title: Radio-guided selective compartment neck dissection improves staging in papillary thyroid carcinoma: a prospective study on 345 patients with a 3-year follow-up.
abstract: BACKGROUND
  Prospective uncontrolled study to investigate in papillary thyroid carcinoma (PTC) patients: (1) Distribution of lymph node metastases within the neck compartments, (2) factors predicting lymph nodes metastases, and (3) disease recurrence after thyroidectomy associated with radio-guided selective compartment neck dissection (RSCND).
  
  
  METHODS
  We studied 345 consecutive PTC patients operated on between February 2004 and October 2011 at the S. Anna University Hospital, Ferrara (Italy). Patients with cervical lymph node metastases on preoperative ultrasonography and fine needle aspiration cytology were excluded. All patients underwent total thyroidectomy associated with SLN identification followed by RSCND in the SLN compartment, without SLN frozen section.
  
  
  RESULTS
  In patients with lymph node metastases, metastatic nodes were not in the central neck compartment in 22.6% of the cases. The presence of infiltrating or multifocal PTC was a predicting factor for lymph nodes metastases. The median follow-up was 35.5 months. RSCND was associated with a false-negative rate of 1.1%, a persistent disease rate of 0.6%, and a recurrent disease rate of 0.9%. The permanent dysphonia rate was 1.3%.
  
  
  CONCLUSIONS
  RSCND associated with total thyroidectomy may improve: (1) the locoregional lymph node staging, and (2) the identification of the site of lymphatic drainage within the neck compartments. Thus, considering the high false-negative rate of sentinel lymph node biopsy (SLNB), a radio-guided technique in PTC patients may guide the lymphadenectomy (ie, RSCND) to increase the metastatic yield and improve staging of the disease rather than avoid prophylactic lymphadenectomy (ie, SLNB).
authors.affiliation: Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, S. Anna University Hospital, Ferrara, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Carcoforo
authors.affiliation: Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, S. Anna University Hospital, Ferrara, Italy. Electronic address: mattia.portinari@unife.it.
authors.forename: Mattia
authors.initials: M
authors.lastname: Portinari
authors.affiliation: Unit of Nuclear Medicine, Department of Diagnostic Imaging, S. Anna University Hospital, Ferrara, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Feggi
authors.affiliation: Unit of Nuclear Medicine, Department of Diagnostic Imaging, S. Anna University Hospital, Ferrara, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Panareo
authors.affiliation: Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, S. Anna University Hospital, Ferrara, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: De Troia
authors.affiliation: Section of Endocrinology, Department of Medical Sciences, S. Anna University Hospital, Ferrara, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Zatelli
authors.affiliation: Section of Endocrinology, Department of Medical Sciences, S. Anna University Hospital, Ferrara, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Trasforini
authors.affiliation: Section of Endocrinology, Department of Medical Sciences, S. Anna University Hospital, Ferrara, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Degli Uberti
authors.affiliation: Unit of Statistics, S. Anna University Hospital, Ferrara, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Forini
authors.affiliation: Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, S. Anna University Hospital, Ferrara, Italy.
authors.forename: Carlo V
authors.initials: CV
authors.lastname: Feo
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D005629:Frozen Sections; D006801:Humans; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009333:Neck; D037981:Neck Dissection / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome