Abstract
Cervical lymph node metastasis is frequent in patients with papillary thyroid carcinoma. In addition to the extent of thyroidectomy, the need as well as the extent of concomitant lymphadenectomy has been a subject of controversy and debate. The central compartment is the most frequent site of metastasis followed by the lateral compartment although skip metastasis in the lateral compartment can occur. Papillary thyroid carcinoma can also present with cervical lymph node metastasis, while the primary tumor remains clinically undetectable. Surgical removal of clinically involved nodal metastasis should be mandatory to prevent recurrence and improve disease prognosis. However, despite a low accuracy of preoperative imaging for microscopic disease and the frequent microscopic metastasis to the central compartment, routine prophylactic neck dissection has not been shown to have any relevance to prevent recurrence or improve disease cure. Routine or prophylactic central compartment dissection is generally not recommended unless in the presence of high-risk tumors. The potential benefit of reducing central compartment recurrence or avoiding high-risk reoperation probably outweighs the risk of inducing surgical complication including hypoparathyroidism during routine central neck dissection. Therapeutic lateral neck dissection is performed for clinically involved nodes detected by preoperative imaging confirmed by needle biopsy, while prophylactic lateral neck dissection is contraindicated. The extent of neck dissection has been de-escalated, and compartmental nodal dissection aiming at preservation of function is performed to achieve a complete surgical resection. Postoperative adjuvant radioiodine is frequently administered for patients with positive nodal metastasis (intermediate-risk group) to avoid future recurrence. Routine central neck dissection may also upstage patients with microscopic nodal metastases and increase the use of postoperative adjuvant radioiodine.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Scheumann GF, Gimm O, Wegener G, Hundeshagen H, Dralle H (1994) Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg 18:559–567
Machens A, Hinze R, Thomusch O, Dralle H (2002) Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg 26:22–28
Qubain SW, Nakano S, Baba M, Takao S, Aikou T (2002) Distribution of lymph node micrometastasis in pN0 well-differentiated thyroid carcinoma. Surgery 131:249–256
Arturi F, Russo D, Giuffrida D, Ippolito A, Perrotti N, Vigneri R, Filetti S (1997) Early diagnosis by genetic analysis of differentiated thyroid cancer metastases in small lymph nodes. J Clin Endocrinol Metab 82:1638–1641
McLeod DSA, Sawka AM, Cooper DS (2013) Controversies in primary treatment of low-risk papillary thyroid cancer. Lancet 381:1046–1057
Mazzaferri EL, Doherty GM, Steward DL (2009) The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid 19:683–689
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
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
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–13
Machens A, Holzhausen HJ, Dralle H (2004) Skip metastases in thyroid cancer leaping the central lymph node compartment. Arch Surg 139:43–45
Gimm O, Rath FW, Dralle H (1998) Pattern of lymph node metastases in papillary thyroid carcinoma. Br J Surg 85:252–254
Chen L, Wu YH, Lee CH, Chen HA, Loh EW, Tam KW (2018) Prophylactic central neck dissection for papillary thyroid carcinoma with clinically uninvolved central neck lymph nodes: a systematic review and meta-analysis. World J Surg 42:2846–2857
Viola-D MD, Valero L, Molinaro E, Agate L, Faviana P, Seccia V, Sensi E, Romei C, Piaggi P, Torregrossa L, Sellari-Franceschini S, Basolo F, Vitti P, Elisei R, Miccoli P (2015) Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. J Clin Endocrinol Metab 100:1316–1324
Ahn JH, Kwak JH, Yoon SG, Yi JW, Yu HW, Kwon H, Kim SJ, Lee KE (2022) A prospective randomized controlled trial to assess the efficacy and safety of prophylactic central compartment lymph node dissection in papillary thyroid carcinoma. Surgery 171:182–189
Hwang HS, Orloff LA (2011) Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope 121:487–491
Curtin HD, Ishwaran H, Mancuso AA, Dalley RW, Caudry DJ, McNeil BJ (1998) Comparison of CT and MR imaging in staging of neck metastases. Radiology 207:123–130
Kim E, Park JS, Son KR, Kim JH, Jeon SJ, Na DG (2008) Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography. Thyroid 18:411–418
Ahn JE, Lee JH, Yi JS, Shong YK, Hong SJ, Lee DH, Choi CG, Kim SJ (2008) Diagnostic accuracy of CT and ultrasonography for evaluating metastatic cervical lymph nodes in patients with thyroid cancer. World J Surg 32:1552–1558
Kovatch KJ, Hoban CW, Shuman AG (2018) Thyroid cancer surgery guidelines in an era of de-escalation. Eur J Surg Oncol 44(3):297–306
Mirallie E, Visset J, Sagan C, Hamy A, Le Bodic MF, Paineau J (1999) Localization of cervical node metastasis of papillary thyroid carcinoma. World J Surg 23:970–974
Musacchio MJ, Kim AW, Vijungco JD, Prinz RA (2003) Greater local recurrence occurs with “berry picking” than neck dissection in thyroid cancer. Am Surg 69:191–196
Albers MB, Nordenström E, Wohlfahrt J, Bergenfelz A, Almquist M (2020) Sentinel lymph node biopsy in thyroid cancer. World J Surg 44(1):142–147
Yu W, Cao X, Xu G, Song Y, Li G, Zheng H, Zhang N (2016) Potential role for carbon nanoparticles to guide central neck dissection in patients with papillary thyroid cancer. Surgery 160:755–761
Zhu Y, Chen X, Zhang H, Chen L, Zhou S, Wu K, Wang Z, Kong L, Zhuang H (2016) Carbon nanoparticle–guided central lymph node dissection in clinically node-negative patients with papillary thyroid carcinoma. Head Neck 38:840–845
Liu J, Xu C, Wang R, Han P, Zhao Q, Li H, Bai Y, Liu L, Zhang S, Yao X (2020) Do carbon nanoparticles really improve thyroid cancer surgery? A retrospective analysis of real-world data. World J Surg Oncol 18:84
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature
About this protocol
Cite this protocol
Lo, C.Y. (2022). Lymph Node Dissection for Papillary Thyroid Carcinoma. In: Lam, A.K. (eds) Papillary Thyroid Carcinoma. Methods in Molecular Biology, vol 2534. Humana, New York, NY. https://doi.org/10.1007/978-1-0716-2505-7_5
Download citation
DOI: https://doi.org/10.1007/978-1-0716-2505-7_5
Published:
Publisher Name: Humana, New York, NY
Print ISBN: 978-1-0716-2504-0
Online ISBN: 978-1-0716-2505-7
eBook Packages: Springer Protocols