Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer.
BACKGROUND
Prophylactic central lymph node dissection with total thyroidectomy (TT) for the treatment of papillary thyroid cancer (PTC) is controversial because of the possibility of increased morbidity with uncertain benefit. The purpose of this study is to determine whether prophylactic central neck dissection provides any advantages over TT alone.


METHODS
Retrospective cohort study of patients with PTC without preoperative evidence of lymph node involvement undergoing either TT or TT with bilateral central lymph node dissection (TT + BCLND).


RESULTS
From 2002 to 2009, 143 patients with clinically node-negative PTC underwent either TT (n = 65) or TT + BCLND (n = 78). The groups were similar in age, gender, tumor size, multifocality, angioinvasion, and metastasis/age/completeness-of-resection/invasion/size score. The presence of involved central neck lymph nodes upstaged 28.6% of patients in the TT + BCLND group to stage III disease, which resulted in higher radioactive iodine ablation doses. Stimulated serum thyroglobulin levels and the number of patients with undetectable stimulated thyroglobulin levels before and 1 year after radioactive iodine ablation were equivalent.


CONCLUSIONS
The addition of routine central lymph node dissection to TT for the treatment of PTC upstages nearly one third of patients over the age of 45 thereby changing the dose of radioactive iodine ablative therapy, but does not change postoperative thyroglobulin levels after completion of radioiodine treatment.
Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA. davhughe@umich.edu
David T
DT
Hughes
Matthew L
ML
White
Barbra S
BS
Miller
Paul G
PG
Gauger
Richard E
RE
Burney
Gerard M
GM
Doherty
D000328:Adult; D002277:Carcinoma; D002291:Carcinoma, Papillary; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011184:Postoperative Period; D013954:Thyroglobulin / Q000097:blood*; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000473:pathology / Q000517:prevention & control / Q000532:radiotherapy / Q000601:surgery
D007457:Iodine Radioisotopes; D013954:Thyroglobulin