Evolution in the surgical management of well‐differentiated thyroid cancer or not: To dissect or not dissect the central lymph node compartment

Zeiger, Martha A.

doi:10.1002/jso.21385

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…13-15 Because of this controversy, many have investigated potential prognostic variables that could help the clinician to tailor appropriate treatments schemes for patients with PTC. Herein, we have attempted to closely examine the role of BRAF as a prognostic variable with a study that included consecutive and evaluable patients.…”

Section: Discussionmentioning

confidence: 99%

Is BRAF mutation associated with lymph node metastasis in patients with papillary thyroid cancer?

Lee

Schneider

et al. 2012

Surgery

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Background Some have proposed using V600E BRAF mutation status to dictate the surgical management of patients with papillary thyroid cancer (PTC). However, well-designed studies examining BRAF association with aggressive clinicopathologic features of PTC, including the presence of lymph node metastases (LNM), in patients who have undergone routine central lymph node dissection (CLND), are lacking. Methods Under institutional review board approval, 63 patients diagnosed with PTC on fine-needle aspiration who underwent total thyroidectomy and CLND were included. BRAF mutation status was determined in fresh frozen or intraoperative fine-needle aspiration samples with a colorimetric assay. Associations between BRAF mutation status and clinicopathologic features of PTC were examined using Chi-square and multivariate logistic regression analyses. Results BRAF mutation was found to be significantly associated with race only on Chi-square analysis. BRAF mutation was not found to be significantly associated with the presence of LNM (P = .167). On multivariate analysis, only size and venous/lymphatic invasion were significantly associated with LNM. Conclusion This small series underscores the prematurity in utilizing BRAF mutation status to determine the surgical management of patients with PTC, specifically whether or not to perform a CLND.

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Section: Discussionmentioning

confidence: 99%

Is BRAF mutation associated with lymph node metastasis in patients with papillary thyroid cancer?

Lee

Schneider

et al. 2012

Surgery

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“…Thus, ipsilateral neck dissection after thyroid resection to excise potential metastatic disease may be indicated in patients with high-risk DTC [77]. To date, however, there is no direct evidence that prophylactic lymph node dissection may be associated with a decreased risk of recurrence and improved survival in patients with DTC [78]. This issue should be resolved by prospective randomized controlled studies.…”

Section: Review Roh and Kochmentioning

confidence: 99%

Role of sentinel lymph node biopsy in thyroid cancer

Roh

Koch

2010

Expert Review of Anticancer Therapy

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Lymphatic mapping and sentinel lymph node biopsy (SLNB) have emerged as a promising minimally invasive surgical technique to detect metastatic nodes in patients with melanoma and breast, colon, esophageal, gastric, lung, head and neck, and thyroid cancers. The SLNB procedure is safe and feasible, with high accuracy in predicting occult metastases of differentiated thyroid cancer. The sensitivity of the SLNB technique has increased as technical details and complementary immunohistochemical and molecular techniques have been developed. SLNB for thyroid cancer may display practical benefits in accurate nodal staging, the detection of metastatic lymph nodes outside the central neck, and the selection of patients who would benefit from complete neck dissection and optimized (131)I ablation therapy. Currently, however, there is no direct evidence that SLNB is associated with long-term clinical and survival benefits in patients with thyroid cancer. Well-controlled prospective clinical trials will determine the clinical significance of occult metastases and their early detection by SLNB in patients with thyroid cancer.

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“…Regional lymph node metastasis is common in patients with PTC, and modified neck dissection is typically considered to be the standard treatment for positive cervical lymph nodes [1,2]. In addition to the neck, the superior mediastinal lymph nodes can be involved in regional metastasis of thyroid cancer.…”

Section: Introductionmentioning

confidence: 99%

Superior Mediastinal Dissection for Papillary Thyroid Carcinoma: Approaches and Outcomes

Liu

Wang

Liu

et al. 2013

ORL

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Background: Superior mediastinal surgery for thyroid carcinoma is not a standardized procedure like the neck dissection. The objective of this study was to evaluate the effectiveness of superior mediastinal dissection for mediastinal metastasis of papillary thyroid carcinoma (PTC). Methods: We conducted a retrospective review of 119 patients who underwent superior mediastinal dissection for the treatment of PTC. The postoperative characteristics and follow-up data were analyzed. Cox regression was performed to identify the factors related to the mediastinal control. Results: No severe complications occurred in this series. The five-year local (mediastinum) disease-free survival rates of comprehensive (n = 29) and partial (n = 90) superior mediastinal dissection were 86.3 and 84.0%, respectively (log-rank = 0.562; p = 0.452). Different patterns of superior mediastinal dissection did not turn out to be related to mediastinal recurrence in the cox regression. Bilateral paratracheal metastasis was identified as an individual risk factor of mediastinal recurrence with a relative risk value of 4.635 (95% CI: 1.399-15.355; p = 0.012). Conclusions: Both partial and comprehensive superior mediastinal dissections are effective and safe for the treatment of mediastinal metastasis of PTC if appropriately designed.

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Evolution in the surgical management of well‐differentiated thyroid cancer or not: To dissect or not dissect the central lymph node compartment

Cited by 4 publications

References 7 publications

Is BRAF mutation associated with lymph node metastasis in patients with papillary thyroid cancer?

Is BRAF mutation associated with lymph node metastasis in patients with papillary thyroid cancer?

Role of sentinel lymph node biopsy in thyroid cancer

Superior Mediastinal Dissection for Papillary Thyroid Carcinoma: Approaches and Outcomes

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