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Impact of prophylactic central neck dissection on oncologic outcomes of papillary thyroid carcinoma: a review

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Abstract

Prophylactic neck dissection (PND) for papillary thyroid carcinoma (PTC) is controversial. Our aim was to assess current levels of evidence (LE) according to the Oxford Centre for Evidence-based Medicine (http://www.cebm.net/?O=1025) regarding the oncologic benefits of PND. Data were analyzed via MEDLINE keywords: PTC, differentiated thyroid carcinoma, PND, central lymph node metastases, central compartment, recurrence-free survival. There was conflicting evidence regarding the rate of reoperation for recurrence, with some studies showing a lower rate after PND with increased recurrence-free survival and a higher rate of undetectable pre- and post-ablation thyroglobulin levels (LE 4), whereas other studies did not show a difference (LE 4). Only one study (LE 4) showed improved disease-specific survival with PND. PND may improve recurrence-free survival, although this is supported by only a low LE. Current recommendations can only be based on low-level evidence.

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References

  1. Siegel R, DeSantis C, Virgo K et al (2012) Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 62:220–241

    Article  PubMed  Google Scholar 

  2. Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29

    Article  PubMed  Google Scholar 

  3. Podnos YD, Smith D, Wagman LD, Ellenhorn JD (2005) The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg 71:731–734

    PubMed  Google Scholar 

  4. Zaydfudim V, Feurer ID, Griffin MR, Phay JE (2008) The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery 144:1070–1077 (discussion 1077–1078)

    Article  PubMed  Google Scholar 

  5. Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214

    Article  PubMed  Google Scholar 

  6. Takami H, Ito Y, Okamoto T, Yoshida A (2011) Therapeutic strategy for differentiated thyroid carcinoma in Japan based on a newly established guideline managed by Japanese Society of Thyroid Surgeons and Japanese Association of Endocrine Surgeons. World J Surg 35:111–121

    Article  PubMed  Google Scholar 

  7. Greene (2010) American Joint Committee on Cancer. Thyroid. In AJCC Cancer Staging Manual, 7th edn, pp 87–96

  8. Randolph GW, Duh QY, Heller KS et al (2012) The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid 22:1144–1152

    Article  PubMed  Google Scholar 

  9. Zetoune T, Keutgen X, Buitrago D et al (2010) Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. Ann Surg Oncol 17:3287–3293

    Article  PubMed  Google Scholar 

  10. Barczynski M, Konturek A, Stopa M, Nowak W (2013) Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg 100:410–418

    Article  CAS  PubMed  Google Scholar 

  11. Giordano D, Valcavi R, Thompson GB et al (2012) Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid 22:911–917

    Article  PubMed  Google Scholar 

  12. Hartl DM, Mamelle E, Borget I et al (2013) Influence of prophylactic neck dissection on rate of retreatment for papillary thyroid carcinoma. World J Surg 37:1951–1958

    Article  PubMed  Google Scholar 

  13. Popadich A, Levin O, Lee JC et al (2011) A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery 150:1048–1057

    Article  PubMed  Google Scholar 

  14. Sippel RS, Chen H (2009) Controversies in the surgical management of newly diagnosed and recurrent/residual thyroid cancer. Thyroid 19:1373–1380

    Article  PubMed  Google Scholar 

  15. Carling T, Carty SE, Ciarleglio MM et al (2012) American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid 22:237–244

    Article  PubMed  Google Scholar 

  16. Moo TA, McGill J, Allendorf J et al (2010) Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg 34:1187–1191

    Article  PubMed  Google Scholar 

  17. Lang BH, Ng SH, Lau L et al (2013) A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid 23:1087–1098

    Article  PubMed  Google Scholar 

  18. Hughes DT, White ML, Miller BS et al (2010) Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery 148:1100–1106 (discussion 1006–1007)

    Article  PubMed  Google Scholar 

  19. Lang BH, Wong KP, Wan KY, Lo CY (2012) Significance of metastatic lymph node ratio on stimulated thyroglobulin levels in papillary thyroid carcinoma after prophylactic unilateral central neck dissection. Ann Surg Oncol 19:1257–1263

    Article  PubMed Central  PubMed  Google Scholar 

  20. Raffaelli M, De Crea C, Sessa L et al (2012) Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery 152:957–964

    Article  PubMed  Google Scholar 

  21. Wang TS, Evans DB, Fareau GG, Carroll T, Yen TW (2012) Effect of prophylactic central compartment neck dissection on serum thyroglobulin and recommendations for adjuvant radioactive iodine in patients with differentiated thyroid cancer. Ann Surg Oncol 19:4217–4222

