Prophylactic Lymph Node Dissection for Papillary Thyroid Cancer Less Than 2 cm: Implications for Radioiodine Treatment

Bonnet, Stéphane; Hartl, Dana M.; Leboulleux, Sophie; Baudin, Éric; Lumbroso, J.; Ghuzlan, Abir Al; Chami, L.; Schlumberger, Martin; Travagli, J. P.

doi:10.1210/jc.2008-1931

Cited by 246 publications

(160 citation statements)

References 39 publications

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“…Bonnet et al (19) reported that patients with T1 tumors undergoing prophylactic neck dissection, were excluded from RAI in 15 % of cases who would have otherwise received RAI without documentation of pN0 status.…”

Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%

Total thyroidectomy and central lymph node dissection. Experience of a referral centre for endocrine surgery

Monacelli¹,

Lucchini²,

Polistena³

et al. 2014

gchir

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Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%

Total thyroidectomy and central lymph node dissection. Experience of a referral centre for endocrine surgery

Monacelli¹,

Lucchini²,

Polistena³

et al. 2014

gchir

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“…On experienced hands the elective (prophylactic) CCND carries almost the same rate of complications, except for temporary hypocalcaemia, where for every 7.7 CCNDs performed with thyroidectomy, there was one extra case of temporary hypocalcaemia when compared to thyroidectomy alone [19]. In literature, despite of the ATA recommendation for a selective indication for an elective CCND, we are observing an emerging number of studies, from different countries, showing good results with the use of an elective CCND for small and large PTCs [7,[20][21][22][23]. When indicated, the use of an ipsilateral CCND, described according to the ATA consensus statement on the anatomy and terminology of central neck dissection [24], showed a high therapeutic efficacy with a low incidence of complications, when compared with the bilateral procedure [25].…”

Section: Introductionmentioning

confidence: 99%

“…Then, a preoperative or intra-operative finding of minimal or massive extrathyroidal extension precludes the indication for a prophylactic CCND. Extra-thyroidal extension is associated with a higher incidence of central compartment subclinical lymph node metastasis in a frequency ranging from 21% to 43% [20,21,37].…”

Section: Introductionmentioning

confidence: 99%

Elective Central Compartment Neck Dissection for Papillary Thyroid Cancer-Hot Topics

Teixeira¹

2012

J Nucl Med Radiat Ther

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“…Bonnet et al [8] reported that RAI was avoided in 15 % of their patients with T1 tumors undergoing prophylactic neck dissection, who would have otherwise received RAI without documentation of pN0 status. This research group expanded on their cohort in a more recent publication in which 30 % of their T1 and T2, pN0 patients did not receive radioiodine (though they also commented on a 26 % rate of upstaging based on pN1 status) [9].…”

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confidence: 99%

Prophylactic central lymph node dissection in differentiated thyroid cancer

Goddard

Steward

2013

Endocrine

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Conzo et al. [1] describe their experience of treating differentiated thyroid carcinoma in patients who lack clinically evident nodal disease (cN0) with total thyroidectomy, without prophylactic central lymph node dissection, followed by radioactive iodine (RAI). 93.8 % of their 221 patients had AJCC Stage I or II papillary thyroid carcinoma. They report a low locoregional recurrence rate of 3.16 % after almost 10 years as well as low complication rates (0.91 % for both permanent hypoparathyroidism and permanent vocal fold paralysis). The merits of prophylactic lymph node dissection are debated in these patients with early-stage disease, and the authors' discussion highlights this debate. They note that the current literature lacks conclusive evidence of survival or recurrence benefit, but has established an increase in complication rates (specifically, transient hypocalcemia) associated with prophylactic central nodal dissection compared with total thyroidectomy alone. Based on their results and their scrutiny of this literature, those authors have come to conclude that their treatment paradigm is acceptable and that prophylactic central neck dissection can be avoided [1].Multiple staging systems for papillary thyroid carcinoma have been developed, many of which do not include cervical nodal metastasis as a factor. However, TNM staging is utilized by the American Thyroid Association in its most recently published guidelines for differentiated thyroid carcinoma. As with other cancers, this system includes clinical staging as well as pathologic staging for nodal metastases. Patients who do not have suspicious cervical lymph nodes by preoperative palpation, preoperative ultrasound, or intraoperative inspection are designated clinically node negative, or cN0. If there are lymph nodes with suspicious characteristics by these evaluations, then patients are considered clinically node positive, or cN1. Pathologic staging is based on microscopic evaluation of nodes in a surgical specimen. Patients without pathologic evidence of nodal disease are staged pN0 and those with disease are designated pN1.The importance of clinical nodal evaluation is evident in the article by Conzo et al. Patients are appropriately classified as cN0 versus cN1, as evidenced by the exclusion of 211 patients who had clinically suspicious lymph node findings by preoperative ultrasound or intraoperative inspection. These cN1 patients underwent therapeutic central nodal dissection rather than prophylactic, and this is a critical distinction. Benefit of central compartment dissection in the setting of clinically positive nodes is widely agreed upon. However, definitive evidence regarding oncologic benefit from dissecting clinically negative nodal basins has yet to be established, and the significance of microscopic nodal disease is widely questioned. A closer look at nodal metastases was recently provided the ATA [2]. In this publication, Randolph et al. note the differences in recurrence risk in node-positive patients based on nodal characteristics...

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Prophylactic Lymph Node Dissection for Papillary Thyroid Cancer Less Than 2 cm: Implications for Radioiodine Treatment

Abstract: Precise LN staging by prophylactic neck dissection for tumors initially staged T1N0 modified the indication for radioiodine ablation for 30% of patients.

Cited by 246 publications

References 39 publications

Total thyroidectomy and central lymph node dissection. Experience of a referral centre for endocrine surgery

Total thyroidectomy and central lymph node dissection. Experience of a referral centre for endocrine surgery

Elective Central Compartment Neck Dissection for Papillary Thyroid Cancer-Hot Topics

Prophylactic central lymph node dissection in differentiated thyroid cancer

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