TY - JOUR
T1 - Is it possible to intraoperatively modulate the extent of thyroidectomy in small papillary thyroid carcinoma?
AU - Raffaelli, Marco
AU - Sessa, L.
AU - De Crea, Carmela
AU - Fadda, G.
AU - Princi, P.
AU - Rossi, E. D.
AU - Traini, E.
AU - Revelli, Luca
AU - Pennestri', Francesco
AU - Gallucci, P.
AU - Ciccoritti, L.
AU - Greco, F.
AU - Bellantone, R.
PY - 2021
Y1 - 2021
N2 - Background: Thyroid lobectomy is the preferred option for small, unifocal papillary thyroid carcinoma. Involvement of the central neck lymph nodes is an indication for total thyroidectomy plus central neck dissection. We aimed to verify if frozen section examination of ipsilateral central neck nodes can identify the subgroup of patients scheduled for thyroid lobectomy intraoperatively who could benefit of more extensive initial operative treatment. Methods: Ninety-four consenting patients with clinically unifocal cN0 papillary thyroid carcinoma underwent thyroid lobectomy plus ipsilateral central neck dissection with frozen section examination. If the frozen section examination was positive for metastases, a completion thyroidectomy and a bilateral central neck dissection were accomplished during the same procedure. Results: Frozen section examination identified occult nodal metastases in 25 of the 94 patients who then underwent immediate completion thyroidectomy and bilateral central neck dissection. Overall, central neck node metastases were found at final histology in 35 cases: occult micrometastases were observed in additional 9 patients and nodal metastases ≥2 mm in additional 1 patient. Conclusion: Intraoperative assessment of nodal status obtained with ipsilateral central neck dissection and frozen section examination is able to change the extent of thyroidectomy in about one-fourth of patients scheduled for thyroid lobectomy. Frozen section examination appears a safe and effective strategy to decrease the need of a second-step completion procedure and, theoretically, the risk of recurrence.
AB - Background: Thyroid lobectomy is the preferred option for small, unifocal papillary thyroid carcinoma. Involvement of the central neck lymph nodes is an indication for total thyroidectomy plus central neck dissection. We aimed to verify if frozen section examination of ipsilateral central neck nodes can identify the subgroup of patients scheduled for thyroid lobectomy intraoperatively who could benefit of more extensive initial operative treatment. Methods: Ninety-four consenting patients with clinically unifocal cN0 papillary thyroid carcinoma underwent thyroid lobectomy plus ipsilateral central neck dissection with frozen section examination. If the frozen section examination was positive for metastases, a completion thyroidectomy and a bilateral central neck dissection were accomplished during the same procedure. Results: Frozen section examination identified occult nodal metastases in 25 of the 94 patients who then underwent immediate completion thyroidectomy and bilateral central neck dissection. Overall, central neck node metastases were found at final histology in 35 cases: occult micrometastases were observed in additional 9 patients and nodal metastases ≥2 mm in additional 1 patient. Conclusion: Intraoperative assessment of nodal status obtained with ipsilateral central neck dissection and frozen section examination is able to change the extent of thyroidectomy in about one-fourth of patients scheduled for thyroid lobectomy. Frozen section examination appears a safe and effective strategy to decrease the need of a second-step completion procedure and, theoretically, the risk of recurrence.
KW - thyroid
KW - thyroid
UR - https://publicatt.unicatt.it/handle/10807/176465
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UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85087088494&origin=inward
U2 - 10.1016/j.surg.2020.04.043
DO - 10.1016/j.surg.2020.04.043
M3 - Article
SN - 0039-6060
VL - 169
SP - 77
EP - 81
JO - Surgery
JF - Surgery
IS - 1
ER -