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 ArticlesDetecting Cancer Earlier is Goal of Rutgers-Developed Medical Imaging Technology
A new medical imaging method being developed at Rutgers University could help physicians detect cancer and other diseases earlier than before, speeding treatment and reducing the need for invasive, time-consuming biopsies.Stress-related inflammation may increase risk for depression
Preexisting differences in the sensitivity of a key part of each individual's immune system to stress confer a greater risk of developing stress-related depression or anxiety, according to a study conducted at the Icahn School of Medicine at Mount Sinai and published October 20 in the Proceedings of the National Academy of Sciences (PNAS). Biomarkers uPA/PAI-1 in breast cancer: benefit and harm of the test unclear
To make a decision for or against adjuvant chemotherapy, a test to measure the concentrations of the biomarkers uPA and PAI-1 in the tumour tissue is available for breast cancer patients. Link between breast implants and cancer under investigation
An international research group including Viennese pathologist Lukas Kenner has reviewed cases of possible association between breast implants and a form of lymphoma that may develop tumours at a later stage.Osteoporosis treatment may also benefit breast cancer patients
Treatment approaches to reduce the risk of bone complications (metastasis) associated with breast cancer may be one step closer to becoming a reality.'Stealth' nanoparticles could improve cancer vaccines
Cancer vaccines have recently emerged as a promising approach for killing tumor cells before they spread. But so far, most clinical candidates haven't worked that well.Cancer during pregnancy: Chemotherapy and radiotherapy are safe for babies, studies show
Children who are exposed to chemotherapy or radiotherapy while in the womb suffer no negative impacts on mental or cardiac development, international studies presented at the ESMO 2014 Congress in Madrid have shown. Lymphatic fluid used for first time to detect bovine paratuberculosis
Paratuberculosis is a bovine disease affecting up to 19 percent of dairy farms in Austria.Experts issue plea for better research and education for advanced breast cancer
Breast cancer experts around the world have issued a plea to researchers, academics, drug companies, funders and advocates to carry out high quality research and clinical trials for advanced breast cancer, a disease which is almost always fatal and for which there are many unanswered questions.New insights on an ancient plague could improve treatments for infections
Dangerous new pathogens such as the Ebola virus invoke scary scenarios of deadly epidemics, but even ancient scourges such as the bubonic plague are still providing researchers with new insights on how the body responds to infections.
More Lymph Nodes Current Events and Lymph Nodes News Articles
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....
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
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)
Diagnostic Pathology: Lymph Nodes and Spleen with Extranodal Lymphomas: Published by Amirsys|
by L. Jeffrey Medeiros MD (Author)
Designed as a practical and very comprehensive reference for the practicing pathologist, Diagnostic Pathology: Lymph Nodes and Spleen with Extranodal Lymphomas is a highly anticipated title in the Diagnostic Pathology series offered by Amirsys. As readers have come to expect from Amirsys reference tools, Diagnostic Pathology: Lymph Nodes and Spleen with Extranodal Lymphomas is filled with superior medical images, including gross and microscopic pathology, a wide range of pathology stains, ancillary tests and detailed medical illustrations. For each anatomical site, you’ll find specimen examination protocols plus detailed immunohistochemistry panels to accompany the images. This one-of-a-kind book covers a variety of benign and malignant disorders and lymphomas, such as infectious...
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...
A Pattern Approach to Lymph Node Diagnosis|
by Anthony S-Y Leong (Author)
While a pattern approach to diagnosis is taught and practiced with almost every other tissue or organ in the body, the lymph node remains a mystery to most residents starting out in pathology and those pathologists with limited experience in the area. A Pattern Approach to Lymph Node Diagnosis demonstrates that a systematic approach to lymph node examination can be achieved through recognition of morphological patterns produced by different disease processes. It presents a combination of knowledge-based assessment and pattern recognition for diagnosis covering the major primary neoplastic and non neoplastic diseases and metastatic tumors in lymph nodes. This volume demonstrates that lymph node compartments can be recognized histologically especially with the aid of immunohistological...
Lymph Node and Spleen Cytohistology (Cytohistology of Small Tissue Samples)|
by Andrew S. Field (Author), William R. Geddie (Author)
Each volume in this richly illustrated series, published in association with the Papanicolaou Society of Cytopathology, provides an organ-based approach to the cytological and histological diagnosis of small tissue samples. Benign, pre-malignant and malignant entities are presented in a well-organized and standardized format with high-resolution color photomicrographs, tables, tabulated specific morphologic criteria and appropriate ancillary testing algorithms. Vignettes allow the reader to assimilate the diagnostic principles in a case-based format. This volume combines a practical approach to performing and interpreting fine-needle biopsy cytology of lymph nodes and spleen, with reports of biopsies and the selection of appropriate ancillary testing required for these challenging small...
Lymph Nodes (Demos Surgical Pathology Guides)|
by Horatiu Olteanu MD PhD (Author), Alexandra Harrington MD (Author), Steven H. Kroft MD (Author), Saul Suster MD (Series Editor)
The Demos Surgical Pathology Guides series presents in summary and visual form the basic knowledge base that every practicing pathologist needs every working day. Series volumes cover the major specialty areas of surgical pathology, and coverage emphasizes the key entities and diagnoses that pathologists will see in practice, and that they must know whether in training or practice. The emphasis is on the basic morphology with newer techniques represented where they are frequently used. The series provides a handy summary and quick reference that any pathology resident or fellow will find useful. Experienced practitioners will find the series valuable as a portable "refresher course" or review tool. Lymph Nodes presents the full gamut of lymph node disorders and diagnoses that...
Diagnostic Histopathology of the Lymph Node|
by James A. Strauchen (Author)
This is a comprehensive text and atlas of lymph node pathology, providing extensive illustrative examples of characteristic diagnostic findings in the lymph node, including both benign and malignant conditions. All major disorders are discussed, including up to date information on HIV infection and AIDS. Although an emphasis has been placed on interpretation of the routinely stained hematoxylin and eosin stained section, consideration has been given to the important immunologic and molecular biologic advances which have revolutionized hematopathology. The author has integrated classic approaches to biopsy interpretation, including histopathology and clinical features, with newer immunophenotypic and molecular biologic techniques. The Revised European-American Lymphoma (REAL)...
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...