Consensus Statement on the Terminology and Classification of Central Neck Dissection for Thyroid Cancer

Background: The primary goals of this interdisciplinary consensus statement are to review the relevant anatomy of the central neck compartment, to identify the nodal subgroups within the central compartment commonly involved in thyroid cancer, and to define a consistent terminology relevant to the central compartment neck dissection. Summary: The most commonly involved central lymph nodes in thyroid carcinoma are the prelaryngeal (Delphian), pretracheal, and the right and left paratracheal nodal basins. A central neck dissection includes comprehensive, compartment-oriented removal of the prelaryngeal and pretracheal nodes and at least one paratracheal lymph node basin. A designation should be made as to whether a unilateral or bilateral dissection is performed and on which side (left or right) in unilateral cases. Lymph node plucking or berry picking implies removal only of the clinically involved nodes rather than a complete nodal group within the compartment and is not recommended. A therapeutic central compartment neck dissection implies that nodal metastasis is apparent clinically (preoperatively or intraoperatively) or by imaging (clinically N1a). A prophylactic/elective central compartment dissection implies nodal metastasis is not detected clinically or by imaging (clinically N0). Conclusion: Central neck dissection at a minimum should consist of removal of the prelaryngeal, pretracheal, and paratracheal lymph nodes. The description of a central neck dissection should include both the indication (therapeutic vs. prophylactic/elective) and the extent of the dissection (unilateral or bilateral).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78103/1/thy.2009.0159.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

Proceedings and insights of the 2019 international association of endocrine surgeons symposium on surgeon well-being

[Extract] Good Morning and Welcome. As you will see from today's presentations by our esteemed international panel of endocrine surgeons, an interest in surgeon job satisfaction and quality of life (QoL) has recently proliferated worldwide. The IAES has a diverse global membership, yet health-related QoL among endocrine surgeons had not been examined. Therefore, to set the stage for today’s symposium, in 2019 we conducted a multi-institutional, IRB-approved, anonymous English language survey of IAES members that aimed to examine how practice-related and geographic factors may contribute to QoL and musculoskeletal pain. The survey had two parts: the short form 36 (SF-36), which is a widely used and extensively validated health-related QoL assessment tool [1], and an original demographic and practice-related pain questionnaire for endocrine surgeons

18F-FDG PET/CT in patients with suspected recurrent or metastatic well-differentiated thyroid cancer

PET using 18F-FDG has been shown to effectively detect various types of cancer by their increased glucose metabolism. The aim of this study was to evaluate the use of coregistered PET and CT (PET/CT) in patients with suspected thyroid cancer recurrence. Methods: After total thyroidectomy followed by radioiodine ablation, 61 consecutive patients with elevated thyroglobulin levels or a clinical suspicion of recurrent disease underwent 18F-FDG PET/CT. Of these, 59 patients had negative findings on radioiodine ( 131I) whole-body scintigraphy (WBS). Fifty-three of the 61 patients had both negative 131I WBS findings and elevated thyroglobulin levels. PET/CT images were acquired 60 min after intravenous injection of 400-610 MBq of 18F-FDG using a combined PET/CT scanner. Any increased 18F-FDG uptake was compared with the coregistered CT image to differentiate physiologic from pathologic tracer uptake. 18F-FDG PET/CT findings were correlated with the findings of histology, postradioiodine WBS, ultrasound, or clinical follow-up serving as a reference. The diagnostic accuracy of 18F-FDG PET/CT was evaluated for the entire patient group and for those patients with serum thyroglobulin levels of less than 5, 5-10, and more than 10 ng/mL. Results: Thirty patients had positive findings on 18F-FDG PET/CT; 26 were true-positive and 4 were false-positive. In 2 patients, increased 18F-FDG uptake identified a second primary malignancy. 18F-FDG PET/CT results were true-negative in 19 patients and false-negative in 12 patients. The overall sensitivity, specificity, and accuracy of 18F-FDG PET/CT were 68.4%, 82.4%, and 73.8%, respectively. The sensitivities of 18F-FDG PET/CT at serum thyroglobulin levels of less than 5, 5-10, and more than 10 ng/mL were 60%, 63%, and 72%, respectively. Clinical management changed for 27 (44%) of 61 patients, including surgery, radiation therapy, or chemotherapy. Conclusion: Coregistered 18F-FDG PET/CT can provide precise anatomic localization of recurrent or metastatic thyroid carcinoma, leading to improved diagnostic accuracy, and can guide therapeutic management. In addition, the findings of this study suggest that further assessment of 131I WBS-negative, thyroglobulin-positive patients by 18F-FDG PET/CT may aid in the clinical management of selected cases regardless of the thyroglobulin level. Copyright © 2007 by the Society of Nuclear Medicine, Inc