PROPHYLACTIC LYMPH NODE DISSECTION AND ITS INFLUENCE ON THE DECISION OF RADIOACTIVE IODINE TREATMENT IN CLINICALLY NODE NEGATIVE PAPILLARY THYROID CARCINOMA

Introduction: The use of prophylactic central lymph node dissection (pCLND) in the treatment of papillary thyroid carcinoma (PTC) patients is still a subject of debate and controversy. The objective of our study was to evaluate the impact of pCLND on PTC patients' risk management and identification of those who may benefit from postoperative radioiodine therapy (RAIT).
Methods: We retrospectively reviewed the medical records of 259 T1-T2, clinically node-negative PTC patients treated with total thyroidectomy and pCLND between 2015-2021. The risk factors for predicting CLNM were also analyzed.
Results: Our findings showed that several factors contribute to the risk of central lymph node metastasis in patients with papillary thyroid carcinoma. Through univariate analysis, we found that factors such as younger age, larger tumor size, multifocality, bilaterality, microscopic extrathyroidal extension, and lymphovascular invasion all contributed to the risk of central lymph node metastasis. 104 patients (40.2%) had central CLNM, with 28.8% of them being reclassified to an intermediate-risk category based on the evaluated risk factors. Furthermore, in seven patients (6.7%), the information on CLNM led to a change in the risk classification, separate from other characteristics. Finally, after adjusting for multiple variables, our study found that CLNM metastasis was an independent factor in determining the need for postoperative RAIT.
Conclusion: Our study highlights the importance of pCLND in improving the risk stratification in PTC, but this benefit must be balanced with the risk of CLND in order to avoid the cost and morbidity of neck dissection in patients without pathologic nodal disease.