Prophylactic central neck dissection in differentiated thyroid cancer: an assessment of the evidence.

An area of ongoing controversy in the management of patients with differentiated thyroid cancer is the role of prophylactic central neck dissection (pCND). This review describes the natural history of differentiated thyroid cancer and provides the limited data regarding the role of routine pCND. An evidence-based analysis was performed of the rationale for routine pCND was performed, including reduced rates of central neck recurrence, reduced morbidity with secondary central neck lymphadenectomy, improved rates of postoperative athyroglobulinemia, and improved stratification of radioactive iodine (RAI) dosage. A critical appraisal of the available literature demonstrates insufficient evidence to indicate that this extra procedure performed routinely leads to improvement in clinically meaningful end points.