Extent of Neck Dissection in Cases of Differentiated Thyroid Carcinoma

Papillary thyroid carcinoma (PTC) is the commonest histopathological type of differentiated thyroid carcinoma (DTC). It was found that cervical LNs were affected in 20–50% of patients having PTC. Cervical metastases frequently takes place first in the central compartment and subsequently in the lateral one. The aim of this study is to detect the impact of the different neck surgeries for DTC on the local control of the disease. Patients and methods: This study was done between 2012 and 2015, on 30 patients with proved DTC either by fine needle aspiration biopsy done preoperatively or by histopathological examination of paraffin section of the excised thyroid glands postoperatively. Those patients were divided into three equal groups: one group underwent total thyroidectomy with ipsilateral LN dissection, the second one underwent total thyroidectomy with central LN dissection (CLND) and the last group only underwent total thyroidectomy. Histopathological examination of all resected tissues was done. Patients underwent whole body scan (WBS) and accordingly they received the appropriate therapy of radioactive iodine. Measuring serum thyroglobulin and thyroglobulin antibodies, and neck ultrasound were employed in the follow up. Results: In the group that underwent CLND, three patients were shown to have positive LNs (30%), whereas in the group that underwent ipsi-lateral neck dissection, all patients showed malignant LNs (100%). In the whole study, seventeen patients (56.6%) received RAI once, 10 patients (33.3%) received RAI twice and 2 patients received a third dose of RAI. About 90% of the patients that received a second RAI therapy were from the groups that underwent ipsi-lateral LN dissection and CLND which indicate that those patients deserved these types of operations and thyroidectomy alone would not be enough to ensure a better outcome for those patients. Conclusion: In patients with DTC, at least CLND should be performed together with total thyroidectomy if preoperative diagnosis is done. If LNs by US show criteria of malignancy, even in the absence of histological proof, total thyroidectomy and ipsi-lateral neck LN dissection is recommended.