The ATA has said that prophylactic neck dissection “may be performed,”
particularly in patients with T3 or T4 tumors, though dissection “may be reasonably avoided” for patients with T1 or T2 disease.3 Furthermore, the role of preoperative genetic mutational status (e.g. BRAF, RET/PTC, etc.) are also controversial Inhibitors,research,lifescience,medical at this point. Proponents of prophylactic central neck dissection cite the frequent involvement of cervical lymph nodes in thyroid cancer, in addition to the fact that preoperative imaging and the operating surgeon are frequently unable accurately to distinguish positive lymph nodes in the central compartment. In a recent study by Noguchi et al., where patients routinely underwent systematic node dissection,
80% of pathologically positive nodes in the study were found to be misjudged by the operating surgeon as being clinically negative.36,37 The removal and adequate identification of involved lymph nodes improves Inhibitors,research,lifescience,medical the accuracy of staging patients Inhibitors,research,lifescience,medical with thyroid cancer; however, this may not routinely affect management or overall survival. Lymphadenectomy is relatively safe to perform at the time of the initial operation, but re-operation, especially in the central neck compartment, is associated with an increased risk to the RLN and parathyroid glands. Additionally, it is unclear whether RAI is effective in eliminating residual disease
in the central or lateral lymph node basins. Frequently cited reasons to avoid routine lymphadenectomy include exposing patients to an unnecessary increased risk of nerve injury and hypoparathyroidism. Additionally, lymph node involvement does not appear to impact recurrence. Inhibitors,research,lifescience,medical In a series of 300 patients that did not undergo dissection, Noguchi et al. reported no recurrences.36,37 Inhibitors,research,lifescience,medical High rates of disease-free survival and overall survival are frequently observed, irrespective of dissection practices. As such, central and lateral neck dissections should generally be performed only in patients with clinically positive nodes. SUMMARY With Brefeldin_A the increasing incidence of thyroid cancer, there has been a similar increase in development and utilization of multidisciplinary tools to assist in clinical management, such as the thoroughly growth of genetic panels, incorporation of tumor biology into screening, improved diagnostic imaging, and the standardized TIRADS classification system. New controversies have emerged in surgical practice, such as the role of prophylactic neck dissection in well-differentiated thyroid cancers. While surgery next remains the center of treatment for most patients with thyroid cancer, an increasing knowledge base and experience in the multidisciplinary management of thyroid cancer will be required.