Papillary thyroid cancer: surgical management of lymph node metastases.
Papillary thyroid cancer (PTC), the most common thyroid malignancy, is associated with cervical lymph node metastases in 30% to 90% of patients. While surgery is the primary treatment modality for PTC, radioactive iodine and thyroid hormone suppression often complement the treatment plan. Although thyroid hormone suppression may decrease the incidence of recurrent disease and radioactive iodine may diagnose and treat metastases, lymph node dissection (LND) is the mainstay treatment for clinically evident cervical lymph node metastases. The surgical treatment options published in the literature include the traditional radical LND, the modified radical LND, the selective LND (compartment-based resection based on documented lymph node metastases), and a 'berry picking' resection (in which only the grossly abnormal lymph nodes are excised). At the University of California, San Francisco, we prefer the modified radical LND with preservation of the cervical sensory nerves for the first lymph node dissection with the 'berry picking' procedure limited to surgical treatment of recurrent nodal metastases in previously resected lymph node basins. Some centers are evaluating the potential role of sentinel lymph node biopsies for PTC. While the extent of lymphadenectomy is debated, most physicians treating patients with PTC agree that clinical evidence of lymphatic metastases should be surgically exercised and there is no role for prophylactic LND.
Caron
Nadine R
NR
University of California, San Francisco and UCSF Comprehensive Cancer Center at Mt. Zion Hospital, 1600 Divisadero Street, Hellman Bldg. Room C347, San Francisco, California 94143, USA.
Clark
Orlo H
OH
D000970:Antineoplastic Agents / Q000627:therapeutic use; D002291:Carcinoma, Papillary / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D037981:Neck Dissection / Q000379:methods; D011878:Radiotherapy; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery*
D000970:Antineoplastic Agents