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Effect of Prophylactic Central Compartment Neck Dissection on Serum Thyroglobulin and Recommendations for Adjuvant Radioactive Iodine in Patients with Differentiated Thyroid Cancer

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Controversy exists in the management of patients with differentiated thyroid cancer (DTC). The purpose of this study was to examine the effect of prophylactic central compartment neck dissection (CCND) on serum thyroglobulin (Tg) levels and recommendations for adjuvant radioactive iodine (RAI).

Methods

The records of 103 patients who underwent completion/total thyroidectomy for DTC between January 2009 and November 2010 were reviewed. Prophylactic CCND was defined as removal of central compartment lymph nodes with no preoperative or intraoperative evidence of lymphadenopathy. Institutional protocol included a diagnostic whole-body scan before RAI; patients with a negative scan and Tg < 2.0 did not receive adjuvant RAI.

Results

Among the 103 patients, therapeutic CCND was performed in 17 (17 %) and prophylactic CCND in 49 (48 %). Of the 49 patients, 20 (41 %) had positive cervical lymph nodes. Positive lymph nodes changed American Joint Committee on Cancer tumor, node, metastasis staging in 17 patients and recommendations for RAI in 14. At a median follow-up of 21 months, there was no difference in Tg level based on the application of CCND; however, 92 % of patients with M0 disease had an undetectable Tg. One patient had recurrent DTC based on serum Tg only.

Conclusions

Prophylactic CCND resulted in detection of unsuspected metastatic lymphadenopathy in 20 (41 %) of 49 patients and changed RAI recommendations in 14 (33 %). To date, most patients have an undetectable Tg. Longer follow-up is needed to detect potential differences in recurrent disease based on the use of CCND or long-term effects of RAI.

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References

  1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.

    Article  PubMed  Google Scholar 

  2. Pereira JA, Jimeno J, Miquel J, et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery. 2005;138:1095–100.

    Article  PubMed  Google Scholar 

  3. Moo TA, Umunna B, Kato M, et al. Ipsilateral versus bilateral central neck lymph node dissection in papillary thyroid carcinoma. Ann Surg. 2009;250:403–8.

    PubMed  Google Scholar 

  4. Popadich A, Levin O, Lee JC, et al. A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery. 2011;150:1048–57.

    Article  PubMed  Google Scholar 

  5. Teixeira G, Teixeira T, Gubert F, Chikota H, Tufano R. The incidence of central neck micrometastatic disease in patients with papillary thyroid cancer staged preoperatively and intraoperatively as N0. Surgery. 2011;150:1161–7.

    Article  PubMed  Google Scholar 

  6. Laird AM, Gauger PG, Miller BS, Doherty GM. Evaluation of postoperative radioactive iodine scans in patients who underwent prophylactic central lymph node dissection. World J Surg. 2012;36:1268–73.

    Article  PubMed  Google Scholar 

  7. Cisco RM, Shen WT, Gosnell JE. Extent of surgery for papillary thyroid cancer; preoperative imaging and role of prophylactic and therapeutic neck dissection. Curr Treat Options Oncol. 2012;13:1–10.

    Article  PubMed  Google Scholar 

  8. Robbins KT, Shaha AR, Medina JE, et al. Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg. 2008;134:536–8.

    Article  PubMed  Google Scholar 

  9. Carty SE, Cooper DS, Doherty GM, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009;19:1153–8.

    Article  PubMed  Google Scholar 

  10. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.

    Article  PubMed  Google Scholar 

  11. Sywak M, Cornford L, Roach P, Stalberg P, Sidhu S, Delbridge L. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery. 2006;140:1000–5.

    Article  PubMed  Google Scholar 

  12. Grubbs EG, Evans DB. Role of lymph node dissection in primary surgery for thyroid cancer. J Natl Compr Cancer Netw. 2007;5:623–30.

    Google Scholar 

  13. Low TH, Delbridge L, Sidhu S, et al. Lymph node status influences follow-up thyroglobulin levels in papillary thyroid cancer. Ann Surg Oncol. 2008;15:2827–32.

    Article  PubMed  Google Scholar 

  14. Moo TA, McGill J, Allendorf J, Lee J, Fahey T 3rd, Zarnegar R. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg. 2010;34:1187–91.

    Article  PubMed  Google Scholar 

  15. Zetoune T, Keutgen X, Buitrago D, et al. Prophylactic central neck dissection and local recurrence in papillary thyroid cancer; a meta-analysis. Ann Surg Oncol. 2010;17:3287–93.

    Article  PubMed  Google Scholar 

  16. Shen WT, Ogawa L, Ruan D, et al. Central neck lymph node dissection for papillary thyroid cancer; comparison of complication and recurrence rates in 295 initial dissections and reoperations. Arch Surg. 2010;145:272–5.

    Article  PubMed  Google Scholar 

  17. Forest VI, Clark JR, Ebrahimi A, et al. Central compartment dissection in thyroid papillary carcinoma. Ann Surg. 2011;253:123–30.

    Article  PubMed  Google Scholar 

  18. Carling T, Carty SE, Ciarleglio MM, et al. American thyroid association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid. 2012;22:237–44.

    Article  PubMed  Google Scholar 

  19. Schroeder PR, Haugen BR, Pacini F, et al. A comparison of short-term changes in health-related quality of life in thyroid carcinoma patients undergoing diagnostic evaluation with recombinant human thyrotropin compared with thyroid hormone withdrawal. J Clin Endocrinol Metab. 2006;91:878–84.

    Article  PubMed  CAS  Google Scholar 

  20. Pacini F, Ladenson PW, Schlumberger M, et al. Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin in differentiated thyroid carcinoma; results of an international, randomized, controlled study. J Clin Endocrinol Metab. 2006;91:926–32.

    Article  PubMed  CAS  Google Scholar 

  21. Tuttle RM, Brokhin M, Omry G, et al. Recombinant human TSH-assisted radioactive iodine remnant ablation achieves short-term clinical recurrence rates similar to those of traditional thyroid hormone withdrawal. J Nucl Med. 2008;49:764–70.

    Article  PubMed  Google Scholar 

  22. Evans DB. Papillary carcinoma of the thyroid; balancing principles of oncology with emerging technology. Surgery. 2011;150:1015–22.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Tracy S. Wang MD, MPH, Douglas B. Evans MD & Tina W. Yen MD, MS

  2. Division of Endocrinology, Metabolism, and Clinical Nutrition, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Gilbert G. Fareau MD & Ty Carroll MD

Authors
  1. Tracy S. Wang MD, MPH
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  2. Douglas B. Evans MD
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  3. Gilbert G. Fareau MD
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  4. Ty Carroll MD
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  5. Tina W. Yen MD, MS
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Correspondence to Tracy S. Wang MD, MPH.

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Wang, T.S., Evans, D.B., Fareau, G.G. et al. Effect of Prophylactic Central Compartment Neck Dissection on Serum Thyroglobulin and Recommendations for Adjuvant Radioactive Iodine in Patients with Differentiated Thyroid Cancer. Ann Surg Oncol 19, 4217–4222 (2012). https://doi.org/10.1245/s10434-012-2594-x

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  • DOI: https://doi.org/10.1245/s10434-012-2594-x

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