Milena Freddi

Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience

Background and aimsThe role of central neck dissection in the treatment of papillary thyroid carcinoma is debated. This retrospective investigation was undertaken to assess whether it augments total thyroidectomy morbidity.Patients/methodsA total of 305 consecutive patients who had undergone total thyroidectomy for papillary thyroid carcinoma were divided into three groups: group A (n = 64) showed evidence of node metastases and received therapeutic bilateral central node dissection; group B (n = 93) showed negative nodes and received prophylactic ipsilateral central node dissection; group C (n = 148) showed negative nodes and received total thyroidectomy alone. The rates of transient and permanent complications within the three groups were compared.ResultsHistopathological examination detected node metastases in 46 (72%) group A patients and in 20 (21%) group B patients. Parathyroid autotransplantation was carried out in 41 (64%) patients in group A, 55 (59%) in group B, and 43 (29%) in group C (P < 0.001). One or more parathyroid glands were found in 20% of the specimens from group A, 11% of those from group B, and 9% of those from group C. None of the patients in either group A or group B reported permanent laryngeal recurrent nerve paralysis, but two (1.3%) in group C did. Transient laryngeal recurrent nerve paralysis occurred most often in group A patients (7.8% versus 5.4% versus 1.3%, respectively) and was bilateral in two patients (one in group A and one in group B). None of the patients in either group A or group B developed permanent hypoparathyroidism, but four (2.7%) in group C did. Transient hypoparathyroidism was highest in group A patients (31% versus 27% versus 13%, respectively; P = 0.003). Postoperative bleeding requiring reoperation occurred in one group B patient and in two group C patients.ConclusionsCentral neck dissection did not increase permanent morbidity and revealed a significant rate of nonclinically evident node metastases. In experienced hands, central neck dissection should be routinely combined with total thyroidectomy in the primary treatment of pre- or intraoperatively diagnosed papillary thyroid cancer. When no macroscopic evidence of metastasis is present, ipsilateral central neck dissection is the best treatment strategy in a balanced decision between the need for achieving local radical excision, correct disease staging, and reducing the risk of complications.

Utilility of flow cytometry as ancillary study to improve the cytologic diagnosis of thyroid lymphomas.

To evaluate the efficacy of the use of flow cytometry (FC) immunophenotyping together with fine‐needle aspiration cytology (FNAC) in the diagnosis of thyroid lymphoma.

Parathyroid Exploration for Primary Hyperparathyroidism

Hypercalcemia detected during routine biochemical screening, associated with an elevated parathyroid hormone (PTH) in the presence of characteristic symptomatology (nephrolithiasis, osteoporosis, fragility fractures, pancreatitis, peptic ulcer disease, and significant neurocognitive dysfunction), is a definite indication for parathyroidectomy (PTx) [1-4]. Once a diagnosis of primary hyperparathyroidism (pHPT) has been biochemically confirmed, a decision must be made by the endocrinologist and the surgeon regarding observation versus surgical treatment. Only then are localization studies indicated to perform minimally invasive surgery. These studies are not diagnostic.

Segmental tracheal resection for invasive differentiated thyroid carcinoma. Our experience in eight cases

PurposeIn differentiated thyroid carcinoma (DTC), complete resection of local disease provides the longest survival and the best palliation. In pursuit of this goal, segmental tracheal or laryngotracheal resection can be performed on patients with DTC invading the airway. The study summarizes the technical aspects of the intervention and analyzes its results in eight patients.MethodsThe results of eight tracheal or laryngotracheal resections for DTC invading the airway were analyzed. Three patients presented with local recurrent disease, whereas five underwent airway resection at the time of thyroidectomy or shortly after. All received a circumferential sleeve resection of the trachea (2–4 tracheal rings) that in three cases extended to the cricoid, followed by end-to-end anastomosis.ResultsPathologic evaluation identified seven papillary and one poorly differentiated carcinomas. No postoperative deaths occurred; one patient required surgical reexploration because of postoperative bleeding, and two air leaks resolved with conservative treatment. Functional results were excellent. During follow-up, one patient died of lung and bone metastases, while in two cases locally persistent/recurrent disease has been detected; two patients are currently free of disease, and in the last three cases only persistent thyroglobulin levels are indicative of residual disease.ConclusionsIn our experience, segmental airway resection is safe, provides excellent functional results, and can warrant adequate control of local disease.