Intraoperative Frozen Biopsy of Central Lymph Node in the Management of Papillary Thyroid Microcarcinoma

Lee, Dong Hoon; Yoon, Tae Mi; Kim, Hee Kyung; Lee, Joon Kyoo; Kang, Hee Yoon; Lim, Sang Chul

doi:10.1007/s12070-015-0900-1

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…In routine clinical practice, the detection of metastatic tissue in lymph nodes during intraoperative frozen section analysis is an indication for conversion from lobectomy to total thyroidectomy. 26 The percentage of conversions from lobectomy to total thyroidectomy in the present cohort is accepted in the clinical environment. To reduce this rate, CDSS must be improved.…”

Section: Discussionmentioning

confidence: 95%

Use of mind maps and iterative decision trees to develop a guideline-based clinical decision support system for routine surgical practice: case study in thyroid nodules

Hussain

Afzal

et al. 2019

Journal of the American Medical Informatics Association

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Objective The study sought to develop a clinical decision support system (CDSS) for the treatment of thyroid nodules, using a mind map and iterative decision tree (IDT) approach to the integration of clinical practice guidelines (CPGs). Materials and Methods Thyroid nodule CPGs of the American Thyroid Association and Korean Thyroid Association were analyzed by endocrine surgeons (domain experts) and computer scientists. Clinical knowledge from the CPGs was expressed using mind maps. The mind maps were analyzed and converted into IDTs. The final IDT was implemented as a set of candidate rules (3700) for a knowledge-based CDSS. The system was evaluated via a retrospective review of the medical records of 483 patients who had undergone thyroidectomy between January and December 2015 at a single tertiary center (Seoul National University Hospital Bundang, Korea). Results Concordance between CDSS recommendations and treatment in routine clinical practice was 78.9%. In the 21.1% discordant cases, deviation from the CDSS treatment recommendation was mainly attributable to (1) refusal of the patient to undergo total thyroidectomy and (2) conversion from lobectomy to total thyroidectomy following an unexpected histological finding during intraoperative frozen biopsy lymph node analysis. Conclusions The present study demonstrated that a knowledge-based CDSS is feasible in the treatment of thyroid nodules. A high-quality knowledge-based CDSS was developed, and medical domain and computer scientists collaborated effectively in an integrated development environment. The mind map and IDT approach represents a pioneering method of integrating knowledge from CPGs.

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Section: Discussionmentioning

confidence: 95%

Use of mind maps and iterative decision trees to develop a guideline-based clinical decision support system for routine surgical practice: case study in thyroid nodules

Hussain

Afzal

et al. 2019

Journal of the American Medical Informatics Association

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“…Despite a controversy over usefulness of frozen exam, several studies showed that intra-operative frozen exam had the effectiveness and clinical value [ 25 , 26 ]. In addition, gross inspection by surgeons is not a precise method for differentiating CLNM [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Is total thyroidectomy with bilateral central neck dissection the only surgery for papillary thyroid carcinoma patients with clinically involved central nodes?

et al. 2022

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Background In clinical practice, we often observed that patients who underwent total thyroidectomy due to clinically involved nodal disease (cN1a) actually had less extensive CLNM on final pathology. This study investigates whether total thyroidectomy and therapeutic bilateral CND are necessary for all PTC patients with cN1a. Methods This study retrospectively reviewed 899 PTC patients who underwent total thyroidectomy with bilateral CND from January 2012 to June 2017. The patients were divided into two groups according to pre-operative central lymph node (CLN) status: cN0, no suspicious CLNM; cN1a, suspicious CLNM. We compared the clinicopathological features of these two groups. Results There was no significant difference in recurrence between cN0 and cN1a groups after a mean follow-up time of 59.1 months. Unilateral cN1a was related to the largest central LN size ≥ 2 mm (OR = 3.67, p < 0.001) and number of CLNM > 5(OR = 2.24, p = 0.006). On the other hand, unilateral cN1a was not associated with an increased risk of contralateral lobe involvement (OR = 1.35, p = 0.364) and contralateral CLNM (OR = 1.31, p = 0.359). Among 106 unilateral cN1a patients, 33 (31.1%) were found to be pN0 or had ≤ 5 metastatic CLNs with the largest node smaller than 2 mm. Conclusions Most cN1a patients were in an intermediate risk group for recurrence and required total thyroidectomy. However, lobectomy with CND should have performed in approximately 30% of the cN1a patients. Pre-operative clinical examination, meticulous radiologic evaluation, and intra-operative frozen sections to check the nodal status are prerequisites for this approach.

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“…Some studies have reported that intraoperative frozen section examinations of ipsilateral lymph nodes have high sensitivity, specificity and accuracy in predicting contralateral nodal status. 14,[38][39][40] However, one limitation of this study was the retrospective nature, which induced the risk of selection bias. The other limitation was that BRAF gene mutation is not the only genetic factor that may impact LNM.…”

Section: Discussionmentioning

confidence: 99%

Effect of Tumor Location on the Risk of Bilateral Central Lymph Node Metastasis in Unilateral 1-4 cm Papillary Thyroid Carcinoma

Liu

Chen

et al. 2021

CMAR

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Purpose: Papillary thyroid carcinoma (PTC) has a high incidence of lymph node metastasis (LNM). Our aim was to determine whether tumor location is a useful feature to predict bilateral central lymph node metastasis (CLNM) in unilateral 1-4 cm PTC. Patients and Methods: Data on unilateral 1-4 cm PTC patients from 2016 to 2019 were collected retrospectively. The clinical and pathological characteristics of the tumors and lymph nodes were analyzed statistically. Results: The mean patient age was 49.1±12.3 (23-73) years, and the majority were women (n=1334, 75.4%). A total of 1767 patients were analyzed, and 256 (14.5%) had bilateral CLNM. Tumor location was an independent risk factor in predicting bilateral CLNM (p<0.001). The odds of bilateral CLNM were the highest in the near isthmus (OR 6.452, p<0.001). In a multivariate regression model adjusting for other risk factors, near-isthmus tumors had the highest risk of bilateral CLNM (OR 7.319, 95% CI: 3.844-13.933, p<0.001), followed by lower lobe tumors (OR 2.338, 95% CI: 1.315-4.155, p=0.004) and middle lobe tumors (OR 1.845, 95% CI: 1.035-3.291, p=0.038), compared to upper lobe tumors. Conclusion:Tumor location is an independent risk factor in predicting the risk of bilateral CLNM. Near-isthmus tumors carry the highest risk of bilateral CLNM.

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Intraoperative Frozen Biopsy of Central Lymph Node in the Management of Papillary Thyroid Microcarcinoma

Cited by 7 publications

References 11 publications

Use of mind maps and iterative decision trees to develop a guideline-based clinical decision support system for routine surgical practice: case study in thyroid nodules

Use of mind maps and iterative decision trees to develop a guideline-based clinical decision support system for routine surgical practice: case study in thyroid nodules

Is total thyroidectomy with bilateral central neck dissection the only surgery for papillary thyroid carcinoma patients with clinically involved central nodes?

Effect of Tumor Location on the Risk of Bilateral Central Lymph Node Metastasis in Unilateral 1-4 cm Papillary Thyroid Carcinoma

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