7
Recommendation 5
➤ When genomic testing is performed on tumor samples for clinical
purposes, both somatic and germline genetic alterations can
be detected. If a potentially clinically relevant germline cancer-
predisposing variant is detected, evaluate patients and their family
histories for clinical correlation, and consider referral for genetic
counseling for possible germline testing. (C-M)
Treatment
Recommendation 6
➤ Due to lower complication rates and improved outcomes on
average associated with high volume thyroid surgeons (>25–50
thyroidectomies/year), patients with thyroid cancer should be offered
referral to a high-volume surgeon, particularly for tumors requiring
more extensive surgery. (S-M)
Recommendation 7
A. Preoperative neck ultrasound to evaluate cervical lymph nodes
in the central and lateral neck compartments as well as for gross
extrathyroidal extension is recommended for all patients undergoing
surgery for malignant cytologic or molecular findings. (S-M)
B. Ultrasound-guided fine needle aspiration (FNA) of sonographically
suspicious lymph nodes greater than 8–10 mm in the smallest
diameter should be performed to confirm malignancy if this would
change management. (S-M)
C. The addition of FNA-Tg washout in the evaluation of suspicious
cervical lymph nodes may be performed in select preoperative
patients, but interpretation may be difficult in patients with an intact
thyroid gland. (C-L)
