Management Of Papillary Thyroid Cancer Research Articles

Genetic trio of BRAF and TERT alterations and rs2853669TT in papillary thyroid cancer aggressiveness.

BRAF V600E and TERT promoter alterations are core components in current genetics-based risk assessment for precision management of papillary thyroid cancer. It remains unknown whether this approach could achieve even better precision through a widely recognized prognostic single-nucleotide variation (SNV, formerly SNP), rs2853669T>C, in the TERT promoter. The genetic status of alterations and SNV were examined by sequencing genomic DNA from papillary thyroid cancer in 608 patients (427 women and 181 men) aged 47 years (interquartile range = 37-57), with a median follow-up time of 75 months (interquartile range = 36-123), and their relationship with clinical outcomes was analyzed. A luciferase reporter assay was performed to examine TERT promoter activities. TERT promoter alterations showed a strong association with papillary thyroid cancer recurrence in the presence of genotype TT of rs2853669 (adjusted hazard ratio [HR] = 2.12, 95% confidence interval [CI] = 1.10 to 4.12) but not TC/CC (adjusted HR = 1.17, 95% CI = 0.56 to 2.41). TERT and BRAF alterations commonly coexisted and synergistically promoted papillary thyroid cancer recurrence. With this genetic duet, TT of rs2853669 showed a robustly higher disease recurrence than TC/CC (adjusted HR = 14.26, 95% CI = 2.86 to 71.25). Patients with the genetic trio of BRAF V600E, TERT alteration, and TT of rs2853669 had a recurrence of 76.5% vs recurrence of 8.4% with neither variation and with TC/CC (HR = 13.48, 95% CI = 6.44 to 28.21). T allele of rs2853669 strongly increased TERT promoter activities, particularly the variant promoters. The SNV rs2853669T>C dramatically refines the prognostic power of BRAF V600E and TERT promoter alterations to a higher precision, suggesting the need for including this SNV in the current genetics-based risk prognostication of papillary thyroid cancer.

A clinically useful and biologically informative genomic classifier for papillary thyroid cancer.

Clinical management of papillary thyroid cancer depends on estimations of prognosis. Standard care, which relies on prognostication based on clinicopathologic features, is inaccurate. We applied a machine learning algorithm (HighLifeR) to 502 cases annotated by The Cancer Genome Atlas Project to derive an accurate molecular prognostic classifier. Unsupervised analysis of the 82 genes that were most closely associated with recurrence after surgery enabled the identification of three unique molecular subtypes. One subtype had a high recurrence rate, an immunosuppressed microenvironment, and enrichment of the EZH2-HOTAIR pathway. Two other unique molecular subtypes with a lower rate of recurrence were identified, including one subtype with a paucity of BRAFV600E mutations and a high rate of RAS mutations. The genomic risk classifier, in addition to tumor size and lymph node status, enabled effective prognostication that outperformed the American Thyroid Association clinical risk stratification. The genomic classifier we derived can potentially be applied preoperatively to direct clinical decision-making. Distinct biological features of molecular subtypes also have implications regarding sensitivity to radioactive iodine, EZH2 inhibitors, and immune checkpoint inhibitors.

How good is lobectomy for the Turkish population with papillary thyroid cancer? A clinicopathological evaluation.

In modern practice, there is an increasing recommendation for higher utilization of lobectomy in the management of papillary thyroid cancer (PTC). However, in this decision where the optimal balance of locoregional recurrence and complication burden should be achieved, there are still conflicting results in the literature. The aim of this study was to evaluate the effect of high-risk factors in the Turkish population with PTC on the decision of hypothetical lobectomy. In this study, 96 PTC patients undergoing total thyroidectomy were retrospectively analyzed. Preoperative and postoperative evaluation differences and the impact of high-risk factors (tumor size, multifocality, extrathyroidal extension and central lymph node metastasis) on the decision for hypothetical lobectomy were investigated. In all patients and lobectomy-eligible patients, postoperative evaluations of multifocality, contralateral multifocality, and central lymph node metastases were significantly higher than preoperative evaluations. Consequently, postoperative evaluation revealed that completion thyroidectomy would be required in 52.9% of 51 patients who were hypothetically suitable for lobectomy. Furthermore, comparisons of tumor size-based grouping in lobectomy and total thyroidectomy suitable patients showed similar high-risk factor distribution except for central lymph node metastasis for tumors <10 mm and contralateral multifocality between 11-20 mm. Completion thyroidectomy will be required in approximately half of the patients evaluated as suitable for lobectomy in the treatment of PTC in the Turkish population. In the treatment decision, in which many patient- and surgeon-related factors are influential, each patient should be considered separately.

