Faculty Collaboration Database

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 2012 Dec;19(13):4217-22

Date

09/27/2012

Pubmed ID

23010732

DOI

10.1245/s10434-012-2594-x

Scopus ID

2-s2.0-84876502486 (requires institutional sign-in at Scopus site)   63 Citations

Abstract

BACKGROUND: Controversy exists in the management of patients with differentiated thyroid cancer (DTC). The purpose of this study was to examine the effect of prophylactic central compartment neck dissection (CCND) on serum thyroglobulin (Tg) levels and recommendations for adjuvant radioactive iodine (RAI).

METHODS: The records of 103 patients who underwent completion/total thyroidectomy for DTC between January 2009 and November 2010 were reviewed. Prophylactic CCND was defined as removal of central compartment lymph nodes with no preoperative or intraoperative evidence of lymphadenopathy. Institutional protocol included a diagnostic whole-body scan before RAI; patients with a negative scan and Tg < 2.0 did not receive adjuvant RAI.

RESULTS: Among the 103 patients, therapeutic CCND was performed in 17 (17 %) and prophylactic CCND in 49 (48 %). Of the 49 patients, 20 (41 %) had positive cervical lymph nodes. Positive lymph nodes changed American Joint Committee on Cancer tumor, node, metastasis staging in 17 patients and recommendations for RAI in 14. At a median follow-up of 21 months, there was no difference in Tg level based on the application of CCND; however, 92 % of patients with M0 disease had an undetectable Tg. One patient had recurrent DTC based on serum Tg only.

CONCLUSIONS: Prophylactic CCND resulted in detection of unsuspected metastatic lymphadenopathy in 20 (41 %) of 49 patients and changed RAI recommendations in 14 (33 %). To date, most patients have an undetectable Tg. Longer follow-up is needed to detect potential differences in recurrent disease based on the use of CCND or long-term effects of RAI.

Author List

Wang TS, Evans DB, Fareau GG, Carroll T, Yen TW

Authors

Ty Carroll MD Associate Professor in the Medicine department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Gilbert G. Fareau MD Associate Professor in the Medicine department at Medical College of Wisconsin
Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Biomarkers, Tumor
Cohort Studies
Female
Follow-Up Studies
Humans
Iodine Radioisotopes
Lymph Nodes
Lymphatic Metastasis
Male
Middle Aged
Neck Dissection
Practice Guidelines as Topic
Prognosis
Radiotherapy, Adjuvant
Thyroglobulin
Thyroid Neoplasms
Thyroidectomy
Young Adult