Guidelines from the Brazilian society of surgical oncology regarding indications and technical aspects of neck dissection in papillary, follicular, and medullary thyroid cancers

Sep 28, 2026

Uploaded by Kurz

These guidelines provide specific recommendations for surgical management of neck metastases in patients with papillary, follicular, and medullary thyroid carcinomas. Recommendations were developed from scientific literature (preferably meta-analyses) and international specialty society guidelines, using the American College of Physicians grading system for evidence and recommendation strength. The document addresses elective neck dissection indications, timing and extent of central/lateral/modified radical surgery, the role of molecular tests, and summarizes key practice recommendations for recurrence and mortality risk reduction.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Epidemiology of thyroid nodules

Need to rule out thyroid cancer

Increasing incidence and diagnostic advances

consensus Guidelines from the Brazilian society of surgical oncology regarding indications and technical aspects of neck dissection in papillary, follicular, and medullary thyroid cancers Terence Farias1,2,3,4 [https://orcid.org/0000-0001-7287-5736](https://orcid.org/0000-0001-7287-5736) Luiz Paulo Kowalski3,4,5,6 [https://orcid.org/0000-0002-0481-156X](https://orcid.org/0000-0002-0481-156X) Fernando Dias1,2,3,4 [https://orcid.org/0000-0003-1000-7436](https://orcid.org/0000-0003-1000-7436) [Carlos S. Ritta Barreira](Carlos S. Ritta Barreira3)[3](Carlos S. Ritta Barreira3),[4](4), [7](7)[ ](7)[https://orcid.org/0000-0002-2126-1811](https://orcid.org/0000-0002-2126-1811) José Guilherme Vartanian3,4,5 [https://orcid.org/0000-0003-1995-6742](https://orcid.org/0000-0003-1995-6742) Marcos Roberto Tavares3,6 [https://orcid.org/0000-0002-9244-7058](https://orcid.org/0000-0002-9244-7058) Fernanda Vaisman8 [https://orcid.org/0000-0002-6835-7108](https://orcid.org/0000-0002-6835-7108) Denise Momesso9 [https://orcid.org/0000-0001-6296-2721](https://orcid.org/0000-0001-6296-2721) Alexandre Ferreira Oliveira4,10 [https://orcid.org/0000-0002-7500-6752](https://orcid.org/0000-0002-7500-6752) Rodrigo Nascimento Pinheiro4,11 [https://orcid.org/0000-0002-2715-7628](https://orcid.org/0000-0002-2715-7628) Heber Salvador de Castro Ribeiro4,12 [https://orcid.org/0000-0002-3412-7451](https://orcid.org/0000-0002-3412-7451) ABSTRACT Objective: The purpose of these guidelines is to provide specific recommendations for the surgical treatment of neck metastases in patients with papillary, follicular, and medullary thyroid carcinomas. Materials and methods: Recommendations were developed based on research of scientific articles (preferentially meta-analyses) and guidelines issued by international medical specialty societies. The American College of Physicians’ Guideline Grading System was used to determine the levels of evidence and grades of recommendations.The following questions were answered: A) Is elective neck dissection indicated in the treatment of papillary, follicular, and medullary thyroid carcinoma? B) When should central, lateral, and modified radical neck dissection be performed? C) Could molecular tests guide the extent of the neck dissection? Results/conclusion: Recommendation 1: Elective central neck dissection is not indicated in patients with cN0 well-differentiated thyroid carcinoma or in those with noninvasiveT1 andT2 tumors but may be considered inT3-T4 tumors orin the presence of metastases in the lateral neck compartments. Recommendation 2: Elective central neck dissection is recommended in medullary thyroid carcinoma. Recommendation 3: Selective neck dissection of levels II–V should be indicated to treat neck metastases in papillary thyroid cancer, an approach that decreases the risk of recurrence and mortality. Recommendation 4: Compartmental neck dissection is indicated in the treatment of lymph node recurrence after elective or therapeutic neck dissection; “berry node picking” is not recommended. Recommendation 5:There are currently no recommendations regarding the use of molecular tests in guiding the extent of neck dissection in thyroid cancer. Keywords Thyroid carcinoma; surgical treatment; papillary thyroid cancer; medullary thyroid cancer; follicular thyroid cancer; lymph node metastasis; elective neck dissection; therapeutic neck dissection; molecular tests; indications; guidelines 1 Instituto Nacional de Câncer, Ringgold Standard Institution, Cabeça e Pescoço, Rio de Janeiro, RJ, Brasil 2 Pontifícia Universidade Católica do Rio de Janeiro, Ringgold Standard Institution, Pós-graduação em Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brasil 3 Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Ringgold Standard Institution, São Paulo, SP, Brasil 4 Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil 5 A. C. Camargo Cancer

FAQs

What is the main objective of these guidelines?

To provide specific recommendations for surgical treatment of neck metastases in patients with papillary, follicular, and medullary thyroid carcinomas.

When is elective central neck dissection recommended or not recommended?

It is not indicated for cN0 well-differentiated thyroid carcinoma or noninvasive T1–T2 tumors, but may be considered for T3–T4 tumors or when there are lateral neck metastases. It is recommended in medullary thyroid carcinoma.

Are molecular tests recommended to guide the extent of neck dissection?

No. The guidelines state that there are currently no recommendations supporting the use of molecular tests to guide neck dissection extent in thyroid cancer.

Sep 28, 2026

Uploaded by Kurz