The Pros and Cons of Prophylactic Central Compartment Lymph Node Dissection for Papillary Thyroid Carcinoma

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78140/1/thy.2009.1578.pd

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63263/1/thy.2006.16.109.pd

American Thyroid Association Design and Feasibility of a Prospective Randomized Controlled Trial of Prophylactic Central Lymph Node Dissection for Papillary Thyroid Carcinoma

Background: The role of prophylactic central lymph node dissection in papillary thyroid cancer (PTC) is controversial in patients who have no pre- or intraoperative evidence of nodal metastasis (clinically N0; cN0). The controversy relates to its unproven role in reducing recurrence rates while possibly increasing morbidity (permanent hypoparathyroidism and unintentional recurrent laryngeal nerve injury). Methods and Results: We examined the design and feasibility of a multi-institutional prospective randomized controlled trial of prophylactic central lymph node dissection in cN0 PTC. Assuming a 7-year study with 4 years of enrollment, 5 years of average follow-up, a recurrence rate of 10% after 7 years, a 25% relative reduction in the rate of the primary endpoint (newly identified structural disease; i.e., persistent, recurrent, or distant metastatic disease) with central lymph node dissection and an annual dropout rate of 3%, a total of 5840 patients would have to be included in the study to achieve at least 80% statistical power. Similarly, given the low rates of morbidity, several thousands of patients would need to be included to identify a significant difference in rates of permanent hypoparathyroidism and unintentional recurrent laryngeal nerve injury. Conclusion: Given the low rates of both newly identified structural disease and morbidity after surgery for cN0 PTC, prohibitively large sample sizes would be required for sufficient statistical power to demonstrate significant differences in outcomes. Thus, a prospective randomized controlled trial of prophylactic central lymph node dissection in cN0 PTC is not readily feasible.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98487/1/thy%2E2011%2E0317.pd

Managing Thyroid Microcarcinomas

Papillary thyroid microcarcinomas (PTMCs) are the most common form of classic papillary thyroid carcinoma (PTC). PTMCs are typically discovered by fine-needle-aspiration biopsy (FNAB), usually with sensitive imaging studies, or are found during thyroid surgery in a patient without a previously known history of thyroid carcinoma. However, the definition of PTMC has not always been universally accepted, thus creating controversy concerning the diagnosis and treatment of PTMC. The aim of this review is to summarize the clinical features of PTMC and identify the widely differing opinions concerning the diagnosis and management of these small ubiquitous thyroid tumors