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Role of RAI in the management of incidental N1a disease in papillary thyroid cancer
Author(s) -
Wang Laura Y.,
Palmer Frank L.,
Migliacci Jocelyn C.,
Nixon Iain J.,
Shaha Ashok R.,
Shah Jatin P.,
Tuttle Robert Michael,
Patel Snehal G.,
Ganly Ian
Publication year - 2016
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12828
Subject(s) - medicine , papillary thyroid cancer , thyroid cancer , neck dissection , cohort , adjuvant therapy , pathological , lymph node , gastroenterology , cancer , occult , dissection (medical) , thyroid , thyroidectomy , lymph , surgery , pathology , alternative medicine
Summary Background Following total thyroidectomy ( TT ) for papillary thyroid cancer ( PTC ), pathological assessment can occasionally reveal incidental perithyroidal lymph nodes ( LN s) with occult metastases. These cN 0pN1a patients often receive radioactive iodine ( RAI ) therapy for this indication alone . The aim of this study was to determine the central compartment nodal recurrence‐free survival in patients treated without RAI compared to those who received RAI treatment. Methods An institutional database of 3664 previously untreated patients with differentiated thyroid cancer operated between 1986 and 2010 was reviewed. A total of 232 pT 1‐3 patients managed with TT and no neck dissection were subsequently found to have incidental level 6 LN s on pathology. Patients with other indications for RAI , such as extrathyroidal extension and close or positive margins, were excluded. One hundred and four patients remained for analysis. Kaplan–Meier method was used to determine central neck LN recurrence‐free survival ( RFS ). Results The median age of the cohort was 40 years (range 17–83). The median follow‐up was 53 months (range 1–211). The median number of positive LN s removed and maximum LN diameter were 1 (range 1–8) and 5 mm (range 1–16 mm), respectively. A total of 67 (64%) patients had adjuvant RAI and 37 (36%) did not. Patients with vascular invasion ( P = 0·01), LN s >2 mm ( P = 0·07) and >2 positive nodes ( P = 0·06) were more likely to be selected for adjuvant RAI therapy. Patients without RAI therapy had similar 5‐year central neck LN RFS compared to those treated with RAI : 96·2% vs 94·6%, respectively ( P = 0·92). Conclusion There is no difference in the 5‐year central compartment nodal recurrence‐free survival in patients treated without RAI compared to those who received RAI treatment.