title: Practice patterns among thyroid cancer surgeons: implications of performing a prophylactic central neck dissection.
abstract: BACKGROUND
  Indications for performing a prophylactic central neck dissection (pCND) in papillary thyroid cancer (PTC) remain controversial. It is unclear how identification of lymph node (LN) metastases should impact the decision to treat with radioactive iodine (RAI). The goals of this study were to identify indications for performing pCND and identify factors that predict the use of adjuvant RAI.
  
  
  METHODS
  This was a population based cross-sectional analysis. A prospectively collected database identified 594 patients who underwent total thyroidectomy +/- CND. A multivariate model was constructed to identify indications for pCND and predictors of the use of RAI.
  
  
  RESULTS
  425 CNDs were performed of which 224 were prophylactic. Conventional risk factors (age, tumor size, extra-thyroidal extension) were not associated with performing a pCND. The presence of clinically suspicious lymphadenopathy was the only factor associated with performing CND, thus rendering the CND therapeutic. Positive LNs were retrieved in 39 % of pCND's, upstaging 87 patients. Among all peri-operative predictors of receiving RAI, presence of LN metastases was the strongest predictor [OR = 5.9 (3.7-9.5)], while tumor size was a modest predictor [OR = 1.8 (1.5-2.1)]. Other conventional risk factors did not predict use of adjuvant RAI.
  
  
  CONCLUSIONS
  Conventional risk factors were not indications for performing a pCND, implying that the decision was based on individual surgeon preference. Performing pCND upstaged 39 % of patients from cN0 to pN1a, increasing the likelihood of receiving RAI 6-fold. Conventional risk factors were not predictors of receiving adjuvant RAI. This highlights the need for a unified approach to performing a pCND and administering RAI.
authors: Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Red Deer Regional Hospital Center, Red Deer, Alberta, Canada.
authors: Michael W
authors: MW
authors: Deutschmann
authors: Division of General Surgery and Surgical Oncology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors: Laura
authors: L
authors: Chin-Lenn
authors: Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors: Steven C
authors: SC
authors: Nakoneshny
authors: Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.|Division of Otolaryngology-Head and Neck Surgery and Surgical Oncology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors: Joseph C
authors: JC
authors: Dort
authors: Division of General Surgery and Surgical Oncology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada.|Division of Endocrinology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors: Janice L
authors: JL
authors: Pasieka
authors: Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada. shamir.chandarana@ucalgary.ca.|Division of Otolaryngology-Head and Neck Surgery and Surgical Oncology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada. shamir.chandarana@ucalgary.ca.
authors: Shamir P
authors: SP
authors: Chandarana
mesh_terms: D002291:Carcinoma, Papillary / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008207:Lymphatic Metastasis; D008297:Male; D037981:Neck Dissection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D013965:Thyroidectomy; D047368:Tumor Burden
chemical_list: D007457:Iodine Radioisotopes
keywords: Central neck dissection; Epidemiology; Lymph node metastasis; Radioactive iodine; Thyroid cancer