Does failure to perform prophylactic level VI node dissection leave persistent disease detectable by ultrasonography in patients with low-risk papillary carcinoma of the thyroid?
BACKGROUND
There is controversy regarding the need for prophylactic level VI central node dissection in patients with low-risk papillary thyroid carcinoma (PTC). This study focuses on the incidence of persistent level VI nodal disease in low-risk PTC without prophylactic central node dissection.


METHODS
PTC was known at the time of thyroidectomy in 304 of the 761 patients who had initial thyroid surgery from 2001 to 2007. Therapeutic level VI node dissection was performed for suspicious or positive nodes. A prophylactic central node dissection was not done if suspicious nodes were not identified. All patients had a high-resolution ultrasonography, and almost all patients had a suppressed serum thyroglobulin level 4-6 months after thyroidectomy.


RESULTS
A total of 112 of 304 patients (37%) had a therapeutic level VI node dissection. A prophylactic central node dissection was not performed in the remaining 192 patients. One hundred and sixty-one of the 192 patients (84%) were low risk. Biopsy-proven persistent disease was identified at the 4-6-month postoperative ultrasonography in only 3 of the 161 low-risk patients (1.8%). The suppressed serum thyroglobulin level was increased in these 3 patients and 2 additional patients.


CONCLUSIONS
Failure to perform a prophylactic central node dissection in low-risk PTC resulted in both a very low incidence of persistent level VI nodal disease and elevated suppressed thyroglobulin 4-6 months after thyroidectomy.
Monchik
Jack M
JM
Division of Endocrine Surgery, Rhode Island Hospital, and the Warren Alpert Medical School of Medicine of Brown University, Providence, RI 02906, USA. monchikjmm@yahoo.com
Simon
Caroline J
CJ
Caragacianu
Diana L
DL
Thomay
Alan A
AA
Tsai
Vicki
V
Cohen
Jonah
J
Mazzaglia
Peter J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D014463:Ultrasonography; D055815:Young Adult
D013954:Thyroglobulin