Management of the Neck in Well-Differentiated Thyroid Cancer

Abstract

Purpose of Review In this narrative review, we discuss the indications for elective and therapeutic neck dissections and the postoperative surveillance and treatment options for recurrent nodal disease in patients with well-differentiated thyroid cancer. Recent Findings Increased availability of advanced imaging modalities has led to an increased detection rate of previously occult nodal disease in thyroid cancer. Nodal metastases are more common in young patients, large primary tumors, specific genotypes, and certain histological types. While clinically evident nodal disease in the lateral neck compartments has a significant oncological impact, particularly in the older age group, microscopic metastases to the central or the lateral neck in well-differentiated thyroid cancer do not significantly affect outcome. Summary As patients with clinically evident nodal disease are associated with worse outcomes, they should be treated surgically in order to reduce rates of regional recurrence and improve survival. The benefit of elective neck dissection remains unverified as the impact of microscopic disease on outcomes is not significant. Keywords Lymphatic metastasis . Neck dissection . Thyroid neoplasmsThis article is part of the Topical Collection on Head and Neck Cancers This article was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com).

The Necessity of Lymph Node Dissection Between Sternocleidomastoid and Sternohyoid Muscles in pN1b Papillary Thyroid Carcinoma

“…Tumor stage was another important predictor. Usually, thyroid LNs only drain to deep cervical LNs, but rarely metastasize to superficial cervical LNs ( 17 ). However, advanced stage tumors can invade peripheral tissues such as anterior cervical muscles; cancer cells can then cause LNSS enlargement through the superficial cervical lymphatic drainage system.…”

Management of lateral neck nodes in common and aggressive variants of thyroid cancer

“…The incidence of nodal metastasis is quite high in papillary carcinoma ranging between 50 and 60% in the central compartment and approximately 20-30% in the lateral compartment [3]. Traditionally, elective nodal dissection has been avoided in papillary carcinoma of the thyroid, as most patients can forgo surgery and still live a normal life with microscopic disease either in the central or in the lateral neck.…”

A Novel Metastasis-related Genes Based Signature for Predicting the Progression-free Interval of Patients With Papillary Thyroid Carcinoma

“…Local invasion and intravasation into the bloodstream, survival in the circulation, and growth in new organ environments are primary features of metastasis [12]. TC frequently metastasizes to the lymph nodes of the neck, and the rate of occult nodal metastases in PTC has been reported to be as high as 60-80% [13,14]. In 60% to 75% of cases of TC recurrence, the phenomenon occurs in the cervical lymph nodes [15].…”