Risk staging with prophylactic unilateral central neck dissection in low-risk papillary thyroid carcinoma

医学 甲状腺癌 解剖(医学) 颈淋巴结清扫术 甲状腺 淋巴结 原发性肿瘤 回顾性队列研究 甲状腺切除术 病态的 放射科 外科 内科学 转移 癌症
作者
Dana M. Hartl,Abir Al Ghuzlan,S. Bidault,Ingrid Breuskin,Joanne Guerlain,Elizabeth Girard,Éric Baudin,Livia Lamartina,Julien Hadoux
出处
期刊:Ejso [Elsevier]
卷期号:49 (3): 568-574 被引量:2
标识
DOI:10.1016/j.ejso.2022.11.007
摘要

Current guidelines favor thyroid lobectomy for intrathyroidal cT1bT2cN0 papillary thyroid carcinoma. Prophylactic neck dissection (PND) is not recommended for these low-risk tumors due to the lack of high-level evidence on improvement in outcomes, but the information from PND may be used for staging. The aim of this study was to evaluate the rate of upstaging with ipsilateral PND.Retrospective study of patients with intrathyroidal unifocal cT1bT2cN0 papillary thyroid carcinoma from 2008 to 2021. All patients underwent total thyroidectomy and PND. Tumors were classified as low or intermediate risk based on the information from pathological analysis of the primary tumor and then from adding the analysis of the lymph nodes. The difference between the tumor-only and the PND-added risk staging was evaluated.Three hundred three patients (241 women, median age 45, median tumor size 17 mm) were included. Microscopic extrathyroidal extension was found in 23.4%, aggressive histology in 6.6%, vascular invasion in 29.3%, and lymph node metastases in 37.3%. One hundred ten patients (36.3%) were intermediate-risk based on the primary tumor. An additional 26 (8.6%) were upstaged to intermediate-risk based on the ipsilateral PND and 2% based on the contralateral PND. Kaplan-Meier 10-year event-free survival in tumors upstaged with ipsilateral PND was not statistically different from intermediate-risk tumors based on the primary tumor characteristics (92% versus 90.9%, Log Rank p = 0.943).Ipsilateral PND upstaged low-risk cT1bT2cN0 patients to intermediate risk in only 8.6% of cases, and contralateral PND in an additional 2%. Routinely performing PND may not be warranted.
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