Urban and Rural Surgical Practice Patterns for Papillary Thyroid Carcinoma.

Background: The 2015 American Thyroid Association (ATA) guidelines shifted recommendations toward less aggressive management of papillary thyroid cancer (PTC). Subsequently, several studies demonstrated a trend in performing thyroid lobectomy (TL) over total thyroidectomy (TT). However, regional variation has persisted without a clear indication of what factors may be influencing practice variation. We aimed to evaluate the surgical management of PTC in patients in rural and urban settings to assess trends of TL compared with TT following the implementation of the 2015 ATA guidelines. Methods: A retrospective cohort analysis was performed using the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2019 of patients with localized PTC <4 cm who underwent TT or TL. Patients were classified as living in urban or rural counties based on the 2013 Rural-Urban Continuum Codes. Procedures performed from 2004 to 2015 were categorized as preguidelines, while those performed from 2016 to 2019 were categorized as postguidelines. Chi-square, Student's t-test, logistic regression, and Cochran-Mantel-Haenszel test were used. Results: A total of 89,294 cases were included in the study. Eighty thousand one hundred and fifty (89.8%) were from urban settings and 9144 (9.2%) were from rural settings. Patients from rural settings were older (52 vs. 50 years, p < 0.001) and had smaller nodules (p < 0.001). On adjusted analysis, patients in rural areas were less likely to undergo TT (adjusted odds ratio 0.81, confidence interval [CI] 0.76-0.87). Before the 2015 guidelines, patients in urban settings had a 24% higher odds of undergoing TT compared with those in rural settings (odds ratio 1.24, CI 1.16-1.32, p < 0.001). There was no difference in the proportions of TT and TL based on setting following guideline implementation (p = 0.185). Conclusions: The 2015 ATA guidelines led to a change in overall practice in surgical management of PTC toward increasing TL. While urban and rural practice variation existed before 2015, both settings had an increase in TL following the guideline change, emphasizing the importance of clinical practice guidelines to ensure best practice in both rural and urban settings.

Management of papillary thyroid cancer with tracheal invasion and lung cancer: A case report.

The present study reports the case of a 64-year-old patient with papillary thyroid cancer (PTC) and tracheal invasion, along with primary lung cancer. Firstly, the patient received tumor electrocautery under tracheoscopy to enlarge the space for tracheal intubation. Next, the patient received one-stage radical thyroidectomy, with window resection of the trachea and thoracoscopic radical resection of the lung cancer. The patient was discharged safely after several days of therapy. To the best of our knowledge, this case is the first reported case of a one-stage radical thyroidectomy with a window resection of the trachea and thoracoscopic radical resection of the lung cancer in the literature. Simultaneous surgery for PTC with tracheal invasion and lung cancer is a great challenge for the patient and the surgeon. Appropriate surgical management of the tracheal invasion is of great importance to the operation and prognosis. This case may provide reference for surgeons in similar situations.

Title: Clinical utility of BRAF and pTERT mutations in precision management of Papillary thyroid cancer

Papillary thyroid cancer (PTC) is the most prevalent and indolent thyroid cancer, but still, around 20% of cases will develop regional recurrence or distant metastasis. Isolated or coexistent BRAF V600E and pTERT mutations in thyroid cancer are associated with poor clinical outcomes. The prior knowledge of BRAF V600E and pTERT mutation may help to identify the cases that may recur or become refractory to standard radioactive iodine treatment. Such cases could be treated initially with complete disease eradication through extensive surgery followed by maximum permissible high-dose radioactive I-131 ablation and vigilant follow-up. Conventional risk assessment coupled with genotype-based risk assessment can help in the precise management of aggressive thyroid cancers.

