Extent of Surgery for Papillary Thyroid Cancer: Preoperative Imaging and Role of Prophylactic and Therapeutic Neck Dissection

Abstract

Papillary thyroid cancer (PTC) has an excellent prognosis, yet lymph node metastases are common. Most authors agree that central and/or lateral lymph node dissection should be undertaken in patients with abnormal lymph nodes detected on ultrasound, physical examination or intraoperative inspection. However the appropriate extent of prophylactic lymph node dissection for clinically node-negative patients remains the subject of controversy. There have been no randomized trials to date to offer guidance on this issue. The 2006 guidelines of the American Thyroid Association recommended consideration of prophylactic bilateral central lymph node dissection (CLND) for all patients undergoing thyroidectomy for PTC. However, the absence of compelling evidence for a benefit in terms of recurrence or survival, and the potential for increased morbidity, have led many, including our institution, to take an approach of selective central lymph node dissection. This approach is guided by the detection of abnormal lymph nodes on preoperative ultrasound, on physical examination, or during surgery. Postoperatively, ultrasound by an experienced ultrasonographer is the mainstay of evaluation for lymph node recurrence and is combined with monitoring of thyroglobulin and antithyroglobulin antibody levels. Reoperative lymph node dissection is typically undertaken upon detection and fine needle aspiration (FNA) of involved lymph nodes 0.8 cm or greater in size.

Prophylactic Level VII Nodal Dissection as a Prognostic Factor in Papillary Thyroid Carcinoma: a Pilot Study of 27 Patients

“…Papillary thyroid cancer (PTC) is the most common type of thyroid cancer accounting for about 80% of all thyroid cancers, and is the fifth leading malignancy in females (Cisco et al, 2012;Siegel et al, 2013).…”

Lymph node metastases in papillary thyroid cancer detected by quantitative real-time polymerase chain reaction for thyroglobulin and cytokeratine-19

“…There have been no randomized trials to date to offer guidance on this issue [7,8]. Some surgeons suppose that the neck lymph nodes should be evaluated preoperatively and during surgery by physical and ultrasound examination.…”

“…Some surgeons suppose that the neck lymph nodes should be evaluated preoperatively and during surgery by physical and ultrasound examination. Only suspected lymph nodes have to be excised [7][8][9]. However, the 2006 guidelines of the American Thyroid Association recommended consideration of prophylactic bilateral cen-tral lymph node dissection for all thyroid cancer patients [10].…”

“…Only suspected lymph nodes have to be excised [7][8][9]. However, the 2006 guidelines of the American Thyroid Association recommended consideration of prophylactic bilateral cen-tral lymph node dissection for all thyroid cancer patients [10]. Total thyroidectomy with central lymphadenectomy does not increase the incidence of main complications: hypocalcemia and vocal cord paresis [11].…”

Safety and Prognostic Impact of Prophylactic Level VII Lymph Node Dissection for Papillary Thyroid Carcinoma

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Asian Pac J Cancer Prev, 16 (18), 8425-8430

IntroductionPapillary thyroid cancer (PTC) is the most common type of thyroid cancer accounting for about 80% of all thyroid cancers, and is the fifth leading malignancy in females (Cisco et al, 2012;Siegel et al, 2013).Given the high rate of subclinical nodal metastases in PTC, many centers, have moved to routine prophylactic central nodal dissection (pCND) at the time of total thyroidectomy (TT) for all patients with PTC, pCND allows for more accurate assessment of nodal status, decreases the rate of local recurrence, reduces morbidity from reoperation if required, and may guide the dose of ablative postoperative radioiodine given (Mazzaferri EL Jhiang 1994;Scheumann et al, 1994;Hughes et al, 1996).Dralle (2012)

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