Prophylactic lymph node dissection in clinically N0 differentiated thyroid carcinoma: example of personalized treatment

2020 ◽  
Vol 17 (4) ◽  
pp. 317-338
Author(s):  
Maria V Deligiorgi ◽  
Mihalis I Panayiotidis ◽  
Dimitrios T Trafalis
Keyword(s):  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Lymph Node Dissection ◽  
Lymph Node Metastases ◽  
Differentiated Thyroid Carcinoma ◽  
Node Dissection ◽  
Main Culprit ◽  
Treatment Paradigm ◽  
Node Metastases ◽  
Prophylactic Lymph Node Dissection

Considering the ‘differentiated thyroid carcinoma (DTC) epidemic’, the indolent nature of DTC imposes a treatment paradigm shift toward elimination of recurrence. Lymph node metastases in cervical compartments, encountered in 20–90% of DTC, are the main culprit of recurrent disease, affecting 5–30% of patients. Personalized risk-stratified cervical prophylactic lymph node dissection (PLND) at initial thyroidectomy in DTC with no clinical, sonographic or intraoperative evidence of lymph node metastases (clinically N0) has been advocated, though not unanimously. The present review dissects the controversy over PLND. Weighing the benefit yielded from PLND up against the PLND-related morbidity is so far hampered by the inconsistent profit yielded by PLND and the challenging patient selection. Advances in tailoring PLND are anticipated to empower optimal patient care.

Is Prophylactic Central Compartment Lymph Node Dissection Necessary for Papillary Thyroid Carcinoma?

2010 ◽  
Vol 2 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Gerard M Doherty ◽  
Travis J McKenzie ◽  
Joseph B Lillegard ◽  
Clive S Grant ◽  
Ian D Hay ◽  
...  
Keyword(s):  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Lymph Node Dissection ◽  
Lymph Node Metastases ◽  
Central Compartment ◽  
Common Finding ◽  
Papillary Thyroid ◽  
Node Dissection ◽  
Node Metastases

ABSTRACT The need for prophylactic central compartment lymph node dissection in patients with papillary thyroid carcinoma continues to be a subject of ongoing debate. Regional lymph node metastases are a common finding with papillary thyroid carcinoma, with an incidence as high as 50% or more. With the widespread use of high resolution ultrasound and sensitive thyroglobulin assays, lymph node metastases, not appreciated at the time of surgery, are showing up in the follow-up period, creating significant angst amongst patients, endocrinologists, and their surgeons. It was previously thought that lymph node metastases in papillary thyroid carcinoma had little bearing on survival, but this has more recently been challenged. Opponents of prophylactic central compartment node dissection cite high perioperative morbidity as a word of caution in performing prophylactic central neck dissections. The following review will look at the most up-to-date literature and best evidence for arriving at logical and sensible recommendations. This review will also look at specific definitions of what is a central compartment lymph node dissection. In the hands of experienced thyroid surgeons, prophylactic central compartment lymph node dissection, performed in a meticulous manner, can limit persistent or recurrent disease in the central compartment, and can diminish the need for routine administration of radioactive iodine, with acceptable perioperative morbidit

Prophylactic Lymph Node Dissection in Papillary Thyroid Carcinoma: Is There a Place for Lateral Neck Dissection?

2013 ◽  
Vol 37 (7) ◽  
pp. 1584-1591 ◽  
Author(s):  
Romain Ducoudray ◽  
Christophe Trésallet ◽  
Gaelle Godiris-Petit ◽  
Frédérique Tissier ◽  
Laurence Leenhardt ◽  
...  
Keyword(s):  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Neck Dissection ◽  
Lymph Node Dissection ◽  
Lateral Neck ◽  
Papillary Thyroid ◽  
Node Dissection ◽  
Lateral Neck Dissection ◽  
Prophylactic Lymph Node Dissection

scholarly journals Lymph Nodes Involvement and Lymphadenectomy in Thymic Tumors: Tentative Answers for Unsolved Questions

Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5085
Author(s):  
Debora Brascia ◽  
Angela De De Palma ◽  
Marcella Schiavone ◽  
Giulia De De Iaco ◽  
Francesca Signore ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Lymph Node Metastases ◽  
Lymph Node Involvement ◽  
Postoperative Management ◽  
Anterior Mediastinum ◽  
Node Dissection ◽  
Node Metastases ◽  
Thymic Tumors

Thymic tumors are the most common primary neoplasms of the anterior mediastinum, although, when compared with the entire thoracic malignancies, they are still rare. Few studies addressed the questions about lymph node involvement pattern in thymic neoplasms, about which subgroup of patients would be appropriate candidates for lymph node dissection or about the extent of lymphadenectomy or which lymph nodes should be harvested. The aim of this review is to collect evidence from the literature to help physicians in designing the best surgical procedure when dealing with thymic malignancies. A literature review was performed through PubMed and Scopus in May 2021 to identify any study published in the last 20 years evaluating the frequency and the extent of lymph node dissection for thymic tumors, its impact on prognosis and on postoperative management. Fifteen studies met the inclusion criteria and were included in this review, with a total of 9452 patients with thymic cancers; lymph node metastases were found in 976 (10.3%) patients in total. The current literature is heterogeneous in the classification and reporting of lymph node metastases in thymic carcinoma, and data are hardly comparable. Surgical treatment should be guided by the few literature-based pieces of evidence and by the experience of the physicians.

Lymph Node Metastases of Differentiated Thyroid Carcinoma: Does Serum Anti-Tg Antibodies or TSH Level Influence Tg measurement in Fine Needle Aspiration Washouts?

2021 ◽  
Author(s):  
Sara Donato ◽  
Joana Maciel ◽  
Paula Font ◽  
Helder Simões ◽  
Susana Prazeres ◽  
...  
Keyword(s):  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Fine Needle Aspiration ◽  
Lymph Node Metastases ◽  
Needle Aspiration ◽  
Differentiated Thyroid Carcinoma ◽  
Fine Needle ◽  
Node Metastases ◽  
Group 2 ◽  
Group 1

Abstract Introduction: Thyroglobulin evaluation in the washout of fine-needle aspiration (FNA-Tg) is an accurate diagnostic method of lymph node metastases (LNM) of differentiated thyroid carcinoma (DTC). Serum anti-thyroglobulin antibodies (AATg) may cause falsely low serum Tg values, but their effect on FNA-Tg has not been well established. There are also concerns about the possibility that suppressed TSH results in false-negative FNA-Tg. Our objectives were to evaluate the effect of serum AATg and TSH level on FNA-Tg of LNM of DTC and to determine the presence of AATg on the washout of fine needle aspiration (FNA-AATg). Methods: Retrospective analysis of patients who underwent FNA-Tg assay in LNM of DTC. The sample was divided in two groups according to the presence of serum AATg at the time of FNA-Tg evaluation (Group 1: positive AATg, n =47; Group 2: negative AATg, n =50). Results: There was no significant difference in the FNA-Tg between the two groups ( p =0.066), although it was lower in Group 1 (1428 ng/mL) than in Group 2 (14842 ng/mL). FNA-Tg was able to identify 10.3% LNM of DTC that would not be diagnosed based solely on cytology. FNA-AATg evaluation was positive in 12.8% of the Group 1 patients and did not seem to interfere with FNA-Tg value ( p =0.732). There were no differences in the median FNA-Tg measurements between those on levothyroxine suppressive therapy and those on substitutive therapy ( p =0.800). Conclusion: FNA-Tg assay appears to be a good diagnostic tool even in patients with positive serum AATg and those under suppressive levothyroxine therapy.

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