title: Role of RAI in the management of incidental N1a disease in papillary thyroid cancer.
abstract: BACKGROUND
  Following total thyroidectomy (TT) for papillary thyroid cancer (PTC), pathological assessment can occasionally reveal incidental perithyroidal lymph nodes (LNs) with occult metastases. These cN0pN1a patients often receive radioactive iodine (RAI) therapy for this indication alone. The aim of this study was to determine the central compartment nodal recurrence-free survival in patients treated without RAI compared to those who received RAI treatment.
  
  
  METHODS
  An institutional database of 3664 previously untreated patients with differentiated thyroid cancer operated between 1986 and 2010 was reviewed. A total of 232 pT1-3 patients managed with TT and no neck dissection were subsequently found to have incidental level 6 LNs on pathology. Patients with other indications for RAI, such as extrathyroidal extension and close or positive margins, were excluded. One hundred and four patients remained for analysis. Kaplan-Meier method was used to determine central neck LN recurrence-free survival (RFS).
  
  
  RESULTS
  The median age of the cohort was 40 years (range 17-83). The median follow-up was 53 months (range 1-211). The median number of positive LNs removed and maximum LN diameter were 1 (range 1-8) and 5 mm (range 1-16 mm), respectively. A total of 67 (64%) patients had adjuvant RAI and 37 (36%) did not. Patients with vascular invasion (P = 0·01), LNs >2 mm (P = 0·07) and >2 positive nodes (P = 0·06) were more likely to be selected for adjuvant RAI therapy. Patients without RAI therapy had similar 5-year central neck LN RFS compared to those treated with RAI: 96·2% vs 94·6%, respectively (P = 0·92).
  
  
  CONCLUSIONS
  There is no difference in the 5-year central compartment nodal recurrence-free survival in patients treated without RAI compared to those who received RAI treatment.
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Laura Y
authors.initials: LY
authors.lastname: Wang
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Palmer
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Jocelyn C
authors.initials: JC
authors.lastname: Migliacci
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Iain J
authors.initials: IJ
authors.lastname: Nixon
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Ashok R
authors.initials: AR
authors.lastname: Shaha
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.affiliation: Department of Medicine, Endocrine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Robert Michael
authors.initials: RM
authors.lastname: Tuttle
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly