Prophylactic Lymph Node Dissection in Papillary Thyroid Carcinoma: Is There a Place for Lateral Neck Dissection?

Ducoudray, Romain; Trésallet, Christophe; Godiris-Petit, G.; Tissier, Frédérique; Leenhardt, Laurence; Ménégaux, Fabrice

doi:10.1007/s00268-013-2020-y

Cited by 59 publications

(47 citation statements)

References 39 publications

(37 reference statements)

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“…However, Ducoudray et al [9] considered that prophylactic CLN and LLN dissection could modify PTC staging and simplify postoperative management for clinicians, so they recommend that selective prophylactic CLN and LLN dissection (ipsilateral to the main tumor) be performed in apparently node-negative PTC patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics Related to Central Lymph Node Metastasis in cN0 Papillary Thyroid Carcinoma: A Retrospective Study of 916 Patients

Jiang

Chen

Tan

et al. 2014

International Journal of Endocrinology

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Background. Papillary thyroid carcinoma (PTC) is a form of thyroid cancer with high risk of cervical lymph node metastasis. Aim. The aim of this study was to investigate the incidence and the predictive factors for occult ipsilateral central lymph node (CLN) metastasis in the patients with papillary thyroid carcinoma. Methods. A total of 916 PTC patients (1017 lesions) undergoing central lymph node dissection in our hospital from 2005 to 2011 were enrolled. The relationship between CLN metastasis and clinical factors such as gender, age, tumor size, tumor number, capsule invasion, and tumor location was analyzed. Results. Occult CLN metastasis was observed in 52.41% (533/1017) of PTC lesions, respectively. Multivariate analysis showed that age ≤ 35 years, tumor size > 1.5 cm, present capsule invasion/extracapsular invasion, and tumor located in upper/middle pole/whole lobe were risk factors of CLN metastasis. Conclusions. Tumor located in upper/middle pole/whole lobe, less than 35 years old, tumor size > 1.5 cm, and present capsule invasion/extracapsular invasion were risk factors of CLN metastasis. We recommend performing ipsilateral prophylactic CLN dissection in cN0 PTC patients.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics Related to Central Lymph Node Metastasis in cN0 Papillary Thyroid Carcinoma: A Retrospective Study of 916 Patients

Jiang

Chen

Tan

et al. 2014

International Journal of Endocrinology

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“…On the other hand, given the potentially high prevalence of LNM in PTMC, some authors agree that prophylactic lymph node dissection (LND) permits an improved staging of the disease that may guide subsequent treatment;14 however, few studies have demonstrated a meaningful role of prophylactic LND in relation to locoregional control or survival in PTMC. A systematic review that included 8,345 PTMC patients explored the risk factors associated with central lymph node metastasis (CLNM) and proposed that prophylactic central lymph node dissection (CLND) should be considered in PTMC patients with risk factors 15.…”

Section: Introductionmentioning

confidence: 99%

Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma

Lin¹,

Qu²,

Shi³

et al. 2016

OTT

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The surgical management of papillary thyroid microcarcinoma (PTMC), especially regarding the necessity of central/lateral lymph node dissection, remains controversial. This study investigated the clinicopathologic factors predictive of lymph node metastasis (LNM) in patients diagnosed with PTMC. Multivariate logistic regression analysis was used for PTMC patients identified from the Surveillance, Epidemiology, and End Results database who were treated by surgery between 2002 and 2012, to determine the association of clinicopathologic factors with LNM. According to the results, a total of 31,017 patients met the inclusion criteria of the study. Final histology confirmed 2,135 (6.9%) cases of N1a disease and 1,684 cases (5.4%) of N1b disease. Our multivariate logistic regression analysis identified variables associated with both central LNM and lateral lymph node metastasis (LLNM), including a younger age (<45 years), male sex, non-Hispanic white and other race, classical papillary histology, larger tumor size, multifocality, and extrathyroidal extension; distant metastasis was also significantly associated with LLNM. The significant predictors identified from multivariable logistic regression were integrated into a statistical model that showed that extrathyroidal extension had maximum weight in the predictive role for LNM. LLNM was validated to be a significant risk factor for cancer-specific death in Cox regression analyses, whereas central LNM failed to predict a worse cancer-specific survival according to our data. Therefore, we suggested that central lymph node dissection could be performed in certain patients with risk factors. Given the prevalence of LLNM in PTMC, a thorough inspection of the lateral compartment is recommended in PTMC patients with risk factors for precise staging; from the viewpoint of a radical treatment for tumors, prophylactic lateral lymph node dissection that aims to remove the occult lateral lymph nodes may be an option for PTMC with risk factors. Multicenter studies with long-term follow-up are recommended to better understand the risk factors and surgical management for cervical nodes in PTMC.

