Impact of Prophylactic Central Neck Lymph Node Dissection on Early Recurrence in Papillary Thyroid Carcinoma

Moo, Tracy-Ann; McGill, Julie; Allendorf, John D.; Lee, James; Fahey, Thomas J.; Zarnegar, Rasa

doi:10.1007/s00268-010-0418-3

Cited by 184 publications

(183 citation statements)

References 29 publications

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“…Fortunately, most PTC patients have relatively excellent clinical outcomes after surgery. However, cervical lymph node metastasis (LNM) is observed in 40~90% of patients in the first operation [2]. As is well known, LNM, which usually follows a regular pattern in PTC, is commonly found in Level VI.…”

mentioning

confidence: 98%

The synergic effect of BRAF<sup>V600E</sup> mutation and multifocality on central lymph node metastasis in unilateral papillary thyroid carcinoma

Qu¹,

Hu³

et al. 2018

Endocr J

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Abstract. The purpose of this study is to evaluate the potential synergic effect of BRAF V600E mutation and multifocality on central lymph nodes metastasis (CLNM) in the patients with unilateral papillary thyroid carcinoma (PTC). We enrolled 413 patients with unilateral PTCs who accepted prophylactic unilateral or bilateral central lymph node dissection (LND). Univariate and multivariate analyses were made to determine the association between related factors and CLNM. Then, all patients were divided into 4 groups based on their status of BRAF V600E mutation and multifocality. Relative excess risk of interaction (RERI), attributable proportion (AP) of interaction and synergy index (SI) were applied to evaluate the interactive effect of these two factors on CLNM. Results showed that BRAF V600E mutation and multifocality were independent risk factors for CLNM. A further study revealed that unilateral PTCs accompanying multifocality with BRAF V600E mutation had the highest incidence of CLNM compared with other subgroups. Besides, RERI was 4.323 (95% CI = 1.276-7.369), AP was 0.523 (95% CI = 0.364-0.682) and SI was 2.469 (95% CI = 1.607 to 3.794), indicating a significant additive interaction of BRAF V600E mutation and multifocality on CLNM. The present study has confirmed that BRAF V600E mutation and multifocality are risk factors for CLNM in unilateral PTC. Additionally, unilateral PTC patients accompanying multifocality with BRAF V600E mutation may have an increased risk of CLNM in clinically negative CLNM.

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mentioning

confidence: 98%

The synergic effect of BRAF<sup>V600E</sup> mutation and multifocality on central lymph node metastasis in unilateral papillary thyroid carcinoma

Qu¹,

Hu³

et al. 2018

Endocr J

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“…The prognosis for PTMC patients is favorable, however, there remains a 1% disease-associated mortality rate, a 5% lymph node recurrence rate and a 2.5% distant metastasis rate (4-7). The reported incidence of lymph node metastasis (LNM) has reached 40%: The common sites of metastasis include the central compartment of the neck (8). The revised American Thyroid Association guidelines recommend that central neck lymph node dissection (CND) should be considered in patients with high-risk thyroid cancer (9).…”

Section: Introductionmentioning

confidence: 99%

Prediction of central lymph node metastasis in 392 patients with cervical lymph node-negative papillary thyroid carcinoma in Eastern China

et al. 2015

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Abstract. Central lymph node metastasis (CLNM) is common in papillary thyroid microcarcinoma (PTMC). The aim of the present study was to investigate the risk factors associated with CLNM in clinical lateral cervical lymph node-negative (cN0) PTMC in Eastern China. A total of 392 patients with confirmed PTMC by histological examination who underwent thyroidectomy and central neck lymph node dissection (CND) between May 2011 and October 2012 at the First Affiliated Hospital of Wenzhou Medical University (Wenzhou, China) were enrolled. The clinicopathological and ultrasonographic data from the patients were analyzed retrospectively. A scoring system was developed on the basis of independent predictive factors for CLNM. Male gender, age <45 years, maximum tumor diameter >5 mm, lower lobe location, multifocal carcinoma with total tumor diameter >10 mm and extracapsular spread were independent predictive factors for CLNM according to logistic regression analysis. The clinicopathological score was statistically significant, with an index point ≥2 indicating CLNM with 86.2% sensitivity and 70.4% specificity. The findings of the present study indicate that CND may be recommended to be routinely performed when the clinicopathological index point ≥2.

