Abstract
Objective
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.
Materials and methods
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.
Results
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).
Conclusions
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.
Keywords
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Article info
Publication history
Published online: November 07, 2022
Accepted:
November 3,
2022
Received in revised form:
October 20,
2022
Received:
September 29,
2022
Identification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
