Skip to main content
Log in

Extent of Surgery for Papillary Thyroid Cancer: Preoperative Imaging and Role of Prophylactic and Therapeutic Neck Dissection

  • Endocrine Tumors (O Clark and A Dackiw, Section Editors)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Papillary thyroid cancer (PTC) has an excellent prognosis, yet lymph node metastases are common. Most authors agree that central and/or lateral lymph node dissection should be undertaken in patients with abnormal lymph nodes detected on ultrasound, physical examination or intraoperative inspection. However the appropriate extent of prophylactic lymph node dissection for clinically node-negative patients remains the subject of controversy. There have been no randomized trials to date to offer guidance on this issue. The 2006 guidelines of the American Thyroid Association recommended consideration of prophylactic bilateral central lymph node dissection (CLND) for all patients undergoing thyroidectomy for PTC. However, the absence of compelling evidence for a benefit in terms of recurrence or survival, and the potential for increased morbidity, have led many, including our institution, to take an approach of selective central lymph node dissection. This approach is guided by the detection of abnormal lymph nodes on preoperative ultrasound, on physical examination, or during surgery. Postoperatively, ultrasound by an experienced ultrasonographer is the mainstay of evaluation for lymph node recurrence and is combined with monitoring of thyroglobulin and antithyroglobulin antibody levels. Reoperative lymph node dissection is typically undertaken upon detection and fine needle aspiration (FNA) of involved lymph nodes 0.8 cm or greater in size.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ries LMD, Krapcho M SEER Cancer Statistics review 1975-2004. 2006; Available from: http://sccr.cancer.gov/CSR/1975-2004.

  2. Fraker DL. Radiation exposure and other factors that predispose to human thyroid neoplasm. Surg Clin North Am. 1995;75:365–75.

    PubMed  CAS  Google Scholar 

  3. Kebebew E, et al. The prevalence and prognostic value of BRAF mutation in thyroid cancer. Ann Surg. 2007;246(3):466–70. discussion 470-1.

    Article  PubMed  Google Scholar 

  4. Hundahl SA, et al. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995 [see commetns]. Cancer. 1998;83(12):2638–48.

    Article  PubMed  CAS  Google Scholar 

  5. Lundgren CI, et al. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer. 2006;106(3):524–31.

    Article  PubMed  Google Scholar 

  6. Kim TH, et al. The association of the BRAF(V600E) mutation with prognostic factors and poor clinical outcome in papillary thyroid cancer: A Meta-Analysis. Cancer. 2011.

  7. Bilimoria KY, et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007;246(3):375–81. discussion 381-4.

    Article  PubMed  Google Scholar 

  8. Clark OH. Thyroid cancer and lymph node metastases. J Surg Oncol. 2011;103(6):615–8.

    Article  PubMed  Google Scholar 

  9. Noguchi S, Noguchi A, Murakami N. Papillary carcinoma of the thyroid. I. Developing pattern of metastasis. Cancer. 1970;26(5):1053–60.

    Article  PubMed  CAS  Google Scholar 

  10. Wada N, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003;237(3):399–407.

    PubMed  Google Scholar 

  11. Pellegriti G, et al. Clinical behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: study of 299 cases. J Clin Endocrinol Metab. 2004;89(8):3713–20.

    Article  PubMed  CAS  Google Scholar 

  12. Pereira JA, et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery. 2005;138(6):1095–100. discussion 1100-1.

    Article  PubMed  Google Scholar 

  13. Hay ID, et al. Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery. 1992;112(6):1139–46. discussion 1146-7.

    PubMed  CAS  Google Scholar 

  14. Spires JR, et al. Metastatic papillary carcinoma of the thyroid: the significance of extranodal extension. Head Neck. 1989;11(3):242–6.

    Article  PubMed  CAS  Google Scholar 

  15. Harwood J, Clark OH, Dunphy JE. Significance of lymph node metastasis in differentiated thyroid cancer. Am J Surg. 1978;136(1):107–12.

