A 30-year-old woman is planned for total thyroidectomy for a 2.5 cm papillary thyroid carcinoma without extrathyroidal extension or nodal disease. Preoperatively, the surgeon discusses prophylactic central neck dissection. According to current evidence, which statement is most accurate regarding prophylactic central compartment dissection in clinically node-negative PTC?

• A It increases the risk of permanent hypoparathyroidism and recurrent laryngeal nerve injury without proven survival benefit ✓
• B It reduces locoregional recurrence rates and should be routinely performed in all PTC
• C It is indicated only when preoperative ultrasound shows suspicious central compartment nodes
• D It is recommended only for tumors larger than 4 cm

Explanation

Prophylactic central neck dissection in clinically node-negative PTC remains controversial. Multiple studies and the ATA guidelines note that while it may modestly reduce locoregional recurrence, it does not confer a survival benefit and is associated with significantly higher rates of transient and permanent hypoparathyroidism as well as recurrent laryngeal nerve injury. It is generally not recommended for routine use in low-risk PTC without radiologically suspicious nodes. Therapeutic central dissection is indicated when nodes are clinically or radiologically involved.

Reference: American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer, 2015 ed.

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Written and medically reviewed by the StethoPrep medical team.