Role of prophylactic central neck lymph node dissection for papillary thyroid carcinoma in the era of de-escalation

Table 1 Papillary thyroid carcinoma, risk stratification and preoperative evaluation

No.	Parameter
1	Tumor size > 4 cm
2	Family history of thyroid carcinoma
3	Previous neck irradiation
4	Multifocality
5	Extrathyroid extension
6	Rapid growth of nodules
7	Sudden swallowing dysfunction or dysphonia
8	Age ≥ 45 yr
9	Female gender

Table 2 Effect of lymph node status in recurrence and survival in papillary thyroid carcinoma

Ref.	Patients (Nu)	Trial	Survival
Tisell et al[33], 1996	195	Single center retrospective study	Increased in ≥ 45 yr; Unaffected in < 45 yr
Zaydfudim et al[20], 2008	30504	United States Registry, Surveillance	Increased in ≥ 45 yr; Unaffected in < 45 yr
Lundgren et al[38], 2006	5123	Swedish Registry Surveillance	Increased

Table 3 Results of routine prophylactic central neck lymph node dissection in papillary thyroid carcinoma

Ref.	Patients (Nu)	Trial	Findings
Barczyński et al[34], 2013	640	Single center retrospective study	Bilateral pCND increases 10-yr disease-specific survival and locoregional control, No increased risk of permanent morbidity
Lee et al[62], 2007	103	Single center retrospective study	Increased transient hypocalcemia in bilateral than ipsilateral pCND
Chisholm et al[63], 2009	1132	Meta-analysis	No increased permanent morbidity
Zhu et al[64], 2013	2298	Meta-analysis	No more complications
Wang et al[69], 2023	2080	Meta-analysis	Reduced local recurrence; Higher risk of permanent hypocalcemia and transient hypopara-thyroidism; No significant differences in transient hypocalcemia, permanent hypopara-thyroidism, both temporary and permanent vocal cord paralysis, and recurrent laryngeal nerve injury

pCND: Prophylactic central neck lymph node dissection.

Table 4 Suspicious ultrasound findings of lymph nodes which predict malignant infiltration

Sign	Sensitivity, %	Specificity, %
Microcalcifications	5-69	93-100
Cystic degeneration	10-34	91-100
Vascularity peripheral	40-86	57-93
Hyperechogenicity	30-87	43-95
Shape round	37	70