    Article  PubMed  Google Scholar 

  22. Zhu W, Zhong M, Ai Z (2013) Systematic evaluation of prophylactic neck dissection for the treatment of papillary thyroid carcinoma. Jpn J Clin Oncol 43:883–888

    Article  PubMed  Google Scholar 

  23. Chan AC, Lang BH, Wong KP (2013) The pros and cons of routine central compartment neck dissection for clinically nodal negative (cN0) papillary thyroid cancer. Gland Surg 2:186–195

    PubMed Central  PubMed  Google Scholar 

  24. Bardet S, Malville E, Rame JP et al (2008) Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma. Eur J Endocrinol 158:551–560

    Article  CAS  PubMed  Google Scholar 

  25. Choi SJ, Lee TY, Lee JC et al (2008) Is routine central neck dissection necessary for the treatment of papillary thyroid microcarcinoma? Clin Exp Otorhinolaryngol 1:41–45

    Article  PubMed Central  PubMed  Google Scholar 

  26. Perrino M, Vannucchi G, Vicentini L et al (2009) Outcome predictors and impact of central node dissection and radiometabolic treatments in papillary thyroid cancers ≤2 cm. Endocr Relat Cancer 16:201–210

    Article  PubMed  Google Scholar 

  27. Costa S, Giugliano G, Santoro L et al (2009) Role of prophylactic central neck dissection in cN0 papillary thyroid cancer. Acta Otorhinolaryngol Ital 29:61–69

    PubMed Central  CAS  PubMed  Google Scholar 

  28. Wang TS, Cheung K, Farrokhyar F, Roman SA, Sosa JA (2013) A meta-analysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer. Ann Surg Oncol 20:3477–3483

    Article  PubMed  Google Scholar 

  29. Cranshaw IM, Carnaille B (2008) Micrometastases in thyroid cancer. An important finding? Surg Oncol 17:253–258

    Article  PubMed  Google Scholar 

  30. Ito Y, Tomoda C, Uruno T et al (2004) Preoperative ultrasonographic examination for lymph node metastasis: usefulness when designing lymph node dissection for papillary microcarcinoma of the thyroid. World J Surg 28:498–501

    Article  PubMed  Google Scholar 

  31. Hartl DM, Leboulleux S, Al Ghuzlan A et al (2012) Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. Ann Surg 255:777–783

    Article  PubMed  Google Scholar 

  32. Zuniga S, Sanabria A (2009) Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 135:1087–1091

    Article  PubMed  Google Scholar 

  33. Pacini F, Molinaro E, Castagna MG et al (2003) Recombinant human thyrotropin-stimulated serum thyroglobulin combined with neck ultrasonography has the highest sensitivity in monitoring differentiated thyroid carcinoma. J Clin Endocrinol Metab 88:3668–3673

    Article  CAS  PubMed  Google Scholar 

  34. Roh JL, Park JY, Park CI (2007) Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg 245:604–610

    Article  PubMed Central  PubMed  Google Scholar 

  35. So YK, Seo MY, Son YI (2012) Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications. Surgery 151:192–198

    Article  PubMed  Google Scholar 

  36. Sywak M, Cornford L, Roach P et al (2006) Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery 140:1000–1005 (discussion 1005–1007)

    Article  PubMed  Google Scholar 

  37. Brassard M, Borget I, Edet-Sanson A et al (2011) Long-term follow-up of patients with papillary and follicular thyroid cancer: a prospective study on 715 patients. J Clin Endocrinol Metab 96:1352–1359

    Article  CAS  PubMed  Google Scholar 

  38. Schlumberger M, Catargi B, Borget I et al (2012) Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med 366:1663–1673

    Article  CAS  PubMed  Google Scholar 

  39. Tuttle RM, Rondeau G, Lee NY (2011) A risk-adapted approach to the use of radioactive iodine and external beam radiation in the treatment of well-differentiated thyroid cancer. Cancer Control 18:89–95

    PubMed  Google Scholar 

  40. Gyorki DE, Untch B, Tuttle RM, Shaha AR (2013) Prophylactic central neck dissection in differentiated thyroid cancer: an assessment of the evidence. Ann Surg Oncol 20:2285–2289

    Article  PubMed  Google Scholar 

  41. Tuttle RM, Tala H, Shah J et al (2010) Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid 20:1341–1349

    Article  CAS  PubMed  Google Scholar 

  42. Glover AR, Gundara JS, Norlen O, Lee JC, Sidhu SB (2013) The pros and cons of prophylactic central neck dissection in papillary thyroid carcinoma. Gland Surg 2:196–205

    PubMed Central  PubMed  Google Scholar 

  43. Nascimento C, Borget I, Al Ghuzlan A et al (2011) Persistent disease and recurrence in differentiated thyroid cancer patients with undetectable postoperative stimulated thyroglobulin level. Endocr Relat Cancer 18:R29–R40

