Nodal Metastases in Thyroid Cancer: Prognostic Implications and Management

Abstract

The significance of cervical lymph node metastases in differentiated thyroid cancer has been controversial and continues to evolve. Current staging systems consider nodal metastases to confer a poorer prognosis, particularly in older patients. Increasingly, the literature suggests that characteristics of the metastatic lymph nodes such as size and number are also prognostic. There is a growing trend toward less aggressive treatment of low-volume nodal disease. The aim of this review is to summarize the current literature and discuss prognostic and management implications of lymph node metastases in differentiated thyroid cancer.

Clinical outcomes of low and intermediate risk differentiated thyroid cancer patients treated with 30mCi for ablation or without radioactive iodine therapy

“…Furthermore, Wang and cols. demonstrated that properly selected patients, even with affected lymph nodes, should not necessarily receive RRA (30,31).…”

Significance and management of incidentally diagnosed metastatic papillary thyroid carcinoma in cervical lymph nodes in neck dissection specimens

“…Although several patients died in our cohort from their HNSCC, not a single patient died from recurrent or metastatic PTC. This is not surprising, as it is well known that patients with metastatic thyroid cancer and certain demographic and histopathological features have favorable outcomes …”

“…This is not surprising, as it is well known that patients with metastatic thyroid cancer and certain demographic and histopathological features have favorable outcomes. 16,17 Although a good prognosis for patients with an incidentally discovered metastatic PTC has been reported previously, the general management strategies have not been well defined in such patients. [7][8][9] Although some authors suggest a total thyroidectomy for these patients, others suggest a less aggressive approach in management of the thyroid gland, as well as dissection of the central compartment lymph nodes.…”

Modified risk stratification based on cervical lymph node metastases following lobectomy for papillary thyroid carcinoma

“…Although patients with intermediate‐N1a disease had poorer DFS than those with N0 or low‐N1a disease, as analysed earlier, this study aimed to identify factors that can be used to subclassify those patients within the intermediate‐N1a group with a higher risk of structural persistent/recurrent disease and minimize unnecessary additional treatments. Previous studies that evaluated the prognostic impacts of specific characteristics of LNs revealed ENE as a useful prognostic factor, with one study reporting ENE as the most important LN characteristic predictive of recurrence in patients with central compartment disease . Considered to occur in the late stage of the progression pathway for PTC, ENE increases the risk of LN recurrence, distant metastasis and disease‐specific mortality .…”