Observation of clinically negative central compartment lymph nodes in papillary thyroid carcinoma.
BACKGROUND
The role of prophylactic central neck dissection in the management of papillary thyroid cancer (PTC) is controversial. We report our experience of an observational approach to the cN0 neck in PTC.


METHODS
We reviewed 1,129 patients with PTC who had total thyroidectomy between 1986 and 2005. In that group, 470 patients were pN1; 384 had benign nodes removed (pN0); and the remaining 275 had no nodes removed (pNx). The pNx group formed the cohort for this study.


RESULTS
With a median follow-up of 70 months, the 10-yr disease-specific survival was 100%. We found 4 patients who had evidence of radioactive iodine uptake on scans performed during follow-up without diagnostic cytology. All subsequently received radioactive iodine and are considered disease free. Three patients had biopsy-proven lateral-neck recurrence and underwent neck dissection; 1 patient developed a low-level thyroglobulin suspicious for recurrence; and 1 patient had a subcentimeter level VI node suspicious for recurrence, which has been observed. Therefore, the rate of structural recurrence in the central neck was 0.4% (1/275), and the rate of reoperation on the central neck was 0.


CONCLUSIONS
Our results suggest that properly selected patients can be managed safely with observation of the central neck rather than prophylactic central neck dissection, which has a higher complication rate.
Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY.
Iain J
IJ
Nixon
Ian
I
Ganly
Snehal G
SG
Patel
Luc G
LG
Morris
Frank L
FL
Palmer
Dorothy
D
Thomas
R Michael
RM
Tuttle
Jatin P
JP
Shah
Ashok R
AR
Shaha
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult