Evaluation of central compartment lymph nodes in well differentiated thyroid malignancies for metastasis

Abstract

Background: In papillary carcinomas occult nodal metastasis in central compartment is common. Central Compartment Neck Dissection (CCND) routinely in all cases of thyroid malignancies is controversial. Recurrence and revision surgery in the central compartment is associated with high risk of vocal cord paralysis and hypocalcaemia. Methods: A prospective study of 30 patients with well differentiated thyroid malignancy underwent total thyroidectomy with Central Compartment Neck Dissection. On histopathological examination the number of lymph nodes showing metastasis and extracapsular spread was documented. Results: A total of 30 patients ( 27 females and 3 males) with the age group ranging from 6 to 62 years with a mean +standard deviation of 40.49 +12.29 years. 18 (63%) patients with age < 45 years and 12 (37% ) patients with age >45 years . 19 patients in Stage I, 3 in Stage II, 7 in Stage III and 1 in Stage IV. TT+CCND [Total Thyroidectomy+ Central Compartment Neck Dissection] was done in 26 patients (86.6%) and Total Thyroidectomy+ Central Compartment Neck Dissection and Functional Neck Dissection (ipsilateral) [TT+CCND+FND] in 4 patients (13.3%). Metastasis in the Central Compartment was seen in 7 (23.3%) and transient hypocalcemia was seen in 8 patients (26.6%). There was no incidence of permanent hypocalcemia or vocal cord palsy. Conclusion: Total Thyroidectomy with Central Compartment Neck Dissection remains the treatment of choice in well differentiated thyroid cancer with an intermediate/ high risk score. An ipsilateral paratracheal clearance in N0 neck prevents chances of regional recurrence in early stages of well differentiated thyroid malignancies (T1 and T2). Transient hypocalcemia is relatively common. However permanent hypocalcemia and Vocal cord paralysis is rare. Key words: Central compartment neck dissection, Metastasis, Total thyroidectomy.