Incidence of Regional Recurrence Guiding Radicality in Differentiated Thyroid Carcinoma

Abstract

Total thyroidectomy has become the routine procedure for treatment of differentiated thyroid carcinoma. However, the necessity of unilateral or bilateral neck dissection is far less standardized. Our usual procedure has been to perform a routine neck dissection in T4 tumors and in all other tumor stages only in the presence of positive diagnostic or intraoperative findings. The results concerning regional tumor recurrence in cervical lymph nodes subsequent to thyroidectomy are studied and discussed. Between April 1986 and December 1992 a group of 252 patients were operated on for differentiated thyroid carcinoma (DTC) (176 papillary, 76 follicular). Postoperative treatment included radioiodine therapy as a rule in all patients more than stage T1, and follow-up encompassed thyroglobulin measurements, cervical ultrasonography, and radioiodine scintigraphy. After a mean follow-up of 6.9 years, 77 (31%) of the patients underwent reoperation because of regional tumor recurrence [46 of 176 (26%) papillary, 31 of 76 (41%) follicular]. In papillary thyroid cancer a significant difference could be demonstrated between patients with thyroidectomy only versus thyroidectomy plus neck dissection in all tumor stages (T2, 13 of 29 (45%) versus 1 of 34 (3%); T3, 10 of 13 (77%) versus 4 of 11 (36%); T4, 6 of 8 (75%) versus 6 of 18 (33%) (p < 0.0001). Similar results could be achieved for follicular thyroid cancer, showing statistical significance with regard to operative procedure (p < 0.009). Our experience demonstrates a positive correlation of regional tumor recurrence with increasing tumor stage for both histologic tumor types. The high rate of regional recurrence justifies a more radical approach, including neck dissection at the initial operation. The impact on survival, however, must be proved by further evaluation.

Sentinel lymph node biopsy as guidance for central neck dissection in patients with papillary thyroid carcinoma

“…1,5,22 Although subclinical lymph node metastases are identified in a high proportion of patients with PTC, 23,24 the management of macroscopic lymph node-negative tumors of the neck remains unclear. Because of the relatively high cervical recurrence rate (31%) 3 and the negative impact of lymph node metastases on disease-free survival, 25 ipsilateral modified radical neck dissection after thyroid resection may be indicated. 22 Routine lateral neck dissection, however, results in longer surgical time and hospitalization and increased surgical morbidity, 4,5 suggesting that it may not be necessary for patients who have PTC without suspicion of positive cervical lymph nodes.…”

“…2 However, cervical lymph node recurrences have been reported in up to 31% of patients. 3 The incidence of local recurrence most likely is reduced by lymph node dissection, but neck dissection has been associated with significant morbidity, 4,5 indicating the importance of better selection of patients PTC who would benefit from compartment-oriented lymph node dissection.…”

Use of preoperative ultrasonography as guidance for neck dissection in patients with papillary thyroid carcinoma

“…Despite its high metastatic activity, prophylactic neck dissection has been discouraged for PTC patients presenting without palpable neck nodes because lymph node metastasis has not been considered prognostic for survival [3,4]. However, cervical recurrences, mostly regional nodal metastases, have been reported in up to 31% of patients [5]. Since macroscopic metastases present at the time of initial diagnosis are unlikely to be eradicated by radioactive iodine therapy, preoperative detection of macroscopic lymph node metastases may prevent subsequent reoperation for PTC recurrence in the neck [6,7].…”

Therapeutic strategy for low-risk thyroid cancer in Kanaji Thyroid Hospital [Review]

“…Prophylactic central node dissection is not recommended by the AACE/AAES guidelines [7]. Indeed, currently available data on the prognostic influence of central node dissection are controversial [23][24][25][26][27][28][29][30][31]. Carling T et al reported that a prospective randomized controlled trial of prophylactic central lymph node dissection in cN0 PTC is not readily feasible [32].…”