Science Current Events | Science News | Brightsurf.com
 

Removal of lymph nodes during surgery for thyroid cancer may be beneficial

December 21, 2011
Procedure may reduce recurrence rates, lower tumor marker levels

Papillary thyroid cancer accounts for the majority of all thyroid malignancies, which primarily impact women. A new study indicates that routinely removing lymph nodes in the neck in these cancer patients may help prevent the disease from coming back.

When thyroid cancer metastasizes, lymph nodes in the neck may be affected, but these lymph-node tumors can be tiny and may not be detected by ultrasounds done before surgery to remove the diseased thyroid - or even during the procedure itself.

In an international academic study published in the December issue of the journal Surgery, UCLA researchers and colleagues demonstrate that routine removal of neck lymph nodes during initial thyroid surgery for papillary cancer may lead to lower disease recurrence rates and lower levels of thyroglobulin, a thyroid tumor marker that can be an indicator of disease when elevated.

Although it is standard procedure in some cancer centers, there has been debate in the worldwide surgical community about the benefits of routinely removing neck lymph nodes, a procedure known as prophylactic central neck lymph-node dissection, or CLND.

"We found that re-operation rates due to cancer were lower in patients who had routine removal of these lymph nodes, which suggests a more thorough surgical clearance of disease," said the study's senior author, Dr. Michael Yeh, an associate professor of surgery at the David Geffen School of Medicine at UCLA. "Our findings may help add to growing evidence that this additional procedure, performed during initial thyroid surgery, may be helpful in management of papillary thyroid cancer."

For the study, researchers examined data on 606 patients who received care in one of three endocrine surgical units in the U.S., England and Australia. Patients were divided into two groups: Group A patients had undergone total thyroid removal alone; Group B patients had undergone both thyroid removal and dissection of central neck lymph nodes. Patients were followed for an average of three-and-a-half years following surgery.

The standard pre-operative evaluation of all patients included a fine-needle biopsy of the primary thyroid tumor and determination of neck lymph-node disease status through physical examination and ultrasound of the neck.

The rate of disease recurrence in the entire study population was 6.9 percent. The researchers found that the need for central neck re-operation was significantly lower among patients who had undergone the routine initial central neck lymph-node dissection, compared with those who had undergone only thyroid removal (1.5 percent vs. 6.1 percent).

Stimulated thyroglobulin levels were also lower among patients in Group B, which may demonstrate a more thorough clearing of disease in the patients who had both thyroid and neck lymph-node removal procedures, the researchers said.

"This significant reduction in the need for further surgery in the critical central area of the neck is important, since it reduces risk to the many vital structures housed here, such as the nerves supplying the voice," said study co-author Dr. Mark Sywak of the University of Sydney in Australia.

UCLA's Yeh noted that blood thyroglobulin levels are a useful and sensitive measure in tracking disease recurrence, especially when many tumors in this area are too tiny to be detected using a physical exam or ultrasound.

Rates of temporarily low calcium levels, a common side effect, were significantly higher in Group B patients (9.7 percent), who had neck lymph nodes removed, than in Group A patients (4.1 percent) who had thyroid-removal surgery alone. The rate of long-term complications was low for both groups - about 1 percent.

The researchers said the next step may be to conduct a prospective, randomized clinical trial to further assess the impact of routinely removing central neck lymph nodes during initial surgery for papillary thyroid cancer.

University of California - Los Angeles Health Sciences


Related Lymph Nodes Current Events and Lymph Nodes News Articles


Why West Nile virus is more dangerous in the elderly
West Nile virus (WNV) is particularly dangerous in older people, who account for a large number of severe cases and deaths caused by the virus.

New studies show that 2 classes of inexpensive generic drugs can reduce breast cancer deaths
Two new studies, both published in The Lancet, suggest that two different classes of drugs, aromatase inhibitors (AIs) and bisphosphonates, can each improve survival prospects for postmenopausal women with early breast cancer.

Additional radiation reduces breast-cancer recurrence for some patients: Hamilton study
A study has found no increase in overall survival but a reduction in breast cancer recurrence when additional radiation is given to the lymph nodes as well as the standard treatment of whole-breast irradiation after breast-conserving surgery.

