What are the NCCN and ATA treatment guidelines for papillary thyroid cancer (PTC)?

Updated: Jun 24, 2020
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NCCN guidelines recommend total thyroidectomy for patients who meet any of the following criteria [5] :

  • History of radiaiton exposure
  • Known distant metastases
  • Bilateral nodularity 
  • Extrathyroidal extension
  • Tumor >4 cm in diameter
  • Cervical lymph node metastases
  • Poorly differentiated tumor

The NCCN considers either total thyroidectomy or lobectomy to be acceptable for patients who meet all of the following criteria [5] :

  • No prior radiation
  • No distant metastases
  • No cervical lymph node metastases
  • No extrathyroidal extension
  • Tumor < 4 cm in diameter

If a lobectomy is performed, completion of the thyroidectomy is recommended for any of the following [5] :

  • Tumor >4 cm in diameter
  • Positive margins
  • Extrathyroidal extension
  • Macroscopic multifocal disease
  • Macroscopic nodal metastases
  • Confirmed contralateral disease
  • Vascular invasion
  • Poorly differentiated

ATA guidelines recommend near-total or total thyroidectomy for all patients with thyroid cancer >1 cm, unless there are contraindications to this surgery. Lobectomy may be considered for small (< 1 cm), low-risk, thyroidal papillary carcinomas in the absence of prior radiation or clinically involved cervical nodal metastases. [1]

Both the NCCN and ATA recommend that therapeutic neck dissection for patients with clinically involved central or lateral neck lymph nodes should accompany total thyroidectomy to provide clearance of disease from the central neck. The ATA, but not the NCCN, advises that prophylactic central-compartment neck dissection (level VI) may be considered in patients with clinically uninvolved central neck lymph nodes, especially for advanced primary tumors (T3 or T4). [1, 5]

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