Controversy surrounding the role for routine central lymph node dissection for differentiated thyroid cancer

Tobias Carling, William D Long, Robert Udelsman
Current Opinion in Oncology 2010, 22 (1): 30-4

PURPOSE OF REVIEW: Differentiated thyroid cancer (DTC), with a rapidly increasing incidence is the most common endocrine malignancy, but with generally favorable survival. Total thyroidectomy with 'therapeutic' cervical lymph node dissection for involved lymph nodes is the standard of care. A more controversial topic is whether routine 'prophylactic' central lymph node dissection (CLND) in patients without evidence of lymph node metastasis should be performed in patients with DTC, as suggested by several recent management guidelines.

RECENT FINDINGS: A number of retrospective studies suggest that regional lymph node metastases are associated with tumor recurrence and adverse survival. CLND is associated with a higher rate of postoperative athyroglobulinemia and may modify the indications for radioactive iodine treatment. Current guidelines from the American Thyroid Association suggest that prophylactic CLND may be performed for papillary thyroid cancer, especially for advanced tumors (T3 and T4).

SUMMARY: Recent studies and the arguments for and against prophylactic CLND are reviewed. There is currently a trend toward more aggressive surgical therapy, including prophylactic CLND and avoidance of radioactive iodine treatment for DTC, when appropriate. Randomized prospective controlled trials are lacking at this point to determine the role of prophylactic CLND in the management of DTC.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"