New analysis points the way to earlier diagnosis of chest tumors
Researchers led by St. Jude Children's Research Hospital scientists have developed new diagnostic criteria to enable clinicians to distinguish malignant cancerous chest cavity masses from those caused by fungal histoplasmosis infection.

Genomic fingerprint may predict aggressive prostate cancer in African-Americans
African American men are more likely to develop prostate cancer than European American men, and are also more than twice as likely to die from it.

Development of new blood vessels not essential to growth of lymph node metastases
While the use of antiangiogenesis drugs that block the growth of new blood vessels can improve the treatment of some cancers, clinical trials of their ability to prevent the development of new metastases have failed.

Safeguarding against chlamydia
Chlamydia trachomatis is a formidable foe. It's the most common sexually transmitted pathogen, infecting more than 100 million people each year.

Lymph nodes signal more aggressive thyroid cancer even in young patients
Patients older than age 45 with thyroid cancer that has spread to neck lymph nodes have long been considered at higher risk of dying, but the same has not been true for younger patients.

Multimodality treatment for metastatic lung cancer with surgery may improve survival rates
Patients diagnosed with an advanced form of metastatic non-small cell lung cancer (NSCLC) may benefit from surgical resection (removal of all or part of the lung) in combination with chemotherapy and radiation therapy, according to an article in the June 2015 issue of The Annals of Thoracic Surgery.

Scientists unveil prostate cancer's 'Rosetta Stone'
Almost 90 per cent of men with advanced prostate cancer carry genetic mutations in their tumours that could be targeted by either existing or new cancer drugs, a landmark new study reveals.
More Lymph Nodes Current Events and Lymph Nodes News Articles

Atlas of Lymph Node Anatomy

Atlas of Lymph Node Anatomy
by Mukesh G. Harisinghani (Editor)


Detailed anatomic drawings and state-of-the-art radiologic images combine to produce this essential Atlas of Lymph Node Anatomy. Utilizing the most recent advances in medical imaging, this book illustrates the nodal drainage stations in the head and neck, chest, and abdomen and pelvis. Also featured are clinical cases depicting drainage pathways for common malignancies. 2-D and 3-D maps offer color-coordinated representations of the lymph nodes in correlation with the anatomic illustrations. This simple, straightforward approach makes this book a perfect daily resource for a wide spectrum of specialties and physicians at all levels who are looking to gain a better understanding of lymph node anatomy and drainage.Edited by Mukesh G. Harisinghani, MD, with chapter contributions from staff...

Ioachim's Lymph Node Pathology

Ioachim's Lymph Node Pathology
by Harry L. Ioachim (Editor), L. Jeffrey Medeiros MD (Editor)


Now in its Fourth Edition, this comprehensive, practical, and thoroughly illustrated reference offers valuable guidance in the diagnostic interpretation of lymph node biopsies. It provides encyclopedic coverage of all the various nonmalignant lesions, lymphomas, other neoplasms, and metastatic tumors in lymph nodes. The discussion of each pathologic entity includes definition, clinical syndrome, histopathology, and differential diagnosis. This edition has more than 700 illustrations, including over 600 in full color. Dr. Ioachim is joined by a new co-editor, L. Jeffrey Medeiros, MD, from the University of Texas MD Anderson Cancer Center. All chapters have been extensively revised and a new chapter on genetics has been added. A companion Website will offer the fully searchable online text...

Lymphatic System (Medical Series)

Lymphatic System (Medical Series)
by Inc. BarCharts (Author)


Complete, labeled illustrations of the parts of the lymphatic system in nine different views and sections.

From pre-teen to pre-med, this chart is loaded with beautifully illustrated diagrams clearly and concisely labeled for easy identification.

Illustrations by award-winning medical illustrator Vincent Perez.

Chart includes detailed diagrams of:
· head & neck
· arm axilla & thorax
· nodes & vessels
· thoracic duct
· deep abdominal & inguinal nodes
· large intestine
· stomach & pancreas
· heart & lungs

Diagnostic Lymph Node Pathology, 2nd Edition

Diagnostic Lymph Node Pathology, 2nd Edition
by Dennis Wright (Author), Bruce J Addis (Author), Anthony S-Y Leong (Author)


Thoroughly updated and revised in line with the latest World Health Organization classification system, the second edition of Diagnostic Lymph Node Pathology continues to be an essential guide to the interpretation of lymph node biopsies for all professional and trainee general pathologists and haematopathologists alike. 

