Selective Neck Dissection in N0 Papillary Thyroid Carcinoma
Abstract
Background: Papillary thyroid carcinoma is the most common form of well differentiated thyroid cancer and constitutes 1% of all solid tissue cancers with a female predominance. Surgical intervention helps in removal of lesion. Lymph node metastasis in cervical compartments is the main reason of recurrence of disease. Personalized risk stratified prophylactic neck dissection at initial thyroidectomy in Papillary thyroid carcinoma with no clinical, sonographic or per-operative evidence of lymph node metastasis has been advocated, though not unanimously. Compartment oriented lymph node dissection in patients with PTC reduces recurrence and improves survival. Objectives: The aim of this study is to determine the Role of selective neck dissection in case of N0 papillary thyroid carcinoma. Methods: A cross-sectional prospective study was conducted in the Dept of Otolaryngology and Head neck surgery, BSMMU, Dhaka for one and a half years from September/2021 to February/2023, with 35 patients underwent total thyroidectomy with selective neck dissection (level VI, III, IV, II) for N0 Papillary thyroid carcinoma. All patients were evaluated by complete clinical head & neck examination, thyroid hormone profile, ultrasonography finding, fine needle aspiration cytology, radiology and histopathology report were recorded. Data were analyzed statistically by using by Statistical Package for Social Scientist (SPSS-24). Results: The age was ranged from 22 to 70 years with mean age was 47.77±14.8 years. Male to female ratio was 1:2.2. 17.4% patients had multiple number of nodules and 82.86% patients had solitary nodule. 11.43 % patients had involvement of both lobes, 31.43 % had involvement of left lobe, 57.14% had involvement of right lobe. More than three-fourth (88.57%) patients, tumor size >4 cm and in case of 11.43% patients, tumor size is within 0- 4 cm. 8.6% patients had mixed echo consistency and 91.4% had solid echo consistency. Conclusion: Most of the patients were in 6th and above decade and female predominant. Solitary nodule, right lobe involvement, size more than 4cm and solid echo consistency were more frequent. Regarding selective neck dissection; 17.1% had metastasis at level VI and no metastasis at level II, III, IV. In brief, 17.1% patients had metastasis on histopathology after neck dissection and 82.9% patients had no metastasis on histopathology after neck dissection. It can be said that, Central compartment neck dissection has role in detecting metastasis at N0 stage of Papillary thyroid carcinoma but Lateral neck dissection has no role in detecting metastasis at N0 stage of Papillary thyroid carcinoma.
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References
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