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Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
733
Utility of intraoperative Delphian lymph node sampling in pediatric thyroid surgery
Monica S Trent1, Brooke M Su-Velez2, Gurpreet Ahuja2
1Department of Otolaryngology - Head and Neck Surgery, University of California Irvine, Orange, CA, USA.
International Journal of Pediatric Otorhinolaryngology
|October 23, 2024
Summary
Routine Delphian lymph node (DLN) sampling in pediatric thyroidectomy alters surgical plans for clinically node-negative papillary thyroid carcinoma (PTC) patients. A positive DLN accurately predicts metastasis, guiding central neck dissection (CND).
Area of Science:
- Pediatric Endocrinology
- Surgical Oncology
- Head and Neck Surgery
Background:
- The Delphian lymph node (DLN) is the initial site of thyroid cancer metastasis.
- Accurate staging is crucial for appropriate surgical management in pediatric thyroid cancer.
- The role of intraoperative DLN analysis in guiding central neck dissection (CND) in pediatric patients remains under investigation.
Purpose of the Study:
- To evaluate if routine Delphian lymph node (DLN) sampling with frozen section analysis during pediatric thyroidectomy impacts intraoperative surgical decision-making.
- To determine the predictive value of DLNs for identifying the need for central neck dissection (CND) in clinically node-negative (CNN) pediatric thyroid cancer patients.
Main Methods:
- Retrospective chart review of pediatric patients undergoing thyroidectomy between 2014 and 2022.
- Inclusion criteria: Fine Needle Aspiration (FNA) results including benign, atypia/follicular neoplasm of undetermined significance (AUS/FNUS), follicular neoplasm (FN), or papillary thyroid carcinoma (PTC).
- All patients underwent intraoperative DLN analysis using frozen section histopathology.
Main Results:
- Of 27 patients, 19 (70.4%) had papillary thyroid carcinoma (PTC) on final pathology.
- A positive DLN on frozen section had a 100% positive predictive value for central neck metastasis.
- In 90% of patients with a positive DLN, the surgical plan was altered to include CND, particularly in clinically node-negative (CNN) cases.
Conclusions:
- Delphian lymph node (DLN) sampling is valuable in guiding surgical treatment for pediatric thyroid cancer.
- A positive DLN accurately predicts central neck metastasis, enabling timely central neck dissection (CND) and potentially reducing the need for reoperation.
- While a positive DLN is highly predictive, a negative DLN does not exclude central neck disease, necessitating careful consideration of other clinical factors.
