title: Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment.
abstract: OBJECTIVE
  Prophylactic neck dissection for small papillary carcinoma remains controversial. Radioiodine ablation is not recommended for tumors less than 10 mm and depends on various factors for tumors between 10 and 20 mm. The aim was to determine the effect of lymph node (LN) staging on the indication for treatment with radioiodine.
  
  
  METHODS
  We conducted a retrospective study of 115 patients presenting with papillary thyroid carcinoma less than 2 cm without ultrasonographically detectable cervical LN treated by total thyroidectomy and complete selective dissection of the central and lateral compartment. Radioiodine treatment was based on definitive pathology (tumor and LN). Follow-up was based on neck ultrasound and thyroglobulin levels.
  
  
  RESULTS
  LN were found for 41.7% of cases. Radioiodine was not used for 42% of patients with tumors less than 20 mm and no metastatic LN. Fifty-eight percent of patients were treated with radioiodine due to LN metastasis, extracapsular thyroid invasion, or unfavorable histological subtype. LN status affected the indication for radioiodine in 30.5% of cases classified as T1, 12 cases with tumors less than 10 mm but with LN metastases (who received radioiodine), and 13 cases with tumors between 10 and 20 mm but without LN metastases (who did not receive radioiodine). Definitive vocal fold paralysis and hypoparathyroidism each occurred in 0.9% of cases. At 1 yr, ultrasound was normal in all patients, and recombinant human TSH-stimulated thyroglobulin was undetectable for 97% of the patients.
  
  
  CONCLUSIONS
  Precise LN staging by prophylactic neck dissection for tumors initially staged T1N0 modified the indication for radioiodine ablation for 30% of patients.
authors.affiliation: Department of Oncologic Surgery, Institut Gustave Roussy, Villejuif Cedex, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bonnet
authors.forename: Dana
authors.initials: D
authors.lastname: Hartl
authors.forename: Sophie
authors.initials: S
authors.lastname: Leboulleux
authors.forename: Eric
authors.initials: E
authors.lastname: Baudin
authors.forename: Jean D
authors.initials: JD
authors.lastname: Lumbroso
authors.forename: Abir
authors.initials: A
authors.lastname: Al Ghuzlan
authors.forename: Linda
authors.initials: L
authors.lastname: Chami
authors.forename: Martin
authors.initials: M
authors.lastname: Schlumberger
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Travagli
mesh_terms: D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D007457:Iodine Radioisotopes