“To be, or not to be”. The place of central neck dissection in the treatment of clinically node-negative differentiated thyroid cancer patients

  • Background. The regional lymph node metastasis in differentiated thyroid cancer (DTC) is still very high: 50–60%, especially in papillary form. Averagely, after central neck lymph node dissection (CNLD), in 30–40% cases hidden metastasis in lymph nodes of VI zone of neck were revealed. But they were not indicated by preoperative diagnostic procedures: ultrasound and/or computer tomography. The main aim of this research to define the factors associated with the increased risk of lymph node metastasis for specification of indications to CNLD performance.

    Methods. The study covers 105 patients with clinical stages of DTC cT1-2N0M0, who received a thyroidectomy with prophylactic CNLD since 2012 till 2017.  One-factor dispersion analysis was used for the investigation of the quantitative signs, and a ?-square criterion was used for the qualitative ones.

    Results. The hidden metastasis are founded in 30.5% cases, multifocality is registered in 27.6% cases, lack of the tumor node capsule – in 61.9% and the thyroid gland capsule invasion – in 36.2%.  According to the multifactorial analysis reliable independent predictors of the hidden metastasis of central neck lymph nodes were thyroid anatomic capsule invasion (? = 0.003), young age of patients: ?45 y.o. (? = 0.005), nonincapsulated form of tumor (? = 0.007).

    Conclusion. The absence of nodule capsule, the patients age 45 and younger, thyroid capsule invasion are indications for thyroidectomy with CNLD. Taking into account high percentage of hidden metastasis after prophylactic CNLD, it’s necessary to continue research to detect clinically node-negative “high-risk” patients.

 

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