Glucose-to-Lymphocyte Ratio (GLR) as a Predictor of Preoperative Central Lymph Node Metastasis in Papillary Thyroid Cancer Patients With Type 2 Diabetes Mellitus and Construction of the Nomogram.

BackgroundDetection of metastasis of central lymph nodes in papillary thyroid cancer is difficult before surgery. The role of routine or preventive central lymph node dissection in the management of papillary thyroid cancer remains inconclusive. Moreover, glucose metabolism and systemic inflammation are related to the aggressiveness of several malignant tumors and the prognoses of these patients. This study aimed to construct a nomogram based on the readily available preoperative clinical features for predicting the occurrence of preoperative central lymph node metastasis in patients with papillary thyroid cancer and type 2 diabetes mellitus. The findings may underlie clinical implications for determining the appropriate treatment strategies for these patients.MethodsA total of 419 patients were enrolled. We used the receiver operating characteristic curves to determine the best cut-off value and converted the continuous into categorical variables. Next, a single-factor logistic analysis for the independent variables was performed, following which a multivariate regression analysis was conducted for the selected significant risk factors. Finally, the nomogram was constructed and verified using external data; the existing data were compared with the original model.ResultsAccording to the receiver operating characteristic curves, the best cut-off values ​​for glucose-to-lymphocyte ratio and tumor size were 4.23 cm and 0.95 cm, respectively. Findings from the multivariate logistic regression analysis suggested that age, bilateral tumors, maximum tumor size, and the ratio of glucose-to-lymphocytes were independent risk factors for preoperative central lymph node metastasis. The C-indexes in the training and the external validation data sets were 0.733 and 0.664, respectively. Both calibration curves and the Hosmer-Lemeshow tests indicated that the model was well-calibrated. Through decision curve analysis, the predictive model was estimated to have strong clinical applicability and greater benefits. To compare the performance of the new with that of the original model, we performed a net reclassification index and the integrated discrimination improvement analyses, both of which indicated that the new model had a better predictive ability.ConclusionIn patients with type 2 diabetes mellitus and papillary thyroid cancer, a high preoperative glucose-to-lymphocyte ratio was an independent predictor of the preoperative central lymph node metastasis. The nomogram so constructed could better predict the preoperative central lymph node metastasis in these patients.

Trends and Outcomes of Surgical Management of Primary Papillary Carcinoma in the Pediatric Population

BackgroundChildhood papillary thyroid cancer is more aggressive than carcinomas in adults. Current American Thyroid Association pediatric guidelines recommend a total or near-total thyroidectomy for all pediatric patients without gross evidence of lymph node metastases. Our objective is to analyze trends in the surgical management of pediatric papillary thyroid cancer and assess how well the guidelines are implemented. MethodsA retrospective cohort study of pediatric patients (ages 19 y and under) who underwent a thyroidectomy was conducted using the Surveillance, Epidemiology, and End Results database 2006-2017. Procedure type was classified as lobectomy or less and subtotal or total thyroidectomy. Descriptive statistics to illustrate patient and tumor characteristics as well as chi-square analysis to evaluate frequency of treatment with total thyroidectomies versus lobectomy or less were performed. Logistic regression analysis controlling for age, sex, size of tumor, rural versus urban institutions, and surgery year was conducted to identify factors predictive of procedure type. ResultsA total of 2271 children underwent surgical management of papillary thyroid cancer between 2006 and 2017. Most patients received a subtotal or total thyroidectomy as surgical management (n = 2,085, 91.8%). One hundred eighty-six patients (8.2%) received a lobectomy or less. The number of lobectomies or less increased with time, with 41 (6.6%) patients between 2006 and 2009, 98 (8.0%) between 2009 and 2015, and 47 (11.1%) between 2016 and 2017 (P = 0.03). Mortality rates were low (n = 15, 0.7%). On logistic regression analysis, later stages, larger sizes, and earlier operative years were predictive of a near-total or total thyroidectomy. ConclusionsDespite the American Thyroid Association Guidelines recommending a total thyroidectomy for pediatric well-differentiated thyroid cancer, the results of this study demonstrate that thyroid lobectomies are being performed in increasing frequency for smaller tumors in earlier stages of disease. Further investigation of whether this trend actually affects the outcomes in this patient cohort is needed.

