Impact of prophylactic central compartment neck dissection on locoregional recurrence of differentiated thyroid cancer in clinically node-negative patients: A retrospective study of a large clinical series

Surgery ◽  
2014 ◽  
Vol 155 (6) ◽  
pp. 998-1005 ◽  
Author(s):  
Giovanni Conzo ◽  
Pietro Giorgio Calò ◽  
Antonio A. Sinisi ◽  
Annamaria De Bellis ◽  
Daniela Pasquali ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Retrospective Study ◽  
Neck Dissection ◽  
Locoregional Recurrence ◽  
Differentiated Thyroid Cancer ◽  
Central Compartment ◽  
Node Negative ◽  
Clinical Series

scholarly journals Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines

2016 ◽  
Vol 130 (S2) ◽  
pp. S150-S160 ◽  
Author(s):  
A L Mitchell ◽  
A Gandhi ◽  
D Scott-Coombes ◽  
P Perros
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Differentiated Thyroid Cancer ◽  
Distant Metastases ◽  
Central Compartment ◽  
Extrathyroidal Extension ◽  
Papillary Thyroid ◽  
Ultrasound Scanning

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the management of thyroid cancer in adults and is based on the 2014 British Thyroid Association guidelines.Recommendations• Ultrasound scanning (USS) of the nodule or goitre is a crucial investigation in guiding the need for fine needle aspiration cytology (FNAC). (R)• FNAC should be considered for all nodules with suspicious ultrasound features (U3–U5). If a nodule is smaller than 10 mm in diameter, USS guided FNAC is not recommended unless clinically suspicious lymph nodes on USS are also present. (R)• Cytological analysis and categorisation should be reported according to the current British Thyroid Association Guidance. (R)• Ultrasound scanning assessment of cervical nodes should be done in FNAC-proven cancer. (R)• Magnetic resonance imaging (MRI) or computed tomography (CT) should be done in suspected cases of retrosternal extension, fixed tumours (local invasion with or without vocal cord paralysis) or when haemoptysis is reported. When CT with contrast is used pre-operatively, there should be a two-month delay between the use of iodinated contrast media and subsequent radioactive iodine (I131) therapy. (R)• Fluoro-deoxy-glucose positron emission tomography imaging is not recommended for routine evaluation. (G)• In patients with thyroid cancer, assessment of extrathyroidal extension and lymph node disease in the central and lateral neck compartments should be undertaken pre-operatively by USS and cross-sectional imaging (CT or MRI) if indicated. (R)• For patients with Thy 3f or Thy 4 FNAC a diagnostic hemithyroidectomy is recommended. (R)• Total thyroidectomy is recommended for patients with tumours greater than 4 cm in diameter or tumours of any size in association with any of the following characteristics: multifocal disease, bilateral disease, extrathyroidal spread (pT3 and pT4a), familial disease and those with clinically or radiologically involved nodes and/or distant metastases. (R)• Subtotal thyroidectomy should not be used in the management of thyroid cancer. (G)• Central compartment neck dissection is not routinely recommended for patients with papillary thyroid cancer without clinical or radiological evidence of lymph node involvement, provided they meet all of the following criteria: classical type papillary thyroid cancer, patient less than 45 years old, unifocal tumour, less than 4 cm, no extrathyroidal extension on ultrasound. (R)• Patients with metastases in the lateral compartment should undergo therapeutic lateral and central compartment neck dissection. (R)• Patients with follicular cancer with greater than 4 cm tumours should be treated with total thyroidectomy. (R)• I131 ablation should be carried out only in centres with appropriate facilities. (R)• Serum thyroglobulin (Tg) should be checked in all post-operative patients with differentiated thyroid cancer (DTC), but not sooner than six weeks after surgery. (R)• Patients who have undergone total or near total thyroidectomy should be started on levothyroxine 2 µg per kg or liothyronine 20 mcg tds after surgery. (R)• The majority of patients with a tumour more than 1 cm in diameter, who have undergone total or near-total thyroidectomy, should have I131 ablation. (R)• A post-ablation scan should be performed 3–10 days after I131 ablation. (R)• Post-therapy dynamic risk stratification at 9–12 months is used to guide further management. (G)• Potentially resectable recurrent or persistent disease should be managed with surgery whenever possible. (R)• Distant metastases and sites not amenable to surgery which are iodine avid should be treated with I131 therapy. (R)• Long-term follow-up for patients with differentiated thyroid cancer (DTC) is recommended. (G)• Follow-up should be based on clinical examination, serum Tg and thyroid-stimulating hormone assessments. (R)• Patients with suspected medullary thyroid cancer (MTC) should be investigated with calcitonin and carcino-embryonic antigen levels (CEA), 24 hour catecholamine and nor metanephrine urine estimation (or plasma free nor metanephrine estimation), serum calcium and parathyroid hormone. (R)• Relevant imaging studies are advisable to guide the extent of surgery. (R)• RET (Proto-oncogene tyrosine-protein kinase receptor) proto-oncogene analysis should be performed after surgery. (R)• All patients with known or suspected MTC should have serum calcitonin and biochemical screening for phaeochromocytoma pre-operatively. (R)• All patients with proven MTC greater than 5 mm should undergo total thyroidectomy and central compartment neck dissection. (R)• Patients with MTC with lateral nodal involvement should undergo selective neck dissection (IIa–Vb). (R)• Patients with MTC with central node metastases should undergo ipsilateral prophylactic lateral node dissection. (R)• Prophylactic thyroidectomy should be offered to RET-positive family members. (R)• All patients with proven MTC should have genetic screening. (R)• Radiotherapy may be useful in controlling local symptoms in patients with inoperable disease. (R)• Chemotherapy with tyrosine kinase inhibitors may help in controlling local symptoms. (R)• For individuals with anaplastic thyroid carcinoma, initial assessment should focus on identifying the small proportion of patients with localised disease and good performance status, which may benefit from surgical resection and other adjuvant therapies. (G)• The surgical intent should be gross tumour resection and not merely an attempt at debulking. (G)

