Current controversies in the management of neck node metastasis in differentiated thyroid cancer

Abstract

The incidence of nodal metastasis is quite common in well-differentiated thyroid cancer. However, its clinical significance is generally quite minimal. The adverse pathological features need to be recognized. The debate continues over prophylactic central compartment dissection. However, it needs to be re-evaluated in terms of complications of elective procedure. The extent of lateral neck dissection is standardized from level II through level V. Recurrent nodal disease is more likely to be persistent nodal disease. Appropriate preoperative imaging is very crucial. Surgery for recurrent disease needs to be considered based on nodal prognostic factors and location of the disease. The approach of using active surveillance and continuous monitoring is reasonable, especially for recurrence below 1 cm.

Keywords

Thyroid cancer / well-differentiated thyroid cancer / nodal metastasis / active surveillance / continuous monitoring / management

References

[1] Ahn HS,Welch HG.Korea’s thyroid-cancer "epidemic"-screening and overdiagnosis.N Engl J Med2014;371:1765-7

[2] Wada N,Sugino K.Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection.Ann Surg2003;237:399-407 PMCID:PMC1514312

[3] Asimakopoulos P,Nixon IJ.Management of the neck in well-differentiated thyroid cancer.Curr Oncol Rep2020;23:1

[4] Cooper DS,Haugen BR.Management guidelines for patients with thyroid nodules and differentiated thyroid cancer.Thyroid2006;16:109-42

[5] Cooper DS,Haugen BR.Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer.Thyroid2009;19:1167-214

[6] Orloff LA.Preoperative imaging for thyroid cancer: beyond ultrasonography.JAMA Otolaryngol Head Neck Surg2016;142:515-6

[7] Lesnik D,Zurakowski D.Papillary thyroid carcinoma nodal surgery directed by a preoperative radiographic map utilizing CT scan and ultrasound in all primary and reoperative patients.Head Neck2014;36:191-202

[8] Mazzaferri EL,Steward DL.The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma.Thyroid2009;19:683-9

[9] Eskander A,Griffiths R.Surgeon thyroidectomy case volume impacts disease-free survival in the management of thyroid cancer.Laryngoscope2023;133 Suppl 4:S1-15

[10] Gonçalves Filho J,Ahmad FI.Decision making for the central compartment in differentiated thyroid cancer.Eur J Surg Oncol2018;44:1671-8

[11] Araque KA,Klubo-Gwiezdzinska J.Updates on the management of thyroid cancer.Horm Metab Res2020;52:562-77 PMCID:PMC7415555

[12] Dismukes J,Obiarinze R.Prophylactic central neck dissection in papillary thyroid carcinoma: all risks, no reward.J Surg Res2021;264:230-5 PMCID:PMC8222095

[13] Dolidze DD,Mumladze RB.A narrative review of preventive central lymph node dissection in patients with papillary thyroid cancer - a necessity or an excess.Front Oncol2022;12:906695

[14] Iyer NG.Controversies and challenges in the management of well-differentiated thyroid cancer.Indian J Surg2009;71:299-307 PMCID:PMC3452739

[15] Moussa AM,Gonzalez-Aguirre AJ,Shaha AR.Thoracic duct embolization in post-neck dissection chylous leakage: a case series of six patients and review of the literature.Cardiovasc Intervent Radiol2020;43:931-7 PMCID:PMC8339939

[16] Shaha AR.Editorial: complications of neck dissection for thyroid cancer.Ann Surg Oncol2008;15:397-9 PMCID:PMC2244697

[17] Hay ID,Davidge-Pitts C,Charboneau JW.Long-term outcome of ultrasound-guided percutaneous ethanol ablation of selected "recurrent" neck nodal metastases in 25 patients with TNM stages III or IVA papillary thyroid carcinoma previously treated by surgery and 131I therapy.Surgery2013;154:1448-54; discussion 1454-5

[18] Randolph GW,Heller KS.The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension.Thyroid2012;22:1144-52

[19] Haugen BR,Bible KC.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.Thyroid2016;26:1-133

[20] Tao Y,Shen X.BRAF V600E status sharply differentiates lymph node metastasis-associated mortality risk in papillary thyroid cancer.J Clin Endocrinol Metab2021;106:3228-38