Surgical management of papillary thyroid cancer: review of current evidence and consensus

The optimal surgical management of papillary thyroid carcinoma has been an ongoing debate. Most recommendations in clinical practice guidelines are based on large retrospective studies and expert opinion. The objective of the article is to summarize the recent evidence and main arguments related to the surgical management of papillary thyroid carcinoma. A definitive correlation between loco-regional recurrence and long-term survival and the extent of thyroid resection or lymph node dissection have not been established through randomized controlled clinical trials. Due to the low rates of recurrence and mortality associated with papillary thyroid cancer, large scale prospective randomized controlled trials that will help identify the optimal surgical management are unlikely to be available in the future as well. According to current consensus, hemithyroidectomy is sufficient for low-risk disease whereas total thyroidectomy should be performed in those with high-risk features. The place of therapeutic and prophylactic central compartment and lateral neck dissection is discussed based on evidence on short-term and long term outcomes. Furthermore, post-operative staging and dynamic risk stratification are important in determining adjuvant therapy and a follow-up plan.

Contemporary Debates in Adult Papillary Thyroid Cancer Management.

An ever-increasing population of patients with papillary thyroid cancer is engaging with health care systems around the world. Numerous questions about optimal management have arisen that challenge conventional paradigms. This is particularly the case for patients with low-risk disease, who comprise most new patients. At the same time, new therapies for patients with advanced disease are also being introduced, which may have the potential to prolong life. This review discusses selected controversial issues in adult papillary thyroid cancer management at both ends of the disease spectrum. These topics include: (i) the role of active surveillance for small papillary cancers; (ii) the extent of surgery in low-risk disease (lobectomy vs total thyroidectomy); (iii) the role of postoperative remnant ablation with radioiodine; (iv) optimal follow-up strategies in patients, especially those who have only undergone lobectomy; and (v) new therapies for advanced disease. Although our current management is hampered by the lack of large randomized controlled trials, we are fortunate that data from ongoing trials will be available within the next few years. This information should provide additional evidence that will decrease morbidity in low-risk patients and improve outcomes in those with distant metastatic disease.

Relationship between focality and cervical lymph nodes metastasis in papillary thyroid carcinoma

Background: Papillary Thyroid Cancer (PTC) is the most common malignancy in thyroid gland and may be unifocal or multifocal. This study compares between unifocal and multifocal PTC to clarify which type has an aggressive behaviour.Methods: This retrospective and prospective cross-sectional study was done on one hundred PTC patients who underwent papillary thyroid cancer management. The unifocal and multifocal groups each one contains 50 patients. The study was done in the period between January 2015 to January 2018. Other types of cancer thyroid and distant metastatic thyroid cancer were excluded from the study. All patients underwent follow up for one year.Results: There are significant differences between unifocal and multifocal PTC regarding to age, the number of positive lymph nodes, history of multinodular goiter (MNG) and capsular invasion. The capsular invasion in multifocal increase the recurrence rate (P=0.03).Conclusions: The new proposed method for PTC tumor size assessment could be a valuable in multifocal PTC patient’s stratification into low risk and high-risk subgroups. Therefore, high risk multifocal PTC patients could have a poor prognosis and high rate of recurrence, for that require aggressive treatment and strict follow up.

Impact of the American Thyroid Association guidelines on the Australian surgical management of papillary thyroid cancer.

