title: The need of prophylactic central lymph node dissection is controversial in terms of postoperative thyroglobulin follow-up of patients with cN0 papillary thyroid cancer.
abstract: OBJECTIVE
  The objective of this study was to investigate whether prophylactic central lymph node dissection (pCLND) facilitates postoperative thyroglobulin (Tg) follow-up in the patients with papillary thyroid carcinoma (PTC). We also questioned whether radioactive iodine (RAI) remnant ablation provides any further advantage in this regard.
  
  
  METHODS
  The records of patients with low-intermediate risk PTC who underwent either only total thyroidectomy (TT) or TT in conjunction with pCLND were reviewed. Adjuvant RAI ablation was performed depending on tumor diameter, multifocality, the presence of positive lymph nodes and adverse histopathologic features. Pre-ablative and post-ablative Tg levels, post-operative complications and clinico-pathological characteristics were compared between the two groups (TT alone and TT with pCLND).
  
  
  RESULTS
  Among the 302 patients, TT was performed in 140 (46.4%) and TT with pCLND in 162 (53.6%). More than half of all patients in both groups had papillary microcarcinoma (58.0% and 53,1%, respectively). Postoperatively, the median preablative Tg level was higher in the TT only group than that of the TT with pCLND group (0.96 vs 0.27 ng/ml, respectively). The post-ablative Tg levels were undetectable in both groups at the last follow-up visit. Also, a subgroup of patients (19.5%) who did not receive RAI ablation all became athyroglobulinemic at one year after surgery.
  
  
  CONCLUSIONS
  Although performing pCLND with TT seems to have an advantage over TT alone as to achieve lower Tg levels in the early post-operative period, Tg levels become comparable following RAI ablation. On the other hand, the patients who have not been treated with adjuvant RAI ablation, also became athyroglobulinemic regardless of the surgical method.
authors.affiliation: Department of Otolaryngology, Yıldırım Beyazıt University Medical School, Ankara, Turkey.
authors.forename: Mehmet Hakan
authors.initials: MH
authors.lastname: Korkmaz
authors.affiliation: Department of Otolaryngology, Ministry of Health, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey. bulentname@yahoo.com.
authors.forename: Bülent
authors.initials: B
authors.lastname: Öcal
authors.affiliation: Department of Otolaryngology, Ministry of Health, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
authors.forename: Güleser
authors.initials: G
authors.lastname: Saylam
authors.affiliation: Department of Endocrinology and Metabolism, Ministry of Health, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
authors.forename: Erman
authors.initials: E
authors.lastname: Çakal
authors.affiliation: Department of Otolaryngology, Ministry of Health, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Bayır
authors.affiliation: Department of Endocrinology and Metabolism, Ministry of Health, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
authors.forename: Esra
authors.initials: E
authors.lastname: Tutal
authors.affiliation: Department of Otolaryngology, Ministry of Health, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
authors.forename: Emel Çadallı
authors.initials: EÇ
authors.lastname: Tatar
mesh_terms: D055011:Ablation Techniques; D000328:Adult; D002291:Carcinoma, Papillary / Q000097:blood / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D012189:Retrospective Studies; D013954:Thyroglobulin / Q000097:blood*; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome
chemical_list: D013954:Thyroglobulin
keywords: Follow-up; Papillary thyroid carcinoma; Prophylactic central neck dissection; Thyroglobulin