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Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence

The most common site of lymph node metastases in papillary thyroid carcinoma is the central compartment of the neck (level VI). In many patients, nodal metastases in this area are not clinically apparent, neither on preoperative imaging nor during surgery. Prophylactic surgical clearance of the leve...

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Autores principales: Kuczma, Paulina, Demarchi, Marco Stefano, Leboulleux, Sophie, Trésallet, Christophe, Mavromati, Maria, Djafarrian, Reza, Mabilia, Andrea, Triponez, Frédéric
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10140587/
https://www.ncbi.nlm.nih.gov/pubmed/37124759
http://dx.doi.org/10.3389/fendo.2023.1110489
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author Kuczma, Paulina
Demarchi, Marco Stefano
Leboulleux, Sophie
Trésallet, Christophe
Mavromati, Maria
Djafarrian, Reza
Mabilia, Andrea
Triponez, Frédéric
author_facet Kuczma, Paulina
Demarchi, Marco Stefano
Leboulleux, Sophie
Trésallet, Christophe
Mavromati, Maria
Djafarrian, Reza
Mabilia, Andrea
Triponez, Frédéric
author_sort Kuczma, Paulina
collection PubMed
description The most common site of lymph node metastases in papillary thyroid carcinoma is the central compartment of the neck (level VI). In many patients, nodal metastases in this area are not clinically apparent, neither on preoperative imaging nor during surgery. Prophylactic surgical clearance of the level VI in the absence of clinically suspicious lymph nodes (cN0) is still under debate. It has been suggested to reduce local recurrence and improve disease-specific survival. Moreover, it helps to accurately diagnose the lymph node involvement and provides important staging information useful for tailoring of the radioactive iodine regimen and estimating the risk of recurrence. Yet, many studies have shown no benefit to the long-term outcome. Arguments against the prophylactic central lymph node dissection (CLND) cite minimal oncologic benefit and concomitant higher operative morbidity, with hypoparathyroidism being the most common complication. Recently, near-infrared fluorescence imaging has emerged as a novel tool to identify and preserve parathyroid glands during thyroid surgery. We provide an overview of the current scientific landscape of fluorescence imaging in thyroid surgery, of the controversies around the prophylactic CLND, and of fluorescence imaging applications in CLND. To date, only three studies evaluated fluorescence imaging in patients undergoing thyroidectomy and prophylactic or therapeutic CLND for thyroid cancer. The results suggest that fluorescence imaging has the potential to minimise the risk of hypoparathyroidism associated with CLND, while allowing to exploit all its potential benefits. With further development, fluorescence imaging techniques might shift the paradigm to recommend more frequently prophylactic CLND.
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spelling pubmed-101405872023-04-29 Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence Kuczma, Paulina Demarchi, Marco Stefano Leboulleux, Sophie Trésallet, Christophe Mavromati, Maria Djafarrian, Reza Mabilia, Andrea Triponez, Frédéric Front Endocrinol (Lausanne) Endocrinology The most common site of lymph node metastases in papillary thyroid carcinoma is the central compartment of the neck (level VI). In many patients, nodal metastases in this area are not clinically apparent, neither on preoperative imaging nor during surgery. Prophylactic surgical clearance of the level VI in the absence of clinically suspicious lymph nodes (cN0) is still under debate. It has been suggested to reduce local recurrence and improve disease-specific survival. Moreover, it helps to accurately diagnose the lymph node involvement and provides important staging information useful for tailoring of the radioactive iodine regimen and estimating the risk of recurrence. Yet, many studies have shown no benefit to the long-term outcome. Arguments against the prophylactic central lymph node dissection (CLND) cite minimal oncologic benefit and concomitant higher operative morbidity, with hypoparathyroidism being the most common complication. Recently, near-infrared fluorescence imaging has emerged as a novel tool to identify and preserve parathyroid glands during thyroid surgery. We provide an overview of the current scientific landscape of fluorescence imaging in thyroid surgery, of the controversies around the prophylactic CLND, and of fluorescence imaging applications in CLND. To date, only three studies evaluated fluorescence imaging in patients undergoing thyroidectomy and prophylactic or therapeutic CLND for thyroid cancer. The results suggest that fluorescence imaging has the potential to minimise the risk of hypoparathyroidism associated with CLND, while allowing to exploit all its potential benefits. With further development, fluorescence imaging techniques might shift the paradigm to recommend more frequently prophylactic CLND. Frontiers Media S.A. 2023-04-14 /pmc/articles/PMC10140587/ /pubmed/37124759 http://dx.doi.org/10.3389/fendo.2023.1110489 Text en Copyright © 2023 Kuczma, Demarchi, Leboulleux, Trésallet, Mavromati, Djafarrian, Mabilia and Triponez https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Kuczma, Paulina
Demarchi, Marco Stefano
Leboulleux, Sophie
Trésallet, Christophe
Mavromati, Maria
Djafarrian, Reza
Mabilia, Andrea
Triponez, Frédéric
Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence
title Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence
title_full Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence
title_fullStr Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence
title_full_unstemmed Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence
title_short Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence
title_sort central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10140587/
https://www.ncbi.nlm.nih.gov/pubmed/37124759
http://dx.doi.org/10.3389/fendo.2023.1110489
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