title: Effect of prophylactic central compartment neck dissection on serum thyroglobulin and recommendations for adjuvant radioactive iodine in patients with differentiated thyroid cancer.
abstract: BACKGROUND
  Controversy exists in the management of patients with differentiated thyroid cancer (DTC). The purpose of this study was to examine the effect of prophylactic central compartment neck dissection (CCND) on serum thyroglobulin (Tg) levels and recommendations for adjuvant radioactive iodine (RAI).
  
  
  METHODS
  The records of 103 patients who underwent completion/total thyroidectomy for DTC between January 2009 and November 2010 were reviewed. Prophylactic CCND was defined as removal of central compartment lymph nodes with no preoperative or intraoperative evidence of lymphadenopathy. Institutional protocol included a diagnostic whole-body scan before RAI; patients with a negative scan and Tg < 2.0 did not receive adjuvant RAI.
  
  
  RESULTS
  Among the 103 patients, therapeutic CCND was performed in 17 (17 %) and prophylactic CCND in 49 (48 %). Of the 49 patients, 20 (41 %) had positive cervical lymph nodes. Positive lymph nodes changed American Joint Committee on Cancer tumor, node, metastasis staging in 17 patients and recommendations for RAI in 14. At a median follow-up of 21 months, there was no difference in Tg level based on the application of CCND; however, 92 % of patients with M0 disease had an undetectable Tg. One patient had recurrent DTC based on serum Tg only.
  
  
  CONCLUSIONS
  Prophylactic CCND resulted in detection of unsuspected metastatic lymphadenopathy in 20 (41 %) of 49 patients and changed RAI recommendations in 14 (33 %). To date, most patients have an undetectable Tg. Longer follow-up is needed to detect potential differences in recurrent disease based on the use of CCND or long-term effects of RAI.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. tswang@mcw.edu
authors.forename: Tracy S
authors.initials: TS
authors.lastname: Wang
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.forename: Gilbert G
authors.initials: GG
authors.lastname: Fareau
authors.forename: Ty
authors.initials: T
authors.lastname: Carroll
authors.forename: Tina W
authors.initials: TW
authors.lastname: Yen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D017410:Practice Guidelines as Topic; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D013965:Thyroidectomy; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D007457:Iodine Radioisotopes; D013954:Thyroglobulin