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Guideline Summary
Guideline Title
Consensus statement on the terminology and classification of central neck dissection for thyroid cancer.
Bibliographic Source(s)
American Thyroid Association Surgery Working Group, Carty SE, Cooper DS, Doherty GM, Duh QY, Kloos RT, Mandel SJ, Randolph GW, Stack BC Jr, Steward DL, Terris DJ, Thompson GB, Tufano RP, Tuttle RM, Udelsman R. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009 Nov;19(11):1153-8. [5 references] PubMed External Web Site Policy
Guideline Status

This is the current release of the guideline.

Scope

Disease/Condition(s)

Thyroid carcinoma

Guideline Category
Evaluation
Management
Clinical Specialty
Endocrinology
Family Practice
Internal Medicine
Oncology
Otolaryngology
Surgery
Intended Users
Physicians
Guideline Objective(s)
  • To review the relevant anatomy of the central neck compartment
  • To identify the nodal subgroups within the central compartment commonly involved in thyroid cancer
  • To define a consistent terminology relevant to the central compartment neck dissection
  • To obtain a multidisciplinary consensus statement on the terminology and classification of the central neck dissection for thyroid cancer
Target Population

Patients with thyroid carcinoma

Interventions and Practices Considered
  1. Central neck dissection with removal of the prelaryngeal, pretracheal, and paratracheal lymph nodes
  2. Consistent description of central neck dissection including both the indication (therapeutic vs. prophylactic/elective) and the extent of the dissection (unilateral or bilateral)
Major Outcomes Considered

Uniformity in terminology and classification

Methodology

Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

Articles were identified by searching MEDLINE using the following search terms: {CENTRAL NECK DISSECTION} or {ANTERIOR NECK DISSECTION} or {CENTRAL NECK COMPARTMENT} and {THYROID} and {CANCER} or {CARCINOMA}. Emphasis was placed on papers published between 1991 and 2008, following publication of the widely adopted report by Robbins et al., standardizing neck dissection terminology.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus
Rating Scheme for the Strength of the Evidence

Not applicable

Methods Used to Analyze the Evidence
Systematic Review
Description of the Methods Used to Analyze the Evidence

The level of evidence primarily relied upon for the development of this article was expert opinion.

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

Experts in thyroid cancer representing the fields of endocrinology, endocrine surgery, otolaryngology—head and neck surgery, and radiology were assembled by the American Thyroid Association (ATA) in consultation with the American Association of Endocrine Surgeons, the American Academy of Otolaryngology—Head and Neck Surgery, and the American Head and Neck Society.

The preliminary meeting of this group occurred at the ATA annual meeting in October 2007 with subsequent meetings in July and October 2008. Supplementing these meetings were multiple teleconferences and detailed electronic mail communications culminating in acceptance by the ATA Board of Directors.

In addition to a review of the literature relevant to the central neck compartment anatomy, neck dissection classification and terminology, as well as central neck dissection for thyroid cancer, the authors solicited and considered recommendations from other experts within the fields of endocrinology, endocrine surgery, and otolaryngology—head and neck surgery.

Rating Scheme for the Strength of the Recommendations

Not applicable

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation
External Peer Review
Internal Peer Review
Description of Method of Guideline Validation

This guideline document was accepted by the American Thyroid Association (ATA) Board of Directors. It was also formally endorsed by the Boards of the American Academy of Otolaryngology—Head and Neck Surgery, American Association of Endocrine Surgeons, and American Head and Neck Society.

Recommendations

Major Recommendations

Summary

The most commonly involved central lymph nodes in thyroid carcinoma are the prelaryngeal (Delphian), pretracheal, and the right and left paratracheal nodal basins. A central neck dissection includes comprehensive, compartment-oriented removal of the prelaryngeal and pretracheal nodes and at least one paratracheal lymph node basin. A designation should be made as to whether a unilateral or bilateral dissection is performed and on which side (left or right) in unilateral cases. Lymph node "plucking" or "berry picking" implies removal only of the clinically involved nodes rather than a complete nodal group within the compartment and is not recommended. A therapeutic central compartment neck dissection implies that nodal metastasis is apparent clinically (preoperatively or intraoperatively) or by imaging (clinically N1a). A prophylactic/elective central compartment dissection implies nodal metastasis is not detected clinically or by imaging (clinically N0).