scholarly journals Recurrent laryngeal nerve injury in endoscopic surgery for thyroid cancer

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Hoàng Hiệp Phan ◽  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Neck Dissection ◽  
Lymph Node Dissection ◽  
Differentiated Thyroid Cancer ◽  
Endoscopic Thyroidectomy ◽  
Central Compartment ◽  
Laryngeal Nerve ◽  
Node Dissection

Tóm tắt Đặt vấn đề: Tổn thương dây thần kinh thanh quản quặt ngược (TQQN) là một biến chứng hay gặp trong phẫu thuật ung thư tuyến giáp. Phẫu thuật nội soi mới được ứng dụng và biến chứng này cũng là một lo ngại với các phẫu thuật viên. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang, theo dõi dọc. Người bệnh được chẩn đoán là ung thư tuyến giáp thể biệt hóa giai đoạn sớm, được điều trị phẫu thuật bằng mổ nội soi tại Bệnh viện Nội tiết trung ương từ tháng 01 năm 2013 đến tháng 9 năm 2016. Kết quả: 95 người bệnh (NB) được chẩn đoán là ung thư tuyến giáp thể biệt hóa giai đoạn sớm được phẫu thuật nội soi theo chỉ định. Tổn thương dây thần kinh TQQN không gặp khi cắt 1 thùy tuyến giáp. Tổn thương dây thần kinh TQQN tạm thời khi cắt toàn bộ tuyến giáp tổn thương là 4,8%, cắt toàn bộ tuyến giáp và nạo vét hạch 1 khoang, 2 khoang và 3 khoang lần lượt là 3,6%, 5,6% và 1/5, tính chung là 5,3%. Tổn thương dây thần kinh TQQN vĩnh viễn (sau mổ 6 tháng) có 1 người bệnh (1,1%), trường hợp này thường là có nhân nằm tại vị trí dây chằng Berry đi vào của dây thần kinh TQQN. Tổn thương dây thần kinh của nhóm nạo vét hạch khoang trung tâm (5,6%) cao hơn so với nạo vét hạch khoang bên (3,6%) sự khác biệt có ý nghĩa thống kê (p=0,015). Liệt dây thần kinh TQQN trong nhóm nạo vét hạch cổ tăng hơn gấp 1,27 lần ở nhóm không nạo vét hạch (p = 0,025). Kết luận: Tỉ lệ tổn thương dây thần kinh TQQN phụ thuộc vào phương pháp phẫu thuật tuyến giáp và có nạo vét hạch cổ hay không. Tỉ lệ này sẽ tăng khi nạo vét hạch, đặc biệt là nạo vét hạch khoang trung tâm. Abstract Background: Recurrent laryngeal nerve (RLN) injury is a common complication in thyroidectomy. Endoscopic thyroidectomy has just been applied for thyroid cancer and RLN injury is also a concern of the surgeons. Materials and Methods: It’s a cross-sectional with longitudinal study. Patients with early differentiated thyroid cancer were enrolled into this study underwent endoscopic thyroidectomy in National hospital of Endocrinology from January 2013 to September 2016. Results: 95 patients with early differentiated thyroid cancer underwent endoscopic thyroidectomy were included. No RLN injury occurred for one lobectomy. Transient RLN injury was 5,3% in total of which was 4,8% after total thyroidectomy (TT), TT with compartment neck dissection were 3,6%; 5,6% and 1/5, respectively. One patient with permanent RLN injury (1,1%) due to the node is located into Berry ligament of RLN. There was a significantly increased risk of RLN injury after TT with central compartment neck dissection compared to TT with lateral compartment neck dissection (5,6% vs 3,6%, p=0,015). RLN injury was significantly higher for TT with lymph node dissection is 1,27 than the group without lymph node dissection (p=0.025). Conclusions: RLN injury rate was significantly influenced by types of thyroidectomy and with/without lymph node dissection. The rate was increased after TT with lymph node dissection, especially central compartment neck dissection. Keywords: Early differentiated thyroid cancer, Endoscopic thyroidectomy.

