Prophylactic central node dissection in differentiated thyroid cancer: A prospective tertiary care center experience

Area of Science:

• Oncology
• Surgical Pathology
• Endocrinology

Background:

• Central lymph node metastasis is the most common recurrence site in differentiated thyroid cancer.
• Optimal management of these nodes remains a clinical challenge.
• Prophylactic central neck dissection (PCND) aims to address this by evaluating nodal status and reducing recurrence.

Purpose of the Study:

• To assess the morbidity associated with PCND in differentiated thyroid cancer.
• To correlate histopathological features of the primary tumor with central lymph node metastasis.
• To evaluate the role of PCND in accurate cancer staging.

Main Methods:

• A prospective, observational study of 30 patients with differentiated thyroid cancer and no prior neck surgery.
• All patients underwent total thyroidectomy with bilateral PCND.
• Surgical outcomes (hypoparathyroidism, nerve palsy) and histopathological findings were analyzed.

Main Results:

• Classical histology, tumor size >4 cm, lymphovascular invasion, and multifocality were significantly linked to increased central lymph node metastasis.
• Transient and permanent hypoparathyroidism occurred in 36.3% and 10% of patients, respectively.
• PCND led to upstaging in 35% of pT1 or T2 lesions, aiding in postoperative treatment planning.

Conclusions:

• PCND can be performed with minimal morbidity at high-volume centers.
• It plays a crucial role in accurate staging for specific patient groups (male, age >45, large tumors, etc.).
• PCND improves risk stratification and guides postoperative management for differentiated thyroid cancer.