Carolina Nylén1, Frida Bragvad Eriksson2, Anna Yang2, Ahmad Aniss3, John Turchini4, Diana Learoyd5, Bruce G Robinson6, Anthony J Gill7, Roderick J Clifton-Bligh6, Mark S Sywak8, Anthony R Glover9, Stan B Sidhu10. 1. Department of Endocrine Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Endocrine Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77 Stockholm, Sweden. Electronic address: carolina.nylen@ki.se. 2. Department of Endocrine Surgery, Uppsala University, Akademiska Hospital, 751 85 Uppsala, Sweden. 3. Department of Endocrine Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. 4. Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia; Department of Histopathology, Douglass Hanly Moir Pathology, Macquarie Park, NSW, 2113, Australia; Discipline of Pathology, MQ Health, Macquarie University, NSW, 2109, Australia; Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. 5. Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia; Department of Endocrinology and Diabetes, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. 6. Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia; Department of Endocrinology and Diabetes, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Cancer Genetics Unit, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. 7. Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia; Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. 8. Department of Endocrine Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia. 9. Department of Endocrine Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia; Endocrine Cancer Program, Cancer Theme, The Kinghorn Cancer Centre, Garvan Institute of Medical Research, St. Vincent's Clinical School. Faculty of Medicine, University of New South Wales Sydney, NSW, 2010, Australia. 10. Department of Endocrine Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia; Cancer Genetics Unit, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
Abstract
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.
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.
Authors: Costanza Chiapponi; Hakan Alakus; Matthias Schmidt; Michael Faust; Christiane J Bruns; Reinhard Büttner; Marie-Lisa Eich; Anne M Schultheis Journal: Front Med (Lausanne) Date: 2022-02-21