Prophylactic Lymph Node Dissection for Papillary Thyroid Cancer Less Than 2 cm: Implications for Radioiodine Treatment

Objective: Prophylactic neck dissection for small papillary carcinoma remains controversial. Radioiodine ablation is not recommended for tumors less than 10 mm and depends on various factors for tumors between 10 and 20 mm. The aim was to determine the effect of lymph node (LN) staging on the indica...

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Bibliographic Details
Published in:The journal of clinical endocrinology and metabolism 2009-04, Vol.94 (4), p.1162-1167
Main Authors: Bonnet, Stéphane, Hartl, Dana, Leboulleux, Sophie, Baudin, Eric, Lumbroso, Jean D, Al Ghuzlan, Abir, Chami, Linda, Schlumberger, Martin, Travagli, Jean Paul
Format: Article
Language:English
Subjects:
Biological and medical sciences
Carcinoma, Papillary - diagnostic imaging
Carcinoma, Papillary - pathology
Carcinoma, Papillary - radiotherapy
Carcinoma, Papillary - surgery
Combined Modality Therapy
Endocrinopathies
Feeding. Feeding behavior
Fundamental and applied biological sciences. Psychology
Humans
Iodine Radioisotopes - therapeutic use
Lymph Node Excision
Lymph Nodes - diagnostic imaging
Lymph Nodes - pathology
Malignant tumors
Medical sciences
Middle Aged
Neoplasm Invasiveness
Prognosis
Retrospective Studies
Thyroid Neoplasms - diagnostic imaging
Thyroid Neoplasms - pathology
Thyroid Neoplasms - radiotherapy
Thyroid Neoplasms - surgery
Thyroid. Thyroid axis (diseases)
Thyroidectomy
Treatment Outcome
Ultrasonography
Vertebrates: anatomy and physiology, studies on body, several organs or systems
Vertebrates: endocrinology
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Summary:Objective: Prophylactic neck dissection for small papillary carcinoma remains controversial. Radioiodine ablation is not recommended for tumors less than 10 mm and depends on various factors for tumors between 10 and 20 mm. The aim was to determine the effect of lymph node (LN) staging on the indication for treatment with radioiodine. Patients and Methods: We conducted a retrospective study of 115 patients presenting with papillary thyroid carcinoma less than 2 cm without ultrasonographically detectable cervical LN treated by total thyroidectomy and complete selective dissection of the central and lateral compartment. Radioiodine treatment was based on definitive pathology (tumor and LN). Follow-up was based on neck ultrasound and thyroglobulin levels. Results: LN were found for 41.7% of cases. Radioiodine was not used for 42% of patients with tumors less than 20 mm and no metastatic LN. Fifty-eight percent of patients were treated with radioiodine due to LN metastasis, extracapsular thyroid invasion, or unfavorable histological subtype. LN status affected the indication for radioiodine in 30.5% of cases classified as T1, 12 cases with tumors less than 10 mm but with LN metastases (who received radioiodine), and 13 cases with tumors between 10 and 20 mm but without LN metastases (who did not receive radioiodine). Definitive vocal fold paralysis and hypoparathyroidism each occurred in 0.9% of cases. At 1 yr, ultrasound was normal in all patients, and recombinant human TSH-stimulated thyroglobulin was undetectable for 97% of the patients. Conclusion: Precise LN staging by prophylactic neck dissection for tumors initially staged T1N0 modified the indication for radioiodine ablation for 30% of patients. Prophylactic lymph node dissection for papillary thyroid carcinoma initially staged T1N0 modified the indication for radioiodine ablation for 30% of patients.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.2008-1931