Surgical Management of the Neck in Thyroid Cancer

Ferlito, Alfio; Silver, Carl E.; Pelizzo, Maria Rosa; Rinaldo, Alessandra; Toniato, Antonio; Owen, Randall P.

doi:10.1159/000055711

Cited by 9 publications

(4 citation statements)

References 9 publications

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“…In the low-risk group, the survival was 99%, while in the intermediate-and highrisk groups it was 87 and 57%, respectively. The understanding of the risk groups and prognostic factors appears to be extremely important in the biology and management of thyroid cancer, especially related to the extent of thyroidectomy [16] and adjuvant forms of therapy.…”

Section: Prognostic Factors and Risk Group Analysismentioning

confidence: 99%

Distant Metastases from Thyroid and Parathyroid Cancer

Shaha

Ferlito²,

Rinaldo³

2001

ORL

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Thyroid cancer represents a unique biological tumor where even with the high incidence of distant metastases, the overall prognosis is not as poor as many other human cancers. The overall long-term survival in patients presenting initially with distant metastasis is approximately 50%. The overall incidence of distant metastases varies between 10 and 35%, depending upon the histology. The overall incidence is directly related to various histologies – being least in papillary thyroid carcinoma (10%) and highest in Hürthle cell tumor (33%). The incidence of distant metastases is also very high in patients with medullary and anaplastic thyroid cancer. The incidence of distant metastases at the time of initial presentation in differentiated thyroid cancer is approximately 4%. In high-risk patients – especially in patients with extrathyroidal extension or massive nodal metastasis – the distant metastases can be evaluated after total thyroidectomy with radioactive iodine ablation. Pulmonary metastases are very common in young individuals, but they are extremely well treated and the mortality from distant metastases in this group is very low. However, distant metastases in patients with poorly-differentiated carcinoma have a poor prognosis. In high-risk patients, generally a total thyroidectomy should be undertaken so that the patient can undergo radioactive iodine dosimetry and ablation as indicated. The surveillance in patients with thyroid cancer includes: close clinical follow-up, chest X-ray, and radioactive iodine dosimetry. Thyroglobulin is commonly used as a prognostic marker in patients having undergone total thyroidectomy. The incidence of distant metastases in medullary thyroid cancer is high, mainly to the lung and liver. Persistent hypercalcitonemia is an indication of regional or distant metastases. A variety of diagnostic tests are helpful, such as octreotide scanning, computed tomography scan, magnetic resonance imaging and positron emission tomography scan. Laparoscopy to evaluate the surface of the liver is also an important investigation to detect distant metastases. The incidence of distant metastases is very high in patients with anaplastic thyroid cancer, but most of the time the outcome depends on the locoregional recurrence and massive disease in the central compartment. The parathyroid cancer is quite rare, less than 1%, in patients undergoing parathyroidectomy. The diagnosis of parathyroid cancer is made by pathological features but the most certain method of diagnosis of a malignant tumor of the parathyroid is the identification of secondary deposits. The incidence of distant metastasis is difficult to determine due to the rarity of this condition, but the most common site is the lung. Patients with distant metastasis have recurrent progressive hypercalcemia along with high parathormone level.

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Section: Prognostic Factors and Risk Group Analysismentioning

confidence: 99%

Distant Metastases from Thyroid and Parathyroid Cancer

Shaha

Ferlito²,

Rinaldo³

2001

ORL

Self Cite

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“…Another unique feature of thyroid cancer is that nodal metastasis has no prognostic bearing (12,32), whereas in other human cancers (e.g. of the lung, head and neck or colon) it reduces the survival rate by : 50%.…”

Section: Diagnosismentioning

confidence: 99%

“…Recently, with the introduction of thyroglobulin monitoring during follow-up, an increasing number of patients with rising thyroglobulin levels have been detected, related mainly to metastatic disease to the lymph nodes. An extended selective neck dissection is generally recommended for such patients if neck ultrasound and ultrasound-guide d ne-needle biopsy con rm metastatic disease to the neck lymph nodes (32). The internal jugular vein, spinal accessory nerve and sternocleidomastoi d muscle should only be sacri ced if they are affected by gross disease.…”

