OUTCOMES AND EFFECTIVENESS OF SURGICAL MANAGEMENT FOR PAPILLARY THYROID CANCER: A PROSPECTIVE STUDY
Main Article Content
Keywords
Papillary thyroid carcinoma (PTC), Thyroidectomy, Prophylactic neck dissection (PCND), metastasis.
Abstract
Papillary thyroid carcinoma (PTC) is the most prevailing thyroid cancer but remains of a favorable prognosis. Thyroidectomy with excision of all positive cervical nodes remains the cornerstone of the management of papillary thyroid carcinoma (PTC). The role for prophylactic central neck dissection (PCND) remains controversial.
Objectives: The aim of this study is to determine the optimal surgical approach for managing papillary thyroid carcinoma (PTC),specifically evaluating the effectiveness of total thyroidectomy with or without cervical lymph node dissection and investigating the role of prophylactic central neck dissection in improving patient outcomes. Study place and duration: The study was conducted at Abbasi Shaheed hospital between August 2023 and June 2024.
Methodology: A prospective non randomised open label study of 20 papillary thyroid carcinoma patients, 8 of them underwent total thyroidectomy with prophylactic central neck dissection (PCND) and 12 underwent total thyroidectomy with modified radical neck dissection. This study reported on the incidence of central lymph node metastasis in clinically node-negative (N0) patients who underwent prophylactic central neck dissection (PCND). It also analyzed the correlation between lymph node metastasis and factors such as lymphovascular invasion and capsular invasion. Additionally, the sensitivity of fine-needle aspiration cytology in diagnosing papillary thyroid carcinoma (PTC) was evaluated.
Results: Occult central lymph node metastasis was observed in 62.5% of papillary thyroid carcinoma (PTC) lesions. The FNAC showed a sensitivity of 85%. Lympho-vascular permeation and capsular invasion showed a sensitivity of 94.12% and 58.82% respectively for lymph nodes metastasis. Thyroiditis is detected in 50% of cases with papillary thyroid carcinoma (PTC). Conclusions: The study concluded that resection is mandatory to cure papillary thyroid carcinoma .Prophylactic central neck dissection remains a debatable issue that needs a large multicentre study with large sample of patients with long term follow up to ascertain the efficacy of PCND in reducing rate of local recurrence, morbidity and mortality.
References
2. Ito Y, Miyauchi A, Kihara M, Fukushima M, Higashiyama T, Miya A. Overall Survival of Papillary Thyroid Carcinoma Patients:A Single- Institution Long-Term Follow-Up of 5897 Patients. World J Surg. 2018;42:615-22.
3. National comprehensive cancer network (NCCN) guidelines version 2, 2021. Thyroid carcinoma- papillary carcinoma. Available at: https://www.nccn.org/professionals/physcian_gls/pdf /thyroid.pdf. Accessed on 05 March 2021.
4. Conzo G, Tartaglia E, Avenia N, Calò PG, De Bellis A, Esposito K et al. Role of prophylactic central compartment lymph node dissection in clinically N0differentiated thyroid cancer patients: analysis of risk factors and review of modern trends. World J Surg Oncol. 2016;14:149.
5. Attard A, Paladino NC, Lo Monte AI, Falco N, Melfa G, Rotolo G et al. Skip metastases to lateral cervical lymph nodes in differentiated thyroid cancer: a systematic review. BMC Surg. 2019;18(1):112.
6. Haugen BR, Alexander EK, Bible KC, Doherty GM. American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133.
7. Lorenz K, Schneider R, Elwerr M. Thyroid Carcinoma: Do We Need to Treat Men and Women Differently. Visc Med. 2020;36:10-3.
8. Brito JP, Yarur AJ, Prokop LJ, McIver B, Murad MH, Montori VM. Prevalence of Thyroid Cancer in Multinodular Goiter versus Single Nodule: A Systematic Review and Meta-Analysis. THYROID. 2013;23(4):449-55.
9. Li G, Lei J, You J, Jiang K, Li Z. Independent predictors and lymph node metastasis characteristics of multifocal papillary thyroid cancer. Medicine. 2018;97:5(e9619).
10. Hajmanoochehri F, Rabiee E. FNAC accuracy in diagnosis of thyroid neoplasms considering all diagnostic categories of the Bethesda reporting system: A single-institute experience. J Cytol. 2015;32(4):238-43.
11. Lai X, Xia Y, Zhang B, Li J, Jiang Y. A meta- analysis of Hashimoto’s thyroiditis and papillary thyroid carcinoma risk. Oncotarget. 2017;8(37):62414-24.
12. Albuja-Cruz MB, Thorson CM, Allan BJ, Lew JI, Rodgers SE. Number of lymph nodes removed during modified radical neck dissection for papillary thyroid cancer does not influence lateral neck recurrence. Surgery. 2012;152:1177-83.
13. Atakan A, Celik M, Bulbul BY, Can N, Tastekin E, Ayturk S et al. Relationship between lymphovascular invasion and clinicopathological features of papillary thyroid carcinoma. Bosn J Basic Med Sci. 2017;17(2):144-51.
14. Mao J, Zhang Q, Zhang H, Zheng K, Wang R, Wang G. Risk Factors for Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. Frontiers in Endocrinol. 2020;11:265.
15. Sun W, Lan X, Zhang H, Dong W, Wang Z, He L et al. Risk Factors for Central Lymph Node Metastasis in CN0 Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. PLoS ONE. 2015;10:e0139021.
16. Lie-Hao J, Chen C, Tan Z. Clinical Characteristics Related to Central Lymph Node Metastasis in cN0 Papillary Thyroid Carcinoma: A Retrospective Study of 916 Patients. Int J Endocrinol. 2014;385787:6.
17. Andresen NS, Buatti JM, Tewfik HH, Pagedar NA, Anderson CM, Watkins JM. Radioiodine Ablation following Thyroidectomy for Differentiated Thyroid Cancer: Literature Review of Utility, Dose, and Toxicity. Eur Thyroid J. 2017;6:187-96.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Muhammad Aijaz
House Officer, Abbasi Shaheed Hospital, Karachi, Pakistan.
Jetha Yogal Kumar
House Officer, Abbasi Shaheed Hospital, Karachi, Pakistan.
Simran
House Officer, Dow University Hospital, Karachi, Pakistan.
Shafein Jatoi
House Officer, Abbasi Shaheed Hospital, Karachi, Pakistan.
Muhammad Wassam
Year MBBS Student, Al Tibri Medical College, Isra University, Karachi, Pakistan.
Hafiz Waqas Ahmed
Consultant General Surgery, Al Tibri Medical College and Hospital, Karachi, Pakistan.
Neha Kumari
MBBS Student, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Yokta Mukhi
MBBS Student, Al Tibri Medical College, Isra University, Karachi, Pakistan