Extent of Surgery for Papillary Thyroid Cancer: Preoperative Imaging and Role of Prophylactic and Therapeutic Neck Dissection

• Published in: Current treatment options in oncology Vol. 13; no. 1; pp. 1 - 10
• Main Authors: Cisco, Robin M., Shen, Wen T., Gosnell, Jessica E.
• Format: Journal Article
• Language: English
• Published: New York Current Science Inc 01.03.2012; Springer Nature B.V
• Subjects: Biopsy, Fine-Needle; Carcinoma; Carcinoma, Papillary; Endocrine Tumors (O Clark and A Dackiw; Female; Humans; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Neck Dissection - methods; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - pathology; Oncology; Prognosis; Secondary Prevention - methods; Section Editors; Thyroid Cancer, Papillary; Thyroid Neoplasms - diagnostic imaging; Thyroid Neoplasms - pathology; Thyroidectomy - methods; Ultrasonography; Papillary thyroid cancer (PTC); Prophylactic lymph node dissection; Lymph node metastases; Lymph node; Surgery; Prophylactic neck dissection; Prophylactic bilateral central lymph node dissection (CLND); Preoperative imaging; Ultrasound; Fine needle aspiration (FNA); Therapeutic neck dissection
• DOI: 10.1007/s11864-011-0175-z
• ISSN: 1527-2729; 1534-6277

Opinion statement Papillary thyroid cancer (PTC) has an excellent prognosis, yet lymph node metastases are common. Most authors agree that central and/or lateral lymph node dissection should be undertaken in patients with abnormal lymph nodes detected on ultrasound, physical examination or intraoperative inspection. However the appropriate extent of prophylactic lymph node dissection for clinically node-negative patients remains the subject of controversy. There have been no randomized trials to date to offer guidance on this issue. The 2006 guidelines of the American Thyroid Association recommended consideration of prophylactic bilateral central lymph node dissection (CLND) for all patients undergoing thyroidectomy for PTC. However, the absence of compelling evidence for a benefit in terms of recurrence or survival, and the potential for increased morbidity, have led many, including our institution, to take an approach of selective central lymph node dissection. This approach is guided by the detection of abnormal lymph nodes on preoperative ultrasound, on physical examination, or during surgery. Postoperatively, ultrasound by an experienced ultrasonographer is the mainstay of evaluation for lymph node recurrence and is combined with monitoring of thyroglobulin and antithyroglobulin antibody levels. Reoperative lymph node dissection is typically undertaken upon detection and fine needle aspiration (FNA) of involved lymph nodes 0.8 cm or greater in size.