Lymph node management in clinically node-negative patients with papillary thyroid carcinoma

Abstract

Aims: Systematic lymph node dissection in patients with papillary thyroid carcinoma (PTC) remains controversial. The objective of this study was to study the pattern of lymph node spread in patients with PTC clinically node-negative and then to propose a lymph node management strategy. Methods:We retrospectively reviewed the records of patients who had undergone total thyroidectomy and a systematic central neck dissection (CND) and lateral neck dissection. Ninety patients with PTC without lymph nodes metastases (LNM) detected on preoperative palpation and ultrasonographic examination were included.Results: Forty-one patients (45.5%) had LNM. Twenty-eight patients (31%) had a central and a lateral involvement. Thirteen patients (14.5%) had only a central involvement. All the patients without LNM in the central compartment were also free in the lateral compartment. There was no correlation between LNM status and TNM staging.The largest LNM in the central compartment was smaller than or equal to 5 mm in 66% of the cases, and that could explain the lack of sensitivity of the preoperative ultrasonographic examination.Conclusion: CND could be considered at preoperative or intraoperative diagnosis of PTC whereas lateral neck dissection should be performed only in patients with preoperative suspected and/or intraoperatively proven LNM. Systematic CND allows an objective evaluation of lymph node status in this central cervical area where the LNM are particularly small and difficult to detect preoperatively.

Risk Factors for Nodal Metastasis in cN0 Papillary Thyroid Microcarcinoma

“…Choi et al reported that the sensitivity of ultrasound for detecting central LNM is only 40% even when the nodes are≥5mm (Choi et al, 2010). Unfortunatly, most of central lymph node metastases are <5mm (Vergez et al, 2010). We observed approximately 40% of patients who underwent central neck dissection had lymph node involvement despite of negative preoperative physical examination and ultrasonography in our study.…”

Clinical impact of cervical lymph node involvement and central neck dissection in patients with papillary thyroid carcinoma: a retrospective analysis of 368 cases

“…However, this treatment is not currently recommended in patients with early stage PTC [1,8,16]. Thus, one of the main objective of prophylactic CND, in patients with small tumors, is to provide an accurate staging of the disease (N0 or N1a) to correctly select patient candidates for postoperative radioiodine therapy [17]. In contrast, in patients with locally advanced tumor, the main objective of prophylactic CND is to clear the central neck of any persistent disease in order to improve the efficacy of postoperative radioiodine therapy, which is always done in these patients, on potential residual cancer cells remote from the primary tumor site [16].…”

Significance of clearing differentiated thyroid carcinoma lymph node by high-frequency color Doppler ultrasonography

“…There is no agreement on DTC neck lymph node removal, either at home or abroad. Studies have suggested that the enlarged neck lymph node removal range is much more likely to increase the risk of recurrent nerve and parathyroid injury rather than to have tumor recurrence, and the former leads to severe clinical complications and greatly lower patients' life quality (7). Nevertheless, it is undeniable that neck lymph node removal has become an important factor affecting the prognosis of thyroid cancer, the prognosis of patients is closely connected with primary surgical approach and surgical resection.…”