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Prophylactic central lymph node dissection informs the decision of radioactive iodine ablation in papillary thyroid cancer


BACKGROUND: Prophylactic central lymph node dissection (CLND) in papillary thyroid cancer (PTC) is controversial. We aimed to investigate if prophylactic CLND aids risk stratification and contributes to the decision for postoperative RAI ablation. METHODS: Patients undergoing thyroidectomy for PTC and prophylactic CLND were identified from an endocrine surgical unit database. Pathology reports where reviewed for number and size of lymph nodes and patients stratified by risk according to the ATA guidelines. RESULTS: 426 patients were identified with PTC </=4 cm and prophylactic CLND. 96 patients (23%) had central lymph node metastasis (CLNM) that qualified them for the intermediate risk group. In 17 patients (4%), the CLNM data led to upgrading independently of other histopathological characteristics. Correcting for multiple variables, CLNM was an independent factor contributing to RAI treatment. CONCLUSION: Prophylactic CLND provides information to aid the selection of RAI ablation independent of primary cancer histology for risk stratification in 4% of patients. This benefit should be carefully balanced with the risk of CLND and patient treatment choice when deciding on management of PTC </=4 cm.

Type Journal
ISBN 1879-1883 (Electronic) 0002-9610 (Linking)
Authors Nylen, C.; Eriksson, F. B.; Yang, A.; Aniss, A.; Turchini, J.; Learoyd, D.; Robinson, B. G.; Gill, A. J.; Clifton-Bligh, R. J.; Sywak, M. S.; Glover, A. R.; Sidhu, S. B.
Responsible Garvan Author Dr Anthony Glover
Published Date 2021-05-31
Published Volume 221
Published Issue 5
Published Pages 886-892
Status Published in-print
DOI 10.1016/j.amjsurg.2020.08.012
URL link to publisher's version