crucial for the extent of surgery or detection of metastases. In these last decades, fine‐needle aspiration cytology (FNAC) has been shown to have a central role in the detection of nodal thyroid metastases. It is adopted for the possibility of confirming suspected metastases either in the presurgical phase or in the follow‐up of patients after thyroidectomy. However, FNAC from CLNs can be challenging, especially in cystic lesions. In this regard, the combination of FNAC with thyroglobulin measurement in the eluate from FNAC (Tg‐FNAC) seems to increase the sensitivity of FNAC in the detection of CLN metastases. The role of FNAC and Tg‐FNAC was investigated in this series.MethodsOne hundred fifty‐three prospective cytological samples of CLNs were studied along with surgical follow‐up in the period between 2020 and 2022. Immunocytochemistry (ICC) was performed on liquid‐based cytology–stored material.ResultsOne hundred fifty‐nine enlarged CLNs included 19 central lymph nodes and 140 CLNs. Forty‐two thyroidal CLN metastases and 117 reactive lymph nodes were found. Thirty‐one CLN dissections were performed in patients with a previous diagnosis of thyroid carcinoma (mostly papillary thyroid carcinoma [PTC]), whereas 128 CLNs with a concomitant suspicious and/or malignant thyroid nodule were found. There was one false‐positive case among all the malignant histologically confirmed cases, and two of 117 reactive CLNs (1.7%) had a diagnosis of metastatic PTC. Markedly high Tg‐FNAC was found in all metastatic CLNs, including 11 cystic metastatic CLNs detected by Tg‐FNAC with a negative FNAC. ICC (including Tg, CK‐19, and LCA) recognized nine cases with low Tg‐FNAC and scant suspicious thyrocytes. Tg‐FNAC plus FNAC diagnosed 94.2% of malignancies.ConclusionsFNAC represents a valid method for the evaluation of CLNs, especially combined with ICC. Tg‐FNAC is an additional method with a useful role in FNAC.

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Cervical lymph node dissection in papillary thyroid cancer: Current trends, persisting controversies, and unclarified uncertainties

Cited by 92 publications

References 113 publications

Sentinel Lymph Node Biopsy in Well Differentiated Thyroid Cancer

Sentinel Lymph Node Biopsy in Well Differentiated Thyroid Cancer

Thyroid Cancer

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

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