scholarly journals Clinical outcome of patients with differentiated thyroid cancer and raised antithyroglobulin antibody levels: a retrospective study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Manish Ora ◽  
Aftab Hasan Nazar ◽  
Prabhakar Mishra ◽  
Sukanta Barai ◽  
Amitabh Arya ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Retrospective Study ◽  
Differentiated Thyroid Cancer ◽  
Central Compartment ◽  
Cervical Lymph Nodes ◽  
Long Term Outcome ◽  
Excellent Outcome ◽  
Antithyroglobulin Antibody

Abstract Background Thyroglobulin (Tg) is a specific tumor marker for differentiated thyroid cancer (DTC). However, in the presence of an antithyroglobulin antibody (TgAb), it becomes unreliable. The purpose of the study was to assess the long-term outcome of DTC patients with raised TgAb. Method In a retrospective study, we included patients with DTC who had raised TgAb following total thyroidectomy. We excluded patients with persistently raised Tg (≥ 1 ng/ml) or radioiodine avid disease. Serial TgAb levels, excellent response (ER), incomplete response (IR), and anatomical recurrence were evaluated. Results A total of seventy-six patients were included in the study. Patients with IR had higher baseline TgAb (1071.27 ± 1216.17 vs. 99.61 ± 91.29 IU/ml, p < 0.001) and central compartment lymph node metastases (70.8% vs. 46.4%, p = 0.035) in comparison to those in the ER group. In the first follow-up, 64 (84.2%) patients had a stable or fall in the TgAb (0 to − 98.3%). Sixty-eight patients received high-dose radioiodine therapy (RIT). Out of these, 59 (86.5%) had transient, and 51 (75%) had a long-term fall in TgAb. After a follow-up period of 58.74 ± 26.26 months, 63.2% (48 out of 76) patients had IR. Nine (11.8%) patients had a rising TgAb level (3.7–170.9%) from baseline. Eleven patients underwent 18F-FDG PET/CT, and five of them demonstrated metabolically active recurrent disease. Three patients underwent cervical lymph nodes dissection. None of the patients died during the follow-up period. Conclusion High post-operative TgAb levels and central compartment lymph nodal metastases are risk factors for IR. RIT leads to a significant fall in the TgAb in these patients. The low level of raised TgAb is associated with an excellent outcome. Patients with recurrences had very high baseline TgAb > 1000 IU/ml. Raised TgAb was associated with good clinical outcomes and not associated with increased mortality.

Prophylactic Central Compartment Neck Dissection in Papillary Thyroid Cancer and Effect on Locoregional Recurrence

2018 ◽  
Vol 25 (9) ◽  
pp. 2526-2534 ◽  
Author(s):  
David T. Hughes ◽  
Jennifer E. Rosen ◽  
Douglas B. Evans ◽  
Elizabeth Grubbs ◽  
Tracy S. Wang ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Neck Dissection ◽  
Papillary Thyroid Cancer ◽  
Locoregional Recurrence ◽  
Central Compartment ◽  
Papillary Thyroid
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