The Effect of Surgeon Experience on the Detection of Metastatic Lymph Nodes in the Central Compartment and the Pathologic Features of Clinically Unapparent Metastatic Lymph Nodes: What Are We Missing When We Don't Perform a Prophylactic Dissection of Central Compartment Lymph Nodes in Papillary Thyroid Cancer?

Abstract

Prophylactic central neck dissection for papillary thyroid cancer is controversial. Recent publications suggest that the number and size of nodes and the presence of extranodal extension are important features for risk stratification of lymph node metastases. In this VE update, Dr. Mark Urken presents the evaluation of the effect of surgeon experience on the identification of abnormal lymph nodes.1 The rate of occult metastases, based on a senior surgeon's assessment, was 26% and did not differ significantly from a fellow/senior resident assessment. The level of agreement between these two surgeon groups was moderate (k=0.665). The clinical assessment based on intraoperative inspection and palpation had poor sensitivity and specificity in identifying metastatic central nodes, regardless of the level of experience of the surgeon. No competing financial interests exist. Running time of video: 6 mins 27 secs