The Role of Central Neck Lymph Node Dissection in the Management of Papillary Thyroid Cancer

Abstract

Papillary thyroid cancer (PTC) is the most common thyroid malignancy, and cervical nodal metastases are frequent at presentation. The most common site for nodal metastases from PTC is the central compartment of the ipsilateral neck in the paratracheal and pretracheal regions. The decision to resect these lymph nodes at the time of thyroidectomy often depends on if nodes with suspected malignancy can be identified preoperatively. If nodal spread to the central neck nodes is known, then the consensus is to remove all nodes in this area. However, there remains significant controversy regarding the utility of removing central neck lymph nodes for prophylactic reasons. Herein, we review the potential utility of central neck lymph node dissection as well as the risks of performing this procedure. As well, we review the potential of molecular testing to stratify patients who would most benefit from this procedure. We advocate a selective approach in which patients undergo clinical neck examination coupled with ultrasound to detect any concerning lymph nodes that warrant additional evaluation with either fine needle aspiration or excisional biopsy in the operating room. In lieu of clinical lymphadenopathy, we suggest the use of patient and disease characteristics as identified by multiple groups, such as the American Thyroid Association and European Society of Endocrine Surgeons, which include extremes of ages, large primary tumor size, and male gender, when deciding to perform central neck lymph node dissection. Patients should be educated on the potential long-terms risks versus the lack of known long-term benefits.

<p>Clinical Analysis of Risk Factors for Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Study of 3686 Patients</p>

“…CLNM is the most common, however, prophylactic CLND remains controversial due to several associated surgical complications, like hypoparathyroidism and recurrent laryngeal nerve injury. 21,22 2015 American Thyroid Association (ATA) guidelines recommend prophylactic CLND for patients with T3 and T4 primary tumors without evidence of nodal metastases or with known lateral lymph node metastasis and it is appropriate to not perform a prophylactic CLND for T1 or T2 tumors. 2 Recently, genetic analysis yielded insights into gene mutations, signaling pathways, and biological functions playing a role in thyroid cancer.…”

Anxiety and Fear of Recurrence Despite a Good Prognosis: An Interview Study with Differentiated Thyroid Cancer Patients

“…Prophylactic central lymph node dissection is debated. The risk of complications might be higher than the benefit, when it comes to reducing recurrences 40 . According to the international guidelines the aims of surgical treatment are; I) to remove the primary tumour and involved lymph nodes, in order to decrease recurrence and metastatic spread II) to facilitate postoperative treatment with radioactive iodine III) to permit accurate long-term surveillance with whole-body scanning (WBS) and Tg measurement Adequate surgery is the most important treatment influencing prognosis, while radioactive iodine, TSH suppression, and external beam radiation play an adjunctive role 32 .…”

PBX3 Promotes Tumor Growth and Angiogenesis via Activation of AT1R/VEGFR2 Pathway in Papillary Thyroid Carcinoma

“…However, some patients die due to local recurrence, and distant metastasis [2]. e poor prognosis of PTC largely stems from insufficient understanding of tumor growth [3,4]. erefore, understanding the molecular mechanisms underlying tumor progression and finding specific prognostic biomarkers are clinically important.…”