Is Lobectomy as Effective as Total Thyroidectomy in Treating Patients With Intermediate-Risk Papillary Thyroid Carcinoma With Lateral Lymph Node Metastasis?

Abstract

There is a recent trend in de-escalating the extent of surgical resection for patients with differentiated thyroid cancer. The guidelines of the American Thyroid Association and American Association of Endocrine Surgeons now allow lobectomy as an option to treat papillary thyroid cancer up to 4 cm in size with no or minimal central nodal metastasis. 1,2 Not removing the contralateral thyroid lobe and not performing prophylactic node dissection incur fewer surgical complications in these patients with low risk for recurrence. But what about patients with higher risk for recurrence? What about those with lateral neck node metastasis? According to the American Joint Committee on Cancer tumor-lymph nodes-metastasis system, metastasis to the lateral nodes (N1b) is more advanced than metastasis limited to the central neck (N1a). So where is the boundary for this de-escalation? Is lobectomy an acceptable alternative to total thyroidectomy for patients with intermediate-risk papillary thyroid cancer with lateral neck node metastasis (cN1b)? In a single-center, retrospective cohort analysis spanning 17 years, Xu et al 3 compared 265 propensity matched pairs of patients (lobectomy vs total thyroidectomy) and found equivalent rates of recurrence-free survival after a 5-year surveillance period (92.3% vs 93.7%). 3 Comparable oncologic outcomes and disease-free survival have been reported regarding tumor size, 4 thyroid hormone suppression therapy, 5 and multifocality when compar-

Direct sub‐atmospheric pressure ionization mass spectrometry: Evaporation/sublimation‐driven ionization is amazing, fundamentally, and practically

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“…At ASMS 2023 Eberlin and collaborators presented work in which they reported the use of a MasSpec Pen on a Waters Xevo Q‐TOF mass spectrometer using a retrofit heated inlet tube, 221 as was done with the iKnife and the SpiderMass sampling devices 222,223 . Further developments of Eberlins' MasSpec Pen version are on‐going 224–226 . Most of these developments seem to focus on small molecule analyses.…”