Background
There is controversy regarding the need for prophylactic level VI central node dissection
in patients with low-risk papillary thyroid carcinoma (PTC). This study focuses on
the incidence of persistent level VI nodal disease in low-risk PTC without prophylactic
central node dissection.
Methods
PTC was known at the time of thyroidectomy in 304 of the 761 patients who had initial
thyroid surgery from 2001 to 2007. Therapeutic level VI node dissection was performed
for suspicious or positive nodes. A prophylactic central node dissection was not done
if suspicious nodes were not identified. All patients had a high-resolution ultrasonography,
and almost all patients had a suppressed serum thyroglobulin level 4–6 months after
thyroidectomy.
Results
A total of 112 of 304 patients (37%) had a therapeutic level VI node dissection. A
prophylactic central node dissection was not performed in the remaining 192 patients.
One hundred and sixty-one of the 192 patients (84%) were low risk. Biopsy-proven persistent
disease was identified at the 4–6-month postoperative ultrasonography in only 3 of
the 161 low-risk patients (1.8%). The suppressed serum thyroglobulin level was increased
in these 3 patients and 2 additional patients.
Conclusion
Failure to perform a prophylactic central node dissection in low-risk PTC resulted
in both a very low incidence of persistent level VI nodal disease and elevated suppressed
thyroglobulin 4–6 months after thyroidectomy.
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Article info
Publication history
Accepted:
October 5,
2009
Identification
Copyright
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
