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Vol. 98. Issue 8.
Pages 497-498 (October 2020)
Vol. 98. Issue 8.
Pages 497-498 (October 2020)
Letter to the Editor
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Reply - Risk factors of metastatic lymph nodes in papillary thyroid microcarcinoma
Respuesta - Factores de riesgo de metástasis ganglionares en el microcarcinoma papilar de tiroides
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José Ruiz Pardoa,
Corresponding author
josrp@hotmail.es

Corresponding author.
, José Manuel Rodrígueza,b,c, Antonio Ríosa,b,c
a Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
b Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
c Departamento de Cirugía, Pediatría y Obstetricia, y Ginecología, Universidad de Murcia, Murcia, Spain
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To the Editor:

First of all, we would like to thank Dr. González and Dr. Franch Arcas for their comment on our article “Risk Factors for Lymph Node Metastasis in Papillary Thyroid Microcarcinoma”.1

The authors’ comments are interesting. However, several factors must be considered, as they determine the study design carried out instead of strictly comparing those cases in which only central lymph node dissection was performed (11 vs. 11 cases, with and without central metastatic lymphadenopathies, respectively).

What initially determines the design of our study is the fact that prophylactic central node dissection in papillary microcarcinoma is practically not performed today. When Dr. González and Dr. Franch Arcas argue that prophylactic dissection of the central compartment is routinely performed, the references they indicate are from Asian centers, where this technique is more widespread.2,3 However, this trend is currently changing, and the treatment that is being used more extensively in these groups involves ‘active surveillance’, meaning conservative management with follow-up and no therapeutic actions. The small percentage of microcarcinomas that are treated surgically are those that present tumor evolution4 and are therefore more aggressive and consequently present greater lymphatic involvement.

Thus, if we only compare patients with central lymph node dissection, a comparison would be made between microcarcinomas with a worse prognosis,1–5 since this the situation in which it is considered. This would provide an unrealistic view of the microcarcinomas treated and exclude the majority of tumors that present an excellent prognosis.

In this context, it is accepted that patients who have been treated with surgery and who, after a long follow-up, meet criteria for cure can be considered cured and do not present lymph node extension. Nevertheless, there will always be a small doubt as to whether or not a subclinical micrometastasis occurred that remained latent over time.

As our colleagues Dr. González and Dr. Franch Arcas have indicated, it is not possible to carry out randomized prospective studies that would resolve all these uncertainties. Above all, because central lymph node dissection is not harmless and entails morbidity.6 Also, there is currently no solid evidence to recommend prophylactic central lymph node dissection in papillary microcarcinomas with a good prognosis (quite the opposite).7 What is important is to be able to select that small percentage of cases that could benefit from therapeutic central lymph node dissection. Despite its limitations, our study tried to address this objective.1

For all these reasons, we consider that the comparison of the groups performed in the study is useful.1

References
[1]
J. Ruiz Pardo, A. Ríos, J.M. Rodríguez, M. Paredes, V. Soriano, M.I. Oviedo, et al.
Risk factors of metastatic lymph nodes in papillary thyroid microcarcinoma.
[2]
Y. Luo, Y. Zhao, K. Chen, J. Shen, J. Shi, S. Lu, et al.
Clinical analysis of cervical lymph node metastasis rick factors in patients with papillary thyroid microcarcinoma.
J Endocrinol Invest, 42 (2019), pp. 227-236
[3]
C. Zhang, B.J. Li, Z. Liu, L.L. Wang, W. Cheng.
Predicting the factors associated with central lymph node metastasis in clinical node negative (cN0) papillary thyroid microcarcinoma.
Eur Arch Otorhinolaryngol, 277 (2020), pp. 1191-1198
[4]
A. Miyauchi, Y. Ito.
Conservative surveillance management of low risk papillary thyroid microcarcinoma.
Endocrinol Metab Clin North Am, 48 (2019), pp. 215-226
[5]
A. Ríos, J.M. Rodríguez, N. Ibáñez, A. Piñero, P. Parrilla.
Detection of the sentinel node using a magnetic tracer in thyroid cancer. A technical pilot study.
[6]
A.R. Zambudio, J. Rodríguez, J. Riquelme, T. Soria, M. Canteras, P. Parrilla.
Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery.
[7]
B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov, et al.
2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer.
Thyroid, 26 (2016), pp. 1-133

Please cite this article as: Ruiz Pardo J, Rodríguez JM, Ríos A. Respuesta - Factores de riesgo de metástasis ganglionares en el microcarcinoma papilar de tiroides. Cir Esp. 2020;98:497–498.

Copyright © 2020. AEC
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