The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer

Maisie Shindo, James C. Wu, Eunice E. Park, Frances Tanzella

Research output: Contribution to journalArticle

135 Citations (Scopus)

Abstract

Objective: To determine the incidence of nodal involvement and assess the role of elective lymph node (LN) exploration and/or dissection in staging of tumors and treatment of patients with papillary thyroid cancer. Design: Retrospective medical chart review. Setting: Academic tertiary care medical center. Patients: One hundred patients diagnosed with papillary thyroid cancer by fine-needle aspiration or intraoperative frozen section who underwent total thyroidectomy with central compartment cervical LN exploration. Main Outcome Measure: Incidence of positive LNs in patients 45 years or older (group A) vs those younger than 45 years (group B). Results: Sixteen (39%) of 41 patients in group A had positive LN status following LN exploration and/or dissection. Seventeen (29%) of 59 patients in group B were found to have positive LNs. According to the American Joint Committee on Cancer staging system, the tumors of 11 patients (28%) in group A would be restaged from stage I/II to stage III after establishment of the positive pathologic nodal status. Conclusions: Lymph node metastasis was present in the central compartment in 39% of patients in group A. Presence of LN metastasis in older patients has been reported to increase the risk of recurrence of papillary thyroid carcinoma. Furthermore, recurrence and reoperation in the central compartment is associated with a higher risk of vocal cord paralysis. In patients in group A diagnosed with papillary thyroid carcinoma, routine central compartment LN exploration and/or dissection at the time of thyroidectomy is advocated, which allows more accurate staging of tumors and appropriate treatment. Elective excision of central compartment LNs in this older age group may improve locoregional control and possibly reduce morbidity in the long run.

Original languageEnglish (US)
Pages (from-to)650-654
Number of pages5
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume132
Issue number6
DOIs
StatePublished - 2006
Externally publishedYes

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Lymph Node Excision
Lymph Nodes
Neoplasm Staging
Therapeutics
Dissection
Thyroidectomy
Papillary Thyroid cancer
Neoplasm Metastasis
Recurrence
Vocal Cord Paralysis
Incidence
Frozen Sections
Fine Needle Biopsy
Reoperation
Tertiary Care Centers
Age Groups
Outcome Assessment (Health Care)
Morbidity

ASJC Scopus subject areas

  • Otorhinolaryngology

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The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer. / Shindo, Maisie; Wu, James C.; Park, Eunice E.; Tanzella, Frances.

In: Archives of Otolaryngology - Head and Neck Surgery, Vol. 132, No. 6, 2006, p. 650-654.

Research output: Contribution to journalArticle

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abstract = "Objective: To determine the incidence of nodal involvement and assess the role of elective lymph node (LN) exploration and/or dissection in staging of tumors and treatment of patients with papillary thyroid cancer. Design: Retrospective medical chart review. Setting: Academic tertiary care medical center. Patients: One hundred patients diagnosed with papillary thyroid cancer by fine-needle aspiration or intraoperative frozen section who underwent total thyroidectomy with central compartment cervical LN exploration. Main Outcome Measure: Incidence of positive LNs in patients 45 years or older (group A) vs those younger than 45 years (group B). Results: Sixteen (39{\%}) of 41 patients in group A had positive LN status following LN exploration and/or dissection. Seventeen (29{\%}) of 59 patients in group B were found to have positive LNs. According to the American Joint Committee on Cancer staging system, the tumors of 11 patients (28{\%}) in group A would be restaged from stage I/II to stage III after establishment of the positive pathologic nodal status. Conclusions: Lymph node metastasis was present in the central compartment in 39{\%} of patients in group A. Presence of LN metastasis in older patients has been reported to increase the risk of recurrence of papillary thyroid carcinoma. Furthermore, recurrence and reoperation in the central compartment is associated with a higher risk of vocal cord paralysis. In patients in group A diagnosed with papillary thyroid carcinoma, routine central compartment LN exploration and/or dissection at the time of thyroidectomy is advocated, which allows more accurate staging of tumors and appropriate treatment. Elective excision of central compartment LNs in this older age group may improve locoregional control and possibly reduce morbidity in the long run.",
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N2 - Objective: To determine the incidence of nodal involvement and assess the role of elective lymph node (LN) exploration and/or dissection in staging of tumors and treatment of patients with papillary thyroid cancer. Design: Retrospective medical chart review. Setting: Academic tertiary care medical center. Patients: One hundred patients diagnosed with papillary thyroid cancer by fine-needle aspiration or intraoperative frozen section who underwent total thyroidectomy with central compartment cervical LN exploration. Main Outcome Measure: Incidence of positive LNs in patients 45 years or older (group A) vs those younger than 45 years (group B). Results: Sixteen (39%) of 41 patients in group A had positive LN status following LN exploration and/or dissection. Seventeen (29%) of 59 patients in group B were found to have positive LNs. According to the American Joint Committee on Cancer staging system, the tumors of 11 patients (28%) in group A would be restaged from stage I/II to stage III after establishment of the positive pathologic nodal status. Conclusions: Lymph node metastasis was present in the central compartment in 39% of patients in group A. Presence of LN metastasis in older patients has been reported to increase the risk of recurrence of papillary thyroid carcinoma. Furthermore, recurrence and reoperation in the central compartment is associated with a higher risk of vocal cord paralysis. In patients in group A diagnosed with papillary thyroid carcinoma, routine central compartment LN exploration and/or dissection at the time of thyroidectomy is advocated, which allows more accurate staging of tumors and appropriate treatment. Elective excision of central compartment LNs in this older age group may improve locoregional control and possibly reduce morbidity in the long run.

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