Tthe new edition covers both classical and less well known features of individual disease processes together with the differential diagnoses of lymph node biopsy specimens. B-cell lymphomas have been reorganized in line with WHO guidelines. Topics such as Epstein-Barr virus, age-related lymphomas and prognostic indicators have been expanded, and new cases using needle core biopsies are presented.

Frozen Section Library: Lymph Nodes

Frozen Section Library: Lymph Nodes
by Cherie H. Dunphy (Editor)


The Frozen Section Library series provides concise, user-friendly, site specific handbooks that are well illustrated and highlight the pitfalls, artifacts and differential diagnosis issues that arise in the hurried frozen section scenario. Frozen Section Library: Lymph Nodes highlights the usefulness of techniques such as touch preparation cytology and fine needle aspiration (FNA) cytology, as well as FNA biopsy. This fascicle also suggests proper handling for subsequent ancillary studies, including flow cytometric, cytogenetic, and molecular studies. Special emphasis is given to the limitations of frozen section diagnosis in lymph node pathology. All chapters are written by experts in their fields and include the most up to date scientific information. This book serves as a very useful...

Lymph Node Surgery in Urology

Lymph Node Surgery in Urology
by John P Donohue (Author)


Written by an international team of contributors, this book presents information on lymph node surgery, both for its staging value and as a therapeutic tool, as well as the benefits, complications and effectiveness of the procedure

Lymph Nodes (Cambridge Illustrated Surgical Pathology)

Lymph Nodes (Cambridge Illustrated Surgical Pathology)
by Lawrence M. Weiss (Author)


This text-atlas is a practical, integrated, and modern approach to lymph node pathology. Intended for both practicing pathologists and pathologists in training, it provides a personal view of lymph node diagnosis by one of the international leaders in the field. Illustrated with over 250 full-color photographs, this book covers the entire range of disease that may be encountered in lymph node pathology. It features extensive coverage of non-neoplastic lymphoid lesions and non-lymphoid lesions, as well as discussing all malignant lymphomas and other neoplasms that may involve lymph nodes in both adult and pediatric populations. The orientation is unique, as the text not only showcases various disease entities but also portrays the progression of disease states from incipient to advanced....

Atlas of Lymph Node Pathology (Atlas of Anatomic Pathology)

Atlas of Lymph Node Pathology (Atlas of Anatomic Pathology)
by Roberto Miranda (Author), Joseph D. Khoury (Author), L. Jeffrey Medeiros (Author)


Atlas of Lymph Node Pathology reviews the histopathology of nodal diseases, illustrating the use of ancillary studies and includes concise discussions of pathogenesis, clinical settings and clinical significance of the pathologic diagnosis. The atlas features an overview of the benign reactive processes secondary to infectious, environmental or unknown insults, as well as relevant illustrations of virtually all primary and secondary neoplasms involving lymph nodes. The atlas also includes macroscopic images of some disorders, tables that help readers understand and comprehend diseases that look alike, and diagnostic algorithms for certain groups of diseases.Authored by highly experienced pathologists, Atlas of Lymph Node Pathology is a valuable resource that illustrates the vast...

  Benign and Reactive Conditions of Lymph Node and Spleen (Atlas of Nontumor Pathology)
by Dennis P. O'Malley (Author), Tracy I., M.D. George (Author), Attilo, M.D. Orazi (Author), Susan L., M.D. Abbondanzo (Author)




Lymph Nodes (Demos Surgical Pathology Guides)

Lymph Nodes (Demos Surgical Pathology Guides)
by Demos Medical


Lymph Nodes presents the full gamut of key lymph nodes disorder entities and diagnoses that a pathologist can expect to encounter in daily practice. Coverage includes infectious lymphadenopathies, reactive lympadenopathies, lymph node inclusions, spindle cell neoplasms of lymph nodes, mature B-cell neoplasms, mature T- and NK-cell neoplasms, Hodgkin lymphoma, precursor lymphoid neoplasms, and more. Lymph Nodes is highly illustrated throughout and provides a handy summary and quick reference guide for pathology residents and less experienced pathologists. In addition, it serves as a portable "refresher course" or MOC review tool for more experienced pathologists.

© 2015 BrightSurf.com