Role of RAI in the management of incidental N1a disease in papillary thyroid cancer Journal Article


Authors: Wang, L. Y.; Palmer, F. L.; Migliacci, J. C.; Nixon, I. J.; Shaha, A. R.; Shah, J. P.; Tuttle, R. M.; Patel, S. G.; Ganly, I.
Article Title: Role of RAI in the management of incidental N1a disease in papillary thyroid cancer
Abstract: Background Following total thyroidectomy (TT) for papillary thyroid cancer (PTC), pathological assessment can occasionally reveal incidental perithyroidal lymph nodes (LNs) with occult metastases. These cN0pN1a patients often receive radioactive iodine (RAI) therapy for this indication alone. The aim of this study was to determine the central compartment nodal recurrence-free survival in patients treated without RAI compared to those who received RAI treatment. Methods An institutional database of 3664 previously untreated patients with differentiated thyroid cancer operated between 1986 and 2010 was reviewed. A total of 232 pT1-3 patients managed with TT and no neck dissection were subsequently found to have incidental level 6 LNs on pathology. Patients with other indications for RAI, such as extrathyroidal extension and close or positive margins, were excluded. One hundred and four patients remained for analysis. Kaplan-Meier method was used to determine central neck LN recurrence-free survival (RFS). Results The median age of the cohort was 40 years (range 17-83). The median follow-up was 53 months (range 1-211). The median number of positive LNs removed and maximum LN diameter were 1 (range 1-8) and 5 mm (range 1-16 mm), respectively. A total of 67 (64%) patients had adjuvant RAI and 37 (36%) did not. Patients with vascular invasion (P = 0·01), LNs >2 mm (P = 0·07) and >2 positive nodes (P = 0·06) were more likely to be selected for adjuvant RAI therapy. Patients without RAI therapy had similar 5-year central neck LN RFS compared to those treated with RAI: 96·2% vs 94·6%, respectively (P = 0·92). Conclusion There is no difference in the 5-year central compartment nodal recurrence-free survival in patients treated without RAI compared to those who received RAI treatment. © 2015 John Wiley & Sons Ltd.
Journal Title: Clinical Endocrinology
Volume: 84
Issue: 2
ISSN: 0300-0664
Publisher: Wiley Blackwell  
Date Published: 2016-02-01
Start Page: 292
End Page: 295
Language: English
DOI: 10.1111/cen.12828
PROVIDER: scopus
PUBMED: 26041503
PMCID: PMC4959964
DOI/URL:
Notes: Article -- Export Date: 3 February 2016 -- Source: Scopus
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MSK Authors
  1. Ashok R Shaha
    535 Shaha
  2. Snehal G Patel
    286 Patel
  3. Robert M Tuttle
    350 Tuttle
  4. Iain James Nixon
    60 Nixon
  5. Ian Ganly
    229 Ganly
  6. Jatin P Shah
    538 Shah
  7. Frank Palmer
    81 Palmer
  8. Laura Wang
    34 Wang