OBJECTIVE: To investigate the clinical value of two side central compartment neck lymph node dissection for cN0 papillary thyroid carcinoma.METHODS: The clinical data of 135 patients with cN0 papillary thyroid carcinoma were studied.The central compartment neck lymph node dissection was routinely performed during radical thyroidectomy of cN0 papillary thyroid carcinoma,and the speciments were routinely send for pathological examination.RESULTS: The incidence of lynph node metastasis was 32.6%(44/135).The lymph node metastasis of same side in unilateral thyroid carcinoma was 26.4%(29/110).The lynph node metastasis of either side in unilateral thyroid carcinoma was 12.7%(14/110).Lymph node metastasis was related with age,number of tumor,whether the thyroid envelope of carcinoma have been invaded or not and micro-calcification findings in ultrasound(P0.05).There were almost no complications of recurrent larvgeal nerve injury and hypocalcaemia.CONCLUSION: It is a safe operative method to perform two side central compartment neck lymph node dissection during radical thyroidectomy of cN0 papillary thyroid carcinoma.
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Objective: To evaluate the value of the central compartment neck dissection for cN0 papillary thyroid carcinoma.Methods: The clinical data of 67 cases with cN0 papillary thyroid carcinoma were studied.The central compartment lymph node dissection was routinely performed during cN0 papillary thyroid carcinoma operation and the specimens were sent for pathological examination.Results:The lymph node metastasis incidence was 50.7% in 67 cN0 cases.The lymph node metastasis rate was related with the carcinoma invaded thyroid envelope(χ2 =8.76,P0.01) and age of 45 or more than 45 years(χ2 =4.30,P0.05) but not with the diameter of the tumors(χ2 =0.42,P0.05).There were no such complications as laryngeal nerves injury and hypocalcaemia tenancy.Conclusion: It is necessary and safe to perform central compartment neck dissection during cN0 papillary thyroid carcinoma operation.
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To discuss the role of the central lymph node dissection in the treatment of papillary thyroid carcinoma.Collect 136 patients who underwent thyroidectomy with papillary thyroid carcinoma in our hospital in 2011-2012,all are conducted with lymph node dissection in the central area as well as resection of primary lesion. Functionl lateral neck lymph node dissection were used for patients with clinical lateral neck lymph node metastasis.In 136 patients, 56. 6%(77/136) of the central lymph node metastasis were detected. Positive rate was 47. 5% in 101 cN0 patients and 82. 9% in 35 cN1 patients.In the case of not increasing risk of surgery, resection of thyroid cancer primary lesion the central lymph node at the same time is a surgical procedure to be recommended.
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Prophylactic central neck dissection (CND) in papillary thyroid carcinoma (PTC) remains controversial. If the presence of central lymph node metastasis could be assessed preoperatively or intraoperatively, unnecessary CND could be avoided. The aim of this study was to evaluate the accuracy of intraoperative determination of central lymph node metastasis by the surgeon using palpation and inspection in clinically node-negative PTC.Prospective study.University tertiary care facility.A total of 122 consecutive patients with clinically node-negative PTC were enrolled. Any suspicious lymph nodes on intraoperative palpation or inspection were sent for frozen biopsy, and then bilateral CND with total thyroidectomy was carried out in all patients. The criteria for a suspicious lymph node included palpable hardness, dark discoloration, or size exceeding 5 mm in diameter. We compared the surgeon's judgments with the final pathologic results.Suspicious lymph nodes were found in 37 (30.3%) patients, and 15 of them had metastasis on permanent biopsy. Of 85 patients with no suspicious lymph nodes, 27 (31.8%) had metastasis on permanent biopsy. The sensitivity and specificity as well as positive and negative predictive values of intraoperative determination of central lymph node metastasis were 35.7%, 72.5%, 40.5%, and 68.2%, respectively. The positive predictive values of enlarged lymph nodes, dark discoloration, and hardness were 30.4%, 50.0%, and 78.6%, respectively.Intraoperative determination of central lymph node metastasis by the surgeon is a limited guide for CND in clinically node-negative PTC because of its low sensitivity and specificity.
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ObjectiveTo investigate the value of central compartment neck lymph node dissection for papillary thyroid carcinoma of non-metastasis of neck lymph node being discovered(cN0).MethodsThe clinical data of 67 patients with cN0 papillary thyroid carcinoma from January 2006 to April 2008 were studied.The central compartment neck lymph node dissection was routinely performed during radical thyroidectomy of cN0 papillary thyroid carcinoma,and the specimens were routinely sent for pathological examination.ResultsThe incidence of lymph node metastasis was 50.7% in 67 patients with cN0 papillary thyroid carcinoma.Lymph node metastasis was related with whether or not the thyroid envelope of carcinoma have been invaded(χ2=8.76,P0.01) and with age less than,equal or more than 45 years old(χ2=4.30,P0.05),and wasn't related with diameter of carcinoma.There were no complications of recurrent laryngeal nerve injury and hypocalcaemia tenancy.ConclusionsIt is necessary and safe to perform central compartment neck lymph node dissection during radical thyroidectomy of cN0 papillary thyroid carcinoma.
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Considering the relatively good prognosis of papillary thyroid carcinoma, surgical treatment should be conducted with an adequate method and extent of surgery with minimal complications. The optimal indications and extent of central neck dissection in papillary thyroid carcinoma has been introduced by variable guidelines. However, there have been controversies in several aspects regarding central neck dissection (i.e., prophylactic versus therapeutic, unilateral versus bilateral), which will remain until a large prospective study is completed. Successful management of cervical lymph node metastasis in papillary thyroid carcinoma requires thorough preoperative evaluation, knowledge on adequate indications and extent of surgery and considerations on surgical anatomy. In this article, we reviewed the rationales for optimal central neck dissection in papillary thyroid carcinoma based on recent studies and presented the surgical strategy and skills based on personal experience of a single surgeon.
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