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This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.
Dear Reader
Thank you very much for showing interest in our article. The point wise reply to your queries is as under:
1. Did the authors perform CCLND (prophylactic and therapeutic) and what proportion of these patients had recurrence?
CCLND was carried out in patients with clearly documented level VI nodes on pre-operative ultrasound or CT scan. For those with no clearly identifiable nodes, a meticulous inspection of the central compartment was undertaken by the surgical team and converted in to a central compartment dissection if there was on-table evidence of abnormal lymph nodes or frozen section was positive for a metastatic lymph node.
The current article is not targeted to study the recurrence rate of the above approach and we are looking at long term follow up of our cohort and will be interested in sharing this details once we have collected them.
2. Did any of the patients have foci of poorly differentiated carcinoma?
None of our patients included in this study had poorly differentiated or anaplastic thyroid cancer in the final pathology. We had 8 patients with tall cell variant PTC, 2 Hurtle cell cancers and 2 widely invasive FVPTC. We agree that in patients with poorly differentiated thyroid cancer reliability of thyroglobulin or anti-Tg becomes low and multi-modal imaging is often used to see the response to treatment.
3. How many Patients had metastasis at the time of presentation? Did any of these patients have Contrast Enhanced CT scan as pre-operative imaging?
Twenty four patients presented with lymph node metastasis in the lateral compartment of the neck, one patient presented with a chest wall mass and two patients presenting with Lung lesions on pre-operative chest X-Ray. All patients with bulky lymph nodal metastasis and those with distant metastasis underwent CT neck and chest/abdomen as part of pre-operative work up. Radio-iodine scan was deferred by at least 3 months after these scans.
4. Did any of these patients haveraisingTg level with no finding on iodine whole body scan which necessitated PET scan?
Two patients with TENIS syndrome (Tg levels 181 and 420 ng/ml with negative antibodies) had negative Iodine scan and underwent PET-CT scan which also did not show metastatic disease. Both these patients have undergone empirical radio-iodine therapy, post therapy scan being negative. These patients are on follow up with close monitoring of Tg and neck imaging.