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“…[4][5][6][7][8][9][10] Given the relatively slow tumor growth and excellent prognosis associated with PTC, a prospective study of sufficient size would be required to evaluate the impact of prophylactic CND on disease outcomes. Both preablative and postablative sTg levels have been shown to be excellent surrogate markers and predictors for disease-free emission and disease-specific survivals in PTC.…”

Section: Discussionmentioning

confidence: 99%

“…3 However, its routine practice remains controversial. [4][5][6][7][8][9][10] The arguments for it include improved pathological staging accuracy, preoperative failure to reliably detect central lymph node metastasis, and avoidance of central compartment reoperations. 3,4,11 On the other hand, arguments against it include increased surgical morbidities such as hypoparathyroidism and recurrent laryngeal nerve (RLN) injury; most important of all, prophylactic CND has not been shown to reduce recurrence or mortality rate.…”

mentioning

confidence: 99%

Impact of Routine Unilateral Central Neck Dissection on Preablative and Postablative Stimulated Thyroglobulin Levels after Total Thyroidectomy in Papillary Thyroid Carcinoma

Lang

Wong

Wan

et al. 2012

Indian J Surg Oncol

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Background. Prophylactic central neck dissection (CND) remains controversial in papillary thyroid carcinoma (PTC).Because postsurgical stimulated thyroglobulin (sTg) level is a good surrogate for recurrence, the study aimed to evaluate the impact of prophylactic CND on preablative and postablative sTg levels after total thyroidectomy. Methods. Of the 185 patients retrospectively analyzed, 82 (44.3%) underwent a total thyroidectomy and prophylactic CND (CND-positive group) while 103 (55.7%) underwent total thyroidectomy only (CND-negative group). All patients had no preoperative or intraoperative evidence of lymph node metastases. Clinicopathological characteristics, postoperative outcomes, and preablative and postablative sTg levels were compared between the two groups. Preablative sTg level was taken at the time of radioiodine ablation, while postablative sTg level was taken 6 months after ablation. A multivariable analysis was conducted to identify factors for preablative athyroglobulinemia (sTg \ 0.5 lg/L). Results. Relative to the CND-negative group, the CNDpositive group had larger tumors (15 mm vs. 10 mm, P \ 0.005), more extrathyroidal extension (26.8% vs. 14.6%, P \ 0.003), more tumor, node, metastasis system stage III disease (32.9% vs. 9.7%, P \ 0.001), and more temporary hypoparathyroidism (18.3% vs. 8.7%, P = 0.017). Fourteen patients (17.1%) in the CND-positive group were upstaged from stages I/II to III as a result of prophylactic CND. The CND-positive group experienced lower median preablative sTg (\0.5 lg/L vs. 6.7 lg/L, P \ 0.001) and a higher rate of preablative athyroglobulinemia (51.2% vs. 22.3%, P = 0.024), but these differences were not observed 6 months after ablation. Prophylactic CND was the only independent factor for preablative athyroglobulinemia. Conclusions. Although performing prophylactic CND in total thyroidectomy may offer a more complete initial tumor resection than total thyroidectomy alone by minimizing any residual microscopic disease, such a difference becomes less noticeable 6 months after ablation.Papillary thyroid carcinoma (PTC) is the most common type of differentiated thyroid carcinoma. Its age-adjusted incidence has doubled over the last 25 years.1 Despite its relatively good prognosis with a 10-year cancer-specific survival above 90%, locoregional recurrence is common.

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Impact of Prophylactic Central Neck Lymph Node Dissection on Early Recurrence in Papillary Thyroid Carcinoma

Abstract: Routine CNLD as an adjunct to total thyroidectomy identifies positive nodes in over 30% of patients with PTC. The discovery of positive nodes is associated with higher doses of RAI for postoperative ablation, and there is a trend toward decreased recurrence in patients undergoing CNLD.

Cited by 184 publications

References 29 publications

The synergic effect of BRAF<sup>V600E</sup> mutation and multifocality on central lymph node metastasis in unilateral papillary thyroid carcinoma

The synergic effect of BRAF<sup>V600E</sup> mutation and multifocality on central lymph node metastasis in unilateral papillary thyroid carcinoma

Prediction of central lymph node metastasis in 392 patients with cervical lymph node-negative papillary thyroid carcinoma in Eastern China

Impact of Routine Unilateral Central Neck Dissection on Preablative and Postablative Stimulated Thyroglobulin Levels after Total Thyroidectomy in Papillary Thyroid Carcinoma

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