    CAS  PubMed  Google Scholar 

  44. Conzo G, Docimo G, Pasquali D et al (2013) Predictive value of nodal metastases on local recurrence in the management of differentiated thyroid cancer. Retrospective clinical study. BMC Surg 13(Suppl 2):S3

    Article  PubMed Central  PubMed  Google Scholar 

  45. Moreno MA, Edeiken-Monroe BS, Siegel ER, Sherman SI, Clayman GL (2012) In papillary thyroid cancer, preoperative central neck ultrasound detects only macroscopic surgical disease, but negative findings predict excellent long-term regional control and survival. Thyroid 22:347–355

    Article  PubMed Central  PubMed  Google Scholar 

  46. Shindo M, Wu JC, Park EE, Tanzella F (2006) The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer. Arch Otolaryngol Head Neck Surg 132:650–654

    Article  PubMed  Google Scholar 

  47. Wu LM, Gu HY, Qu XH et al (2012) The accuracy of ultrasonography in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma: a meta-analysis. Eur J Radiol 81:1798–1805

    Article  PubMed  Google Scholar 

  48. Choi JS, Kim J, Kwak JY et al (2009) Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol 193:871–878

    Article  PubMed  Google Scholar 

  49. Morita S, Mizoguchi K, Suzuki M, Iizuka K (2010) The accuracy of (18)[F]-fluoro-2-deoxy-d-glucose-positron emission tomography/computed tomography, ultrasonography, and enhanced computed tomography alone in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma. World J Surg 34:2564–2569

    Article  PubMed  Google Scholar 

  50. Mulla MG, Knoefel WT, Gilbert J, McGregor A, Schulte KM (2012) Lateral cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging-guided and prophylactic removal of the lateral compartment. Clin Endocrinol (Oxf) 77:126–131

    Article  Google Scholar 

  51. Roh JL, Park JY, Kim JM, Song CJ (2009) Use of preoperative ultrasonography as guidance for neck dissection in patients with papillary thyroid carcinoma. J Surg Oncol 99:28–31

    Article  PubMed  Google Scholar 

  52. Leboulleux S, Rubino C, Baudin E et al (2005) Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab 90:5723–5729

    Article  CAS  PubMed  Google Scholar 

  53. Bonnet S, Hartl D, Leboulleux S et al (2009) Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment. J Clin Endocrinol Metab 94:1162–1167

    Article  CAS  PubMed  Google Scholar 

  54. Balasubramanian SP, Harrison BJ (2011) Systematic review and meta-analysis of sentinel node biopsy in thyroid cancer. Br J Surg 98:334–344

    Article  CAS  PubMed  Google Scholar 

  55. Ito Y, Tsushima Y, Masuoka H et al (2011) Significance of prophylactic modified radical neck dissection for patients with low-risk papillary thyroid carcinoma measuring 1.1–3.0 cm: first report of a trial at Kuma Hospital. Surg Today 41:1486–1491

    Article  PubMed  Google Scholar 

  56. Eun YG, Lee YC, Kwon KH (2014) Predictive factors of contralateral paratracheal lymph node metastasis in papillary thyroid cancer: prospective multicenter study. Otolaryngol Head Neck Surg 150:210–215

    Article  PubMed  Google Scholar 

  57. Chae BJ, Jung CK, Lim DJ et al (2011) Performing contralateral central lymph node dissection in papillary thyroid carcinoma: a decision approach. Thyroid 21:873–877

    Article  PubMed  Google Scholar 

  58. Moo TA, Umunna B, Kato M et al (2009) Ipsilateral versus bilateral central neck lymph node dissection in papillary thyroid carcinoma. Ann Surg 250:403–408

    PubMed  Google Scholar 

  59. Raffaelli M, De Crea C, Sessa L et al (2013) Can intraoperative frozen section influence the extension of central neck dissection in cN0 papillary thyroid carcinoma? Langenbecks Arch Surg 398:383–388

    Article  PubMed  Google Scholar 

  60. Koo BS, Choi EC, Yoon YH et al (2009) Predictive factors for ipsilateral or contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma. Ann Surg 249:840–844

    Article  PubMed  Google Scholar 

  61. Alvarado R, Sywak MS, Delbridge L, Sidhu SB (2009) Central lymph node dissection as a secondary procedure for papillary thyroid cancer: is there added morbidity? Surgery 145:514–518

    Article  PubMed  Google Scholar 

  62. Shen WT, Ogawa L, Ruan D et al (2010) Central neck lymph node dissection for papillary thyroid cancer: comparison of complication and recurrence rates in 295 initial dissections and reoperations. Arch Surg 145:272–275