    Article  PubMed  CAS  Google Scholar 

  16. Choi JS, et al. Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol. 2009;193(3):871–8.

    Article  PubMed  Google Scholar 

  17. Stulak JM, et al. Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg. 2006;141(5):489–94. discussion 494-6.

    Article  PubMed  Google Scholar 

  18. Choi YJ, et al. Clinical and imaging assessment of cervical lymph node metastasis in papillary thyroid carcinomas. World J Surg. 2010;34(7):1494–9.

    Article  PubMed  Google Scholar 

  19. Park JS, et al. Performance of preoperative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC/UICC TNM classification system. AJR Am J Roentgenol. 2009;192(1):66–72.

    Article  PubMed  Google Scholar 

  20. Cooper, D.S., et al., Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009. 19(11): p. 1167-214.

    Article  PubMed  Google Scholar 

  21. Sywak M, et al. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery. 2006;140(6):1000–5. discussion 1005-7.

    Article  PubMed  Google Scholar 

  22. Hughes, D.T., et al., Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery, 2010. 148(6): p. 1100-6; discussion 1006-7.

    Article  PubMed  Google Scholar 

  23. Roh JL, Park JY, Park CI. 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. 2007;245(4):604–10.

    Article  PubMed  Google Scholar 

  24. Bardet S, et al. Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma. Eur J Endocrinol. 2008;158(4):551–60.

    Article  PubMed  CAS  Google Scholar 

  25. Gemsenjager E, et al. Lymph node surgery in papillary thyroid carcinoma. J Am Coll Surg. 2003;197(2):182–90.

    Article  PubMed  Google Scholar 

  26. Zetoune, T., et al., Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. Ann Surg Oncol, 2010. 17(12): p. 3287-93.

    Article  PubMed  Google Scholar 

  27. Tisell LE, et al. Improved survival of patients with papillary thyroid cancer after surgical microdissection. World J Surg. 1996;20(7):854–9.

    Article  PubMed  CAS  Google Scholar 

  28. Henry JF, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg. 1998;383(2):167–9.

    PubMed  CAS  Google Scholar 

  29. Palestini N, et al. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg. 2008;393(5):693–8.

    Article  PubMed  CAS  Google Scholar 

  30. Mazzaferri EL, Doherty GM, Steward DL. The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid. 2009;19(7):683–9.

    Article  PubMed  Google Scholar 

  31. Roh JL, Kim JM, Park CI. Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol. 2008;15(4):1177–82.

    Article  PubMed  Google Scholar 

  32. Shen WT, et al. Central neck lymph node dissection for papillary thyroid cancer: the reliability of surgeon judgment in predicting which patients will benefit. Surgery. 2010;148(2):398–403.

    Article  PubMed  Google Scholar 

  33. Forest VI, et al. Central compartment dissection in thyroid papillary carcinoma. Ann Surg. 2011;253(1):123–30.

    Article  PubMed  Google Scholar 

  34. Jonklaas J, et al. Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid. 2006;16(12):1229–42.

    Article  PubMed  Google Scholar 

  35. Sippel RS, et al. Localization of recurrent thyroid cancer using intraoperative ultrasound-guided dye injection. World J Surg. 2009;33(3):434–9.

    Article  PubMed  Google Scholar 

  36. Shen WT, et al. Central neck lymph node dissection for papillary thyroid cancer: comparison of complication and recurrence rates in 295 initial dissections and reoperations. Arch Surg. 2010;145(3):272–5.

    Article  PubMed  Google Scholar 

  37. Takami H, et al. 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. 2011;35(1):111–21.

    Article  PubMed  Google Scholar 

  38. Ito Y, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg. 2010;34(1):28–35.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robin M. Cisco MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cisco, R.M., Shen, W.T. & Gosnell, J.E. Extent of Surgery for Papillary Thyroid Cancer: Preoperative Imaging and Role of Prophylactic and Therapeutic Neck Dissection. Curr. Treat. Options in Oncol. 13, 1–10 (2012). https://doi.org/10.1007/s11864-011-0175-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-011-0175-z

Keywords

Navigation