Impact of the American Thyroid Association guidelines on the Australian surgical management of papillary thyroid cancer.

Applicability of sentinel lymph node biopsy in papillary thyroid cancer.

The optimal surgical management of papillary thyroid cancer (PTC) for T1-T2 tumors without pre or intrasurgical evidence of lymph node metastasis (cN0) remains controversial, since approximately 40% of patients have lymph node involvement (pN1) which becomes evident when a prophylactic lymphadenectomy (PL) is performed. The aim of this study was to investigate the feasibility of sentinel lymph node (SLN) identification with SPECT/CT lymphoscintigraphy imaging along with intraoperatory image techniques in early stages of PTC undergoing PL of central neck compartment (CNC). A single-center, prospective consecutive study was designed for SLN mapping in patients with high suspicion of PTC (Bethesda V or VI) in early stage (cT1-2, cN0). Twenty-four patients underwent SLN identification with preoperative SPECT/CT and planar images (99mTc-nanocolloid albumin intratumoral injection). During surgery, SLN located in CNC was found by means of a gamma probe and portable gamma camera, and excised. Afterwards, CNC lymphadenectomy was performed in all cases without modifying the established protocol. SLNs were identified and accurately located in 23 (95.8%) patients. Nodal metastases (pN1) were confirmed in 9 (37.5%) patients, with one false negative case. The sensitivity was 88.9% and negative predictive value (NPV) was 93.3%, would have allowed to avoid PL in more than half of cases, a higher proportion than those found in other similar studies. No complications associated with the procedure were observed. Our results support that SLN biopsy by SPECT/CT along with intraoperatory image techniques is applicable in early stages of PTC (cT1-2, cN0), allowing to avoid unnecessary PL.

The thyroid cancer epidemic, 2017 perspective.

Thyroid cancer incidence and mortality trends have been identified as being consistent with overdiagnosis, and several recent efforts have been made to mitigate this problem. Major guidelines for thyroid nodule management recommend against general biopsy of nodules less than 1 cm in size. Data supporting the safety of active surveillance of low-risk thyroid cancers is now recognized. Tumors previously labeled as encapsulated follicular variant papillary thyroid cancers are now recommended to be called noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Workup, diagnostic, and management of papillary thyroid cancer are changing rapidly to accommodate the recognition that many thyroid cancers are low risk and do not require aggressive, immediate intervention.

The Role of Central Neck Lymph Node Dissection in the Management of Papillary Thyroid Cancer.

Papillary thyroid cancer (PTC) is the most common thyroid malignancy, and cervical nodal metastases are frequent at presentation. The most common site for nodal metastases from PTC is the central compartment of the ipsilateral neck in the paratracheal and pretracheal regions. The decision to resect these lymph nodes at the time of thyroidectomy often depends on if nodes with suspected malignancy can be identified preoperatively. If nodal spread to the central neck nodes is known, then the consensus is to remove all nodes in this area. However, there remains significant controversy regarding the utility of removing central neck lymph nodes for prophylactic reasons. Herein, we review the potential utility of central neck lymph node dissection as well as the risks of performing this procedure. As well, we review the potential of molecular testing to stratify patients who would most benefit from this procedure. We advocate a selective approach in which patients undergo clinical neck examination coupled with ultrasound to detect any concerning lymph nodes that warrant additional evaluation with either fine needle aspiration or excisional biopsy in the operating room. In lieu of clinical lymphadenopathy, we suggest the use of patient and disease characteristics as identified by multiple groups, such as the American Thyroid Association and European Society of Endocrine Surgeons, which include extremes of ages, large primary tumor size, and male gender, when deciding to perform central neck lymph node dissection. Patients should be educated on the potential long-terms risks versus the lack of known long-term benefits.

Identification of Thyroid-Associated Serum microRNA Profiles and Their Potential Use in Thyroid Cancer Follow-Up.