Conclusion

Central neck dissection at a minimum should consist of removal of the prelaryngeal, pretracheal, and paratracheal lymph nodes. The description of a central neck dissection should include both the indication (therapeutic vs. prophylactic/elective) and the extent of the dissection (unilateral or bilateral).

Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

The level of evidence primarily relied upon for the development of this article was expert opinion.

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

Uniformity in definition may lead to more uniform central neck surgery and may facilitate consistent and clear communication among physicians involved in the management of patients with thyroid cancer.

Potential Harms

Not stated

Qualifying Statements

Qualifying Statements
  • Despite the publication of the widely adopted report by Robbins et al., standardizing neck dissection terminology and subsequent updates, there remains controversy regarding the inferior extent of the central neck dissection, validity of unilateral versus bilateral central neck dissection, and inconsistent terminology regarding indications such as routine rather than therapeutic versus prophylactic/elective.
  • Specific recommendations regarding indications for central neck dissection are beyond the scope of this consensus statement.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools
Foreign Language Translations
Patient Resources
For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Staying Healthy
IOM Domain
Effectiveness

Identifying Information and Availability

Bibliographic Source(s)
American Thyroid Association Surgery Working Group, Carty SE, Cooper DS, Doherty GM, Duh QY, Kloos RT, Mandel SJ, Randolph GW, Stack BC Jr, Steward DL, Terris DJ, Thompson GB, Tufano RP, Tuttle RM, Udelsman R. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009 Nov;19(11):1153-8. [5 references] PubMed External Web Site Policy
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
2009 Nov
Guideline Developer(s)
American Thyroid Association - Professional Association
Source(s) of Funding

American Thyroid Association

Guideline Committee

The American Thyroid Association Surgery Working Group

Composition of Group That Authored the Guideline

Authors: Sally E. Carty, Department of Surgery, Section of Endocrine Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; David S. Cooper, Division of Endocrinology and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Gerard M. Doherty, Department of Surgery, University of Michigan Health Systems, Ann Arbor, Michigan; Quan-Yang Duh, Surgical Services, Veterans Affairs Medical Center and University of California, San Francisco, California; Richard T. Kloos, Divisions of Endocrinology, Diabetes and Metabolism and Nuclear Medicine; Departments of Internal Medicine and Radiology; The Ohio State University, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, and The Ohio State University Comprehensive Cancer Center, Columbus, Ohio; Susan J. Mandel, Division of Endocrinology, Diabetes and Metabolism, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Gregory W. Randolph, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Brendan C. Stack, Jr., Department of Otolaryngology—Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; David L. Steward, Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; David J. Terris, Department of Otolaryngology—Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia; Geoffrey B. Thompson, Mayo Clinic, Rochester, Minnesota; Ralph P. Tufano, Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; R. Michael Tuttle, Department of Endocrinology, Memorial Sloan-Kettering Cancer Center, New York, New York; Robert Udelsman, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut

Financial Disclosures/Conflicts of Interest

GMD is a consultant for MedTronic ENT. RTK has received grant-research support from Genzyme, Bayer-Onyx, Eisai, and Veracyte; is a consultant for Genzyme, Bayer-Onyx, Abbott, and Veracyte; and is on the Speakers Bureau for Genzyme and Abbott. He has received no honoraria for commercial speaking since November 2006 and all commercial consulting since that time has been approved by the American Thyroid Association (ATA) Board of Directors, the ATA Ethics Committee, and has been without financial compensation. SJM has received grant-research support from Veracyte and has been a CME speaker for Genzyme. GWR has been a consultant for Genzyme. DLS has received grant-research support from Veracyte, Wyeth, Astra-Zeneca, and Gyrus. RMT is a consultant for Genzyme, Abbott, and Eli Lilly, and has received honoraria from Genzyme and Abbott. SEC, DSC, Q-YD, BCS Jr., DJT, GBT, RPT, and RU report that no competing financial interests exist.

Guideline Status

This is the current release of the guideline.

Guideline Availability

Electronic copies: Available in Portable Document Format (PDF) from the American Thyroid Association (ATA) Web site External Web Site Policy.

Print copies: Available from American Thyroid Association, 6066 Leesburg Pike, Suite 550, Falls Church, VA 22041.

Availability of Companion Documents

None available

Patient Resources

The following is available:

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC Status

This NGC summary was completed by ECRI Institute on September 21, 2010. The information was verified by the guideline developer on December 2, 2010.

Copyright Statement

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

Disclaimer

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