3
32. A) Preoperative neck US for cervical (central and especially lateral
neck compartments) lymph nodes is recommended for all patients
undergoing thyroidectomy for malignant or suspicious for malignancy
cytologic or molecular findings. (SR-M)
B) US-guided FNA of sonographically suspicious lymph nodes
>8–10 mm in the smallest diameter should be performed to confirm
malignancy if this would change management. (SR-M)
C) The addition of FNA-Tg washout in the evaluation of suspicious
cervical lymph nodes is appropriate in select patients, but
interpretation may be difficult in patients with an intact thyroid
gland. (WR-L)
33. A) Preoperative use of cross-sectional imaging studies (CT, MRI) with
intravenous contrast is recommended as an adjunct to ultrasound
for patients with clinical suspicion for advanced disease including
invasive primary tumor, or clinically apparent multiple or bulky
lymph node involvement. (SR-L)
B) Routine preoperative
18
FDG-PET scanning is NOT recommended.
(SR-L)
34. Routine preoperative measurement of serum Tg or Tg antibodies is
NOT recommended. (WR-L)
Differentiated Thyroid Cancer
Guideline Grading System
Strength of Recommendation Quality of Evidence
SR Strong Recommendation H High-quality evidence
WR Weak Recommendation M Moderate-quality evidence
NR No Recommendation L Low-quality evidence
I Insufficient evidence