Context:Trends toward more conservative management of papillary thyroid cancer (PTC) diminish the primacy of serum thyroglobulin (Tg) assays as a posttreatment surveillance tool.Objective:To identify thyroid tumor-associated microRNAs (miRNAs) in the serum with potential for development as unique biomarkers of PTC recurrence.Methods:We measured expression of 754 miRNAs in serum samples collected from 11 patients with PTC before and 30 days after thyroidectomy. Major candidates were then re-evaluated by absolute quantitative polymerase chain reaction analysis in an independent cohort of patients with PTC (n = 44) or benign nodules and 20 healthy controls (HCs). The 2 miRNAs most significantly associated with thyroid tumors were then assessed in matched serum samples (before and 30 days and 1 to 2 years after surgery) from the 20 PTC patients with complete follow-up datasets and results correlated with American Thyroid Association (ATA) responses to therapy.Results:Eight miRNAs (miR-221-3p, miR-222-3p, miR-146a-5p, miR-24-3p, miR-146b-5p, miR-191-5p, miR-103a-3p, and miR-28-3p) displayed levels in prethyroidectomy serum samples from patients with PTC that significantly exceeded those measured after thyroidectomy and those found in samples from HCs. The 2 most promising candidates—miR-146a-5p and miR-221-3p —were further analyzed in the 20 PTC patients mentioned earlier. Serum levels of both miRNAs after 1 to 2 years of follow-up were consistent with ATA responses to therapy in all patients, including 2 with structural evidence of disease whose Tg assays remained negative (<1 ng/mL).Conclusion:miR-146a-5p and miR-221-3p hold remarkable promise as serum biomarkers for post-treatment monitoring of PTC patients, especially when Tg assay results are uninformative.

The Role of Intraoperative Thyroglobuline Level of Lymph Node in the Management of Papillary Thyroid Cancer (Determination of a Cutoff Point).

Background:Some studies have shown that a preoperative high concentration of thyroglobulin (Tg) in wash out of fine-needle aspiration cytology of cervical lymph nodes mandate therapeutic lymph node dissection. However, there is disagreement about the minimum concentration of Tg which could have diagnostic value. Hence, according to our literature review, this study is the first one which designed to do intraoperatively. Therefore, this study was conducted and aimed to determine the clinical diagnostic value of Tg lymph nodes in the diagnosis of metastatic thyroid cancer.Methods:In a cross-sectional study, 65 patients with papillary thyroid carcinoma (PTC) who were thyroidectomy candidates were chosen and during surgery, before the removal of lymph nodes in the neck, fine-needle sampling was performed and the level of Tg in the samples, nature of the sample sent for biopsy and Tg levels in affected and unaffected lymph nodes were determined.Results:The mean levels of washout Tg in malignant and nonmalignant lymph nodes were 622.1 ± 66.2 and 1.38 ± 0.43 ng/ml, respectively, and the difference between the two groups was significant (P < 0.001). The Tg cut-off point for the detection of lymph node metastases was 0.7 ng/dl, and according to it, Tg washout sensitivity was 93.8%, specificity of 92.4%, false positives 7.76%, false negatives 6.3%, positive predictive value was 92.3%, and negative predictive value was 93.8% and accuracy was 93.1%.Conclusion:Based on the results, Tg level of cervical lymph nodes in patients with PTC is a suitable criterion for the diagnosis of lymph node which can be determined through fine-needle biopsy. Therefore, it is suggested that in patients with suspicion of lymph nodes involvement during surgery, fine-needle biopsy and determination of the Tg level performed.

