Sub-centimetric recurrent and persistent metastatic lymph nodes in well-differentiated thyroid cancer: Operate or observe?

JOURNAL TITLE: Indian Journal of Endocrine Surgery and Research

Author
1. Goonj Johri
2. Sanjeet Kumar Jaiswal
3. Nishtha Yadav
4. Chandan Kumar Jha
5. Sanjay Kumar Yadav
6. Arvind Baghel
7. Ashutosh Silodia
ISSN
DOI
10.5005//jp-journals-10088-11139
Volume
15
Issue
1
Publishing Year
2020
Pages
3
Author Affiliations
    1. Assistant Professor, Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, India
    1. Assistant Professor, Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
    1. Assitant Professor (Endocrine Surgery), Department of Surgery, AIIMS, Patna, India
    1. Professor, Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
    1. Associate Professor, Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
    1. Department of Radiodiagnosis and Imaging, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
    1. Assistant Professor, Department of Endocrine Surgery, KIMS, Bhubaneswar
  • Article keywords
    Differentiated thyroid cancer, Metastatic lymph node, lymph node dissection, recurrent lymph node, persistent lymph node

    Abstract

    Differentiated thyroid carcinoma (DTC) constitutes > 90% of all thyroid cancers and is generally associated with a very good prognosis due to effective surgery and adjuvant therapies. The overall survival (OS) rate at 10 years is reported to be 80 to 94%. Despite an excellent prognosis, locoregional recurrences are common and warrant lifelong follow up. Locoregional recurrence is a significant cause of morbidity among DTC patients. Various studies have reported that mortality in DTC patients is directly related to loco-regional recurrence. Optimal treatment for the management of recurrent/persistent lymph nodes in DTC is still debatable, especially for low volume disease. Modalities available for treatment are either surgery/and RAI or observation. Local ablative therapies like alcohol ablation and radiofrequency ablation are also being used by various groups. The contentious issue is recurrences of less than one centimeter. Follow up with Tg/ATg and USG neck is a reasonable alternative to surgery as finding subcentimetric lymph node in scarred tissue is particularly difficult even in expert hands.

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