    Article  PubMed  Google Scholar 

  63. Kim WW, Park HY, Jung JH (2013) Surgical extent of central lymph node dissection in clinically node-negative papillary thyroid cancer. Head Neck 35:1616–1620

    Article  PubMed  Google Scholar 

  64. Lee YS, Lim YS, Lee JC et al (2010) Clinical implication of the number of central lymph node metastasis in papillary thyroid carcinoma: preliminary report. World J Surg 34:2558–2563

    Article  PubMed  Google Scholar 

  65. Lombardi CP, Bellantone R, De Crea C et al (2010) Papillary thyroid microcarcinoma: extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goiter area. World J Surg 34:1214–1221

    Article  PubMed  Google Scholar 

  66. So YK, Son YI, Hong SD et al (2010) Subclinical lymph node metastasis in papillary thyroid microcarcinoma: a study of 551 resections. Surgery 148:526–531

    Article  PubMed  Google Scholar 

  67. Teixeira G, Teixeira T, Gubert F, Chikota H, Tufano R (2011) The incidence of central neck micrometastatic disease in patients with papillary thyroid cancer staged preoperatively and intraoperatively as N0. Surgery 150:1161–1167

    Article  PubMed  Google Scholar 

  68. Tufano RP, Teixeira GV, Bishop J, Carson KA, Xing M (2012) BRAF mutation in papillary thyroid cancer and its value in tailoring initial treatment: a systematic review and meta-analysis. Medicine (Baltimore) 91:274–286

    Article  CAS  Google Scholar 

  69. Lang BH, Chai YJ, Cowling BJ et al (2014) Is BRAFV600E mutation a marker for central nodal metastasis in small papillary thyroid carcinoma? Endocr Relat Cancer 21:285–295

    Article  CAS  PubMed  Google Scholar 

  70. Pitoia F, Ward L, Wohllk N et al (2009) Recommendations of the Latin American Thyroid Society on diagnosis and management of differentiated thyroid cancer. Arq Bras Endocrinol Metabol 53:884–887

    Article  PubMed  Google Scholar 

  71. Sancho JJ, Lennard TW, Paunovic I, Triponez F, Sitges-Serra A (2014) Prophylactic central neck dissection in papillary thyroid cancer: a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg 399:155–163

    Article  PubMed  Google Scholar 

  72. Pacini F, Schlumberger M, Dralle H et al (2006) European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 154:787–803

    Article  CAS  PubMed  Google Scholar 

  73. (2010) Thyroid Carcinoma. 2nd edn. NCCN Guidelines, pp 1–104. Available online: http://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf. Accessed 25/8/2013

  74. Pacini F, Castagna MG, Brilli L, Pentheroudakis G; ESMO Guidelines Working Group (2012) Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl 7):vii110–vii119

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Authors and Affiliations

  1. Thyroid Surgery Unit, Department of Head and Neck Oncology, Institut Gustave Roussy, Paris-Sud University, Villejuif, France

    Elisabeth Mamelle, Haïtham Mirghani & Dana M. Hartl

  2. Biostatistics and Epidemiology Unit, Department of Clinical Research, Institut Gustave Roussy, Paris-Sud University, Villejuif, France

    Isabelle Borget

  3. Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy, Paris-Sud University, Villejuif, France

    Sophie Leboulleux

  4. Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain

    Carlos Suárez & Juan P. Rodrigo

  5. Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain

    Carlos Suárez & Juan P. Rodrigo

  6. Department of Otolaryngology-Head and Neck Surgery, Guthrie Health System, Sayre, PA, USA

    Phillip K. Pellitteri

  7. Department of Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Ashok R. Shaha

  8. Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and Cancer Center, Brussels, Belgium

    Marc Hamoir

  9. Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA

    K. Thomas Robbins

  10. Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel

    Avi Khafif

  11. Departments of Surgery and Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA

    Carl E. Silver

  12. University of Udine School of Medicine, Piazzale S. Maria della Misericordia, 33100, Udine, Italy

    Alessandra Rinaldo & Alfio Ferlito

Authors
  1. Elisabeth Mamelle
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  2. Isabelle Borget
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  3. Sophie Leboulleux
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  4. Haïtham Mirghani
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  7. Ashok R. Shaha
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  15. Dana M. Hartl
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Correspondence to Alfio Ferlito.

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This paper was written by members and invitees of the International Head and Neck Scientific Group (http://www.IHNSG.com).

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Mamelle, E., Borget, I., Leboulleux, S. et al. Impact of prophylactic central neck dissection on oncologic outcomes of papillary thyroid carcinoma: a review. Eur Arch Otorhinolaryngol 272, 1577–1586 (2015). https://doi.org/10.1007/s00405-014-3104-5

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