Section: Diagnosismentioning

confidence: 99%

Thyroid Cancer: A Unique Human Neoplasm

Shaha

Ferlito

Rinaldo

2002

Acta Oto-Laryngologica

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“…Although some studies have shown that the presence of LN metastases does not alter survival, [1][2][3] other studies have shown that PTC recurrence increases morbidity and mortality and that the presence of cervical LN metastasis at diagnosis is the single most important factor that ultimately increases the risk of local recurrence.…”

mentioning

confidence: 99%

The Role of SPECT/CT Lymphoscintigraphy and Radioguided Sentinel Lymph Node Biopsy in Managing Papillary Thyroid Cancer

Cabrera

Chone

Zantut-Wittmann

et al. 2016

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Single-photon emission computed tomography/computed tomography (SPECT/CT) and radioguided sentinel lymph node biopsy (rSLNB) are techniques that could potentially benefit surgeons and pathologists in the identification of sentinel lymph node (SLN) metastases in patients with papillary thyroid carcinoma (PTC). Evidence suggests that these novel techniques lead to substantial changes in PTC management by reducing understaging and of occult lymph node (LN) metastases and optimizing neck surgery by increasing the necessity of lateral lymphadenectomy and decreasing central lymphadenectomy.OBJECTIVES To correlate the presence of LN metastases in PTC with clinical and pathological features using SPECT/CT and rSLNB. DESIGN, SETTING, AND PARTICIPANTS For this prospective cohort study from June 2010 to November 2013, 42 patients with thyroid nodules suspicious for papillary carcinoma or classified as malignant on cytology examination without suspicion of lymph node metastases by clinical and ultrasound examinations were recruited from a single public medical institution.INTERVENTIONS All 42 patients underwent preoperative lymphoscintigraphy after an ultrasound-guided peritumoral injection of Technetium Tc 99m nanocolloid. Cervical images were acquired with a SPECT/CT scanner 15 minutes after radiotracer injection. Approximately 2 hours after lymphoscintigraphy, the patients were submitted to intraoperative rSLNB using a handheld gamma probe. All SLNs identified were removed alongside with non-SLNs from the same compartment. Papillary thyroid carcinoma, SLNs and non-SLNs were submitted for histopathology and immunohistochemical analyses. RESULTSOf the 42 patients initially enrolled, 37 were included in analysis, including 6 men and 31 women with a mean (range) age of 47 (22-83) years. Overall, T stage was as follows: T1, 23 patients (62.2%); T2, 8 patients (21.6%); and T3, 6 patients (16.2%). Sentinel lymph nodes were identified in 92% of the patients, and among these metastases were present in 17 patients (46%). The SLNs were false-negative in 3 patients. Metastases in the lateral compartment ocurred in 7 patients (18%). There was a significant association between LN metastases and tumor size (odds ratio, 1.06; 95% CI, 1.00-1.13; P = .02), with a Cohen d effect of 0.683 (medium to large effect). Overall, 17 patients (46%) with LN metastases had management changed because they were submitted to higher radioiodine ablation doses and closer clinical surveillance.CONCLUSIONS AND RELEVANCE Radioguided SLNB is able to detect occult cervical lymph node metastases in patients with papillary thyroid carcinoma, and in 7 patients (18%) rSLNB detected lymph node metastases in the lateral compartments. The rSLNB technique lead to management change in 14 patients (37.8%).

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Surgical Management of the Neck in Thyroid Cancer

Cited by 9 publications

References 9 publications

Distant Metastases from Thyroid and Parathyroid Cancer

Distant Metastases from Thyroid and Parathyroid Cancer

Thyroid Cancer: A Unique Human Neoplasm

The Role of SPECT/CT Lymphoscintigraphy and Radioguided Sentinel Lymph Node Biopsy in Managing Papillary Thyroid Cancer

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