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| |  Some Patients Don't Require Central Neck Dissection for Node-Negative Papillary Thyroid Cancer: Presented at SSO By Mary Beth Nierengarten CHICAGO -- March 17, 2008 -- Patients with clinically node-negative papillary thyroid cancer (PTC) treated by thyroidectomy without central-neck lymph node dissection experience low recurrence rates, suggesting a need for careful evaluation of the need to prophylactically treat these nodes at initial operation, researchers reported March 17 at the Society of Surgical Oncology (SSO) 61st Annual Cancer Symposium. Recent guidelines published in 2006 by the American Thyroid Association (ATA) suggested performing an elective central-neck lymph node dissection as part of the initial operation for patients with clinically node-negative PTC. Many physicians, however, question the necessity of this elective procedure, and wonder whether this may be overtreatment for many patients. Data supporting the current ATA guidelines are relatively weak, noted lead author Rebecca S. Sippel, MD, Assistant Professor, Department of Surgery, University of Wisconsin, Madison, Wisconsin. "[The data] tend to lump all lymph nodes together, and don't distinguish between them," she said. Although the risk of lymph node recurrence after PTC is common, data on the risk of central-neck node recurrence after thyroidectomy is not well established. For that reason, Dr. Sippel and colleagues conducted their study, which retrospectively evaluated the long-term incidence of recurrence only in patients with clinically node-negative PTC treated by primary thyroidectomy at a single tertiary-care teaching hospital (n = 249). The patients were treated between 1994 and 2006. The majority of patients were female (n = 142), with a median age of 45.7 years. Mean nodule size was 1.8 cm. Most of the patients (70%) received postoperative radioactive iodine. At a mean follow-up of 36 months, only 16 of 249 patients (6.5%) had a neck lymph node recurrence, and only 7 patients (2.8%) had a central-neck lymph node recurrence. No significant differences were found in recurrence rates based on age, sex, or nodule size. According to Dr. Sippel, the low 2.8% recurrence rate in the central neck argues for the importance of evaluating the risk/benefit ratio of the elective nodal dissection. "Do we want to expose a much larger population to a potentially increased risk, for a benefit that will only be seen in a small group of patients?" she asked. Although Dr. Sippel said that some doctors have jumped onboard with the current ATA recommendations, many physicians remain skeptical. "If we operate on everybody, who will benefit?" she questioned. In older patients or those at a high risk of central-neck node recurrence, initial dissection may be added, Dr. Sippel noted, but she feels it is not needed for younger, healthier individuals at low risk. [Presentation title: Central Neck Dissection in Node Negative Papillary Thyroid Cancer: Is it Overkill or the Optimal Operation? Abstract P46]
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