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“…To avoid regional recurrence, predictive factors for regional LNM, such as primary tumor size, extracapsular invasion, or maximum Standardized Uptake Value (SUVmax) on PET were vigorously investigated (22), and prophylactic neck dissections were required in some studies (5). In this study, the factors affecting central LNM were age, main tumor size, and the number of retrieved central LNs, according to multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Metastatic LNs are hard to cure without surgical removal and any surgical intervention for recurrent LNs increases the risk of surgical complications due to postoperative adhesion. To overcome such challenges, many surgeons perform prophylactic CCND (5). However, unnecessary and excessive prophylactic CCND can also cause adverse events including permanent hypocalcemia or irreversible nerve injury.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of PET/MR for Evaluating Central Lymph Node Status in Patients with Papillary Thyroid Carcinoma

et al. 2017

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Purpose: Ultrasonography and computed tomography of the neck are commonly used for preoperative evaluation of neck lymph node (LN) status in papillary thyroid carcinoma (PTC). This study evaluated the accuracy of preoperative positron emission tomography/magnetic resonance (PET/MR) imaging of cervical LN status in PTC. F-fluorodeoxyglucose uptake and preoperative morphologic abnormalities of nodal shape, cortical thickness, and the fatty hilum of neck nodes were analyzed using PET/MR imaging. Results: Total thyroidectomy and lobectomy were conducted in 78.2% (223/285) and 21.8% (62/285) of cases, respectively. The status of central neck LN were evaluated in all patients during surgery and additional evaluation of lateral neck LN were conducted in 11.9% (34/285) of patients through selective sampling or modified radical neck dissection. In total, 36.1% (103/285) of patients had pathologic neck LN metastasis (LNM). PET/MR imaging showed an accuracy of 68.8%, sensitivity of 32.7%, and specificity of 88.6% for the detection of central neck LNM; moreover, an accuracy of 95.1%, sensitivity 68.4%, and specificity of 97.0% for lateral neck LNM. PET/MR imaging showed higher accuracy for detecting neck LNM in the 164 patients who did not have suspected clinical thyroiditis than others. Conclusion: PET/MR has a high specificity for detecting central LNM, especially for patients diagnosed with PTC without pathologic thyroiditis.

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Prophylactic Lymph Node Dissection in Papillary Thyroid Carcinoma: Is There a Place for Lateral Neck Dissection?

Abstract: In preoperatively N0 PTC patients, LN metastases are frequent in central and ipsilateral lateral compartments. Prophylactic LND in the central and ipsilateral lateral compartments should therefore be recommended in the presence of PTC to identify high-risk patients.

Cited by 59 publications

References 39 publications

Clinical Characteristics Related to Central Lymph Node Metastasis in cN0 Papillary Thyroid Carcinoma: A Retrospective Study of 916 Patients

Clinical Characteristics Related to Central Lymph Node Metastasis in cN0 Papillary Thyroid Carcinoma: A Retrospective Study of 916 Patients

Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma

Diagnostic Accuracy of PET/MR for Evaluating Central Lymph Node Status in Patients with Papillary Thyroid Carcinoma

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