The questions then arise: 1) Which patients are high-risk for central neck metastases? 2) In which patients will the presence of nodal disease dictate treatment? In general all patients with pathologically confirmed PTC should undergo a pre-operative investigation for metastatic lymphadenopathy. However, the thyroid can obstruct the ultrasonographic view of the central compartment. Therefore, the 2009 ATA guidelines suggest that pCND may be performed in patients with clinically-staged T3/4 PTC disease, tumor size > 4cm, or presence of extrathyroidal extension, which has been confirmed as risk factors for occult lymph node metastases in other studies. The presence of a BRAF mutation, detected preoperatively on FNA, confers a 2.8-fold increase in the risk for occult central compartment metastases. Hence, the use of molecular testing for BRAF may further improve the ability to identify patients in need of a prophylactic central neck dissection. Finally, due to the overall excellent prognosis seen with PTC, prophylactic CND is a procedure with potential for increased iatrogenic harm and questionable benefit, implying that a surgeon’s comfort level with the procedure should also be taken into consideration. Read the full article in The Laryngoscope. | ← Previous | | | Next → | Single Page
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