Risk staging with prophylactic unilateral central neck dissection in low-risk papillary thyroid carcinoma |
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| Affiliation: | 1. Department of Anesthesia, Surgery, and Interventional Radiology, Thyroid Surgery Unit, Head and Neck Oncology Service, Gustave Roussy Cancer Campus and University Paris-Saclay, Villejuif, France;2. Department of Biology and Pathology, Gustave Roussy Cancer Campus and University Paris-Saclay, Villejuif, France;3. Department of Radiology, Gustave Roussy Cancer Campus and University Paris-Saclay, Villejuif, France;4. Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy Cancer Campus and University Paris-Saclay, Villejuif, France;1. Health Services Research Unit, Institute of Applied Health Science, University of Aberdeen, UK;2. Department of Pathology, University of Aberdeen, UK;3. Medical Statistics Team, Institute of Applied Health Science, University of Aberdeen, UK;4. Department of Surgery, University of Aberdeen, UK;1. Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China;2. Gastrointestinal Surgery Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, Hubei, China;3. Zhongshan People''s Hospital Affiliated to Guangdong Medical University, Guangdong, China;1. Division of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan;2. Division of Endocrine Surgery, Department of Surgery, Nippon Medical School, Tokyo, Japan;3. Division of Ultrasonography Examination, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan |
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| Abstract: | ObjectiveCurrent guidelines favor thyroid lobectomy for intrathyroidal cT1bT2cN0 papillary thyroid carcinoma. Prophylactic neck dissection (PND) is not recommended for these low-risk tumors due to the lack of high-level evidence on improvement in outcomes, but the information from PND may be used for staging. The aim of this study was to evaluate the rate of upstaging with ipsilateral PND.Materials and methodsRetrospective study of patients with intrathyroidal unifocal cT1bT2cN0 papillary thyroid carcinoma from 2008 to 2021. All patients underwent total thyroidectomy and PND. Tumors were classified as low or intermediate risk based on the information from pathological analysis of the primary tumor and then from adding the analysis of the lymph nodes. The difference between the tumor-only and the PND-added risk staging was evaluated.ResultsThree hundred three patients (241 women, median age 45, median tumor size 17 mm) were included. Microscopic extrathyroidal extension was found in 23.4%, aggressive histology in 6.6%, vascular invasion in 29.3%, and lymph node metastases in 37.3%. One hundred ten patients (36.3%) were intermediate-risk based on the primary tumor. An additional 26 (8.6%) were upstaged to intermediate-risk based on the ipsilateral PND and 2% based on the contralateral PND. Kaplan-Meier 10-year event-free survival in tumors upstaged with ipsilateral PND was not statistically different from intermediate-risk tumors based on the primary tumor characteristics (92% versus 90.9%, Log Rank p = 0.943).ConclusionsIpsilateral PND upstaged low-risk cT1bT2cN0 patients to intermediate risk in only 8.6% of cases, and contralateral PND in an additional 2%. Routinely performing PND may not be warranted. |
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| Keywords: | Papillary thyroid cancer Prophylactic neck dissection Risk of recurrence Lobectomy |
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