Is a Prophylactic Central Neck Dissection Required in Papillary Thyroid Carcinoma Patients with Clinical N1b Disease?

  • Background
    The 2015 American Thyroid Association (ATA) guidelines recommend considering a prophylactic central compartment neck dissection (PCND) in patients with papillary thyroid carcinoma (PTC) and clinically involved lateral neck lymph nodes (cN1b). The objective of our study was to determine the rate of central neck recurrence (CNR) in patients treated with a PCND and those that had no PCND.

    Methods
    After IRB approval, adult PTC patients with cN1b disease treated with total thyroidectomy and lateral neck dissection were identified from an institutional database of 6262 patients with well-differentiated thyroid cancer. Patients with gross extrathyroidal extension (ETE), distant metastasis at presentation, non-papillary histology and clinical central (cN1a) or unknown clinical nodal disease were excluded. Three hundred twenty-nine N1b patients were included and categorized into a non-PCND and PCND group.

    Central neck recurrence free survival (CNRFS) was calculated using Kaplan-Meier method. Unadjusted hazard ratio was determined using Cox proportional hazard model.

    Results
    One hundred eighty-five (56.2%) patients were selected to have a PCND. CNR occurred in nine PCND and three non-PCND patients. With a median follow-up of 91 months, the 5- and 10-year CNRFS was 98.9% and 95.5% in the non-PCND group and 96.5% and 93.4% in the PCND group (p=0.296).

    Conclusion
    In PTC patients with cN1b disease but no evidence of clinically involved central neck lymph nodes or gross ETE, patients selected to have no PCND had comparable rates of CNR to PCND patients.

 

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