391P Incremental value of preoperative CT in the surgical management of papillary thyroid cancer

391P Incremental value of preoperative CT in the surgical management of papillary thyroid cancer

391P Incremental value of preoperative CT in the surgical management of papillary thyroid cancer

Background Extrathyroidal extension (ETE) and Tracheal invasion (TI) are difficult to be accurately ascertained by preoperative clinical examination, especially if there is no gross invasion The aim was to evaluate the diagnostic value of USG and CT scan for preoperative prediction of the ETE and TI in patients with PTC. Methods We analyzed the medical records of 50 patients (61 surgical nodules:39 u/l, 11b/l) having PTC. Preoperative USG and CT were performed in all. ETE was categorised into 3 groups based on contact of tumor and disruption of thyroid capsule on both imaging modalities. Tracheal invasion was scored as per SHIN classification on CT scan. Considering histopathology as the gold standard diagnostic performance of pre-operative imaging for predicting ETE and TI was calculated. Results Based on HPR ETE was present in 36 (59%) and TI in 15 (24.5%). The frequency of ETE was higher in patients with greater degrees of tumor contact and disruption of capsule, as revealed by both US and CT scans (Sensitivity, specificity, NPV, PPV of 97, 83, 96, 86% and 69, 76, 76, 69%, resp. p value <0.001). US had limitation in evaluating posterior capsular ETE and hence the performance was lower than CT. A combination of US and CT findings did not increase the diagnostic performance for predicting ETE. CT had high specificity (98%) and NPV (93%) for predicting TI which otherwise was difficult to be evaluated on USG. When compared to USG CT showed significantly better diagnostic performance for ETE in tumors having > 50% capsular contact. More than 90 degree contact with trachea and associated fat plane loss between trachea and tumor is a predictor of TI. Incidence of LVI and nodal metastasis was found to be statistically higher in patients with ETEþ/-TI (p- 0.004). Conclusions Our study suggests that ETE and TI can be predicted most accurately by pre-operativeCTscansandifincludedinthediagnosticwork-upCThasthepotential tobetteroptimizethe management. • If > 1mm normalparenchymais surrounding the nodule can be demonstrated in both ofUS and CT, the possibility ofETE <10%. If the tumor measures > 1cm and has direct contact with the capsule, ETE might be present in > 80% cases. Incidence of nodal metastases and LVI is higher in presence of ETE. Legal entity responsible for the study N/A Funding N/A Disclosure All authors have declared no conflicts ofinterest.

Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients.

BackgroundLymph nodal involvement is very common in differentiated thyroid cancer, and in addition, cervical lymph node micrometastases are observed in up to 80 % of papillary thyroid cancers. During the last decades, the role of routine central lymph node dissection (RCLD) in the treatment of papillary thyroid cancer (PTC) has been an object of research, and it is now still controversial. Nevertheless, many scientific societies and referral authors have definitely stated that even if in expert hands, RCLD is not associated to higher morbidity; it should be indicated only in selected cases.Main bodyIn order to better analyze the current role of prophylactic neck dissection in the surgical treatment of papillary thyroid cancers, an analysis of the most recent literature data was performed. Prophylactic or therapeutic lymph node dissection, selective, lateral or central lymph node dissection, modified radical neck dissection, and papillary thyroid cancer were used by the authors as keywords performing a PubMed database research. Literature reviews, PTCs large clinical series and the most recent guidelines of different referral endocrine societies, inhering neck dissection for papillary thyroid cancers, were also specifically evaluated. A higher PTC incidence was nowadays reported in differentiated thyroid cancer (DTC) clinical series. In addition, ultrasound guided fine-needle aspiration citology allowed a more precocious diagnosis in the early phases of disease. The role of prophylactic neck dissection in papillary thyroid cancer management remains controversial especially regarding indications, approach, and surgical extension. Even if morbidity rates seem to be similar to those reported after total thyroidectomy alone, RCLD impact on local recurrence and long-term survival is still a matter of research. Nevertheless, only a selective use in high-risk cases is supported by more and more scientific data.ConclusionsIn the last years, higher papillary thyroid cancer incidence and more precocious diagnoses were worldwide reported. Among endocrine and neck surgeons, there is agreement about indications to prophylactic treatment of node-negative “high-risk” patients. A recent trend toward RCLD avoiding radioactive treatment is still debated, but nevertheless, prophylactic dissections in low-risk cases should be avoided. Prospective randomized trials are needed to evaluate the benefits of different approaches and allow to drawn definitive conclusions.