Thyroid Cancer Nodal Metastases: Biologic Significance and Therapeutic Considerations

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

“…Differentiated thyroid carcinoma (particularly papillary carcinoma) involves cervical lymph nodes in 20%-50% of patients in most series using standard pathologic techniques (75)(76)(77)(78)(79), and may be present even when the primary tumor is small and intrathyroidal (37,80). The frequency of micrometastases may approach 90%, depending on the sensitivity of the detection method (81,82).…”

“…Thyroid lobectomy alone may be sufficient treatment for small, low-risk, isolated, intrathyroidal papillary carcinomas in the absence of cervical nodal metastases-Recommendation A Lymph node dissection. Regional lymph node metastases are present at the time of diagnosis in 20%-90% of patients with papillary carcinoma and a lesser proportion of patients with other histotypes (75,102). In many cases, these lymph nodes do not appear abnormal to inspection (103).…”

“…Routine central-compartment (level VI) neck dissection should be considered for patients with papillary thyroid carcinoma and suspected Hürthle carcinoma. Near-total or total thyroidectomy without central node dissection may be appropriate for follicular cancer, and when followed by radioactive iodine therapy, may provide an alternative approach for papillary and Hürthle cell cancers-Recommendation B Lymph nodes in the lateral neck (compartments II-IV) and posterior triangle (compartment V) may also be involved by thyroid cancer, most often in papillary and Hürthle cell carcinoma (75,108). For those patients in whom nodal disease is evident clinically, on preoperative ultrasound, or at the time of surgery, surgical resection may reduce the risk of recurrence and possibly mortality (102,109,110).…”

Safety and Prognostic Impact of Prophylactic Level VII Lymph Node Dissection for Papillary Thyroid Carcinoma

“…In 1956, Crile noted the anatomical continuity of level VI and level VII nodes Crile (1956), which was described later, by Grebe and Hay in 1996, as a lymphatic continuity between the neck and the superior mediastinum (Grebe and Hay, 1996).…”

Radioiodine Avid Axillary Lymph Node Metastasis in Papillary Thyroid Cancer: Report of a Case

“…Regional lymph node metastasis is a very frequent finding in DTC. However, non regional lymph node metastasis especially to the axillary nodes has been rarely reported in literature and it is not considered to be a typical site for metastasis from DTC [3].…”