Ongoing discussion: Is prophylactic central neck dissection necessary in TN papillary thyroid cancer?

OBJECTIVE

To analyze the central lymph node metastasis (CLNM) rates of patients who underwent prophylactic central lymph node dissection (pCLND) with total thyroidectomy for cT1-2N0 papillary thyroid cancer in our clinic, to evaluate the conditions associated with lymph node metastasis, and to examine the necessity of pCLND in these patient groups.

METHODS

This study includes a retrospective review of the medical data of patients who underwent bilateral/unilateral central lymph node dissection (CLND) (b/uCLND) with total thyroidectomy in our center between 2013 and 2021, whose fine needle aspiration biopsy result was reported as malignant, who were detected as cT1a-1b-2N0 on thyroid and neck ultrasonography.

RESULTS

Of the 251 patients included in the study, 63 (25%) had CLNM (49 (19.5%) ipsilateral and 14 (5.5%) had contralateral CLNM). Twenty-two (20.1%) of 109 patients with cT1a, 30 (28.3%) of 106 patients with cT1b, and 11 (30.5%) of 36 patients with cT2 had CLNM, and metastasis rates increased with increasing cT category. CLNM rates increased with increasing pT category (p=0.005). CLNM was present in 21 (38.8%) of 54 patients (21.5%) with collision tumors, and metastasis rates increased significantly compared to the presence of a single histopathologic tumor (p=0.006). CLNM rates were higher in patients with multicentric tumor localization than in those with unicentric localization (p=0.006).

CONCLUSION

Multicentricity, bilaterality, capsule invasion, collision tumors and tumors larger than 1 cm increase the risk of CLNM. uCLND for tumors larger than 1 cm, bCLND for tumors larger than 2 cm can be considered. We believe that patients with unilateral CLNM also have an increased risk of contralateral metastasis.