Central Compartment Neck Dissection

Question 1

What are the indications for a therapeutic central neck dissection?

Answer 1

1) cN1 disease for differentiated thyroid cancer (Papillary, Follicular, or Hurthle Cell Carcinoma)
- Clinically palpable lymph nodes in the central neck compartment
- Obvious central compartment node involvement on neck U/S
- Biopsy proven central compartment node involvement (FNA is preferred)
2) Medullary thyroid cancer even in the absence of any clinical evidence of lymph node involvement
3) Central neck recurrence of thyroid cancer (if not already done in prior operations)

Question 2

What are the indications for a prophylactic central neck dissection?
Note: The indications for prophylactic central neck dissection remain a topic of debate.

Answer 2

1) Older or very young patients (as they have a higher risk of at last microscopic lymph node involvement)
2) T3 or T4 differentiated thyroid cancer without clinical evidence of central or lateral lymph node involvement (i.e. extrathyroidal extension or invasion to surrounding structures and organs).
3) Unfavorable histology (i.e. Tall-cell variant, diffuse sclerosing variant, or solid variant)
4) Ipsilateral clinically apparent lateral neck disease (cN1b) is present and is being targeted with lateral neck dissection.

Question 3

When should a central compartment neck dissection be performed?

Answer 3

The central neck dissection is most commonly performed at the time of total thyroidectomy. The thyroidectomy is performed first. Most surgeons will remove the thyroid specimen first and then remove the central neck nodes as one or 2 other specimens.