Diagnosis
Table 1. Variables to Consider When Deciding How Best to
Manage a Differentiated Thyroid Cancer Patient with
Recurrent/Persistent Nodal Disease (cont'd)
Variables
Consider active
surveillance Consider surgery
Comorbidities for surgery Yes No
Invasion into/proximity to critical anatomic
structures
No Yes
Good long-term prognosis No Yes
Patient wishes to undergo surgery No Yes
Disease likely to be identified intraoperatively No Yes
Biological considerations
RAI-avid
b
Yes No
(unless other criteria
for surgery met)
FDG-PET-avid No Yes
Aggressive histolog y No Yes
Extrathyroidal extension of primary tumor No Yes
More advanced initial T stage (>4 cm) and
more advanced nodal disease
No Yes
Extranodal extension (features of nodes at
initial surgery)
No Yes
Molecular prognosticator for aggressive
biolog y (see full text of article)
No Yes
Surgical technical considerations
First recurrence in that compartment? No Yes
Recurrent or persistent disease in previously
formally dissected compartment or multiple
dissections in same compartment
c
Stable disease Limited/focused
dissection if
progressive disease and
threatening important
structures
a
Most authors agree that nodes <1 cm can usually be observed. However, depending on the unique
situation of each patient, it may be reasonable to avoid surgery on nodes as large as 1.5–2 cm in carefully
selected patients.
b
Active surveillance or RAI therapy are both reasonable options if the lymph node metastasis is RAI-avid.
c
Initial intervention was a formal attempt at central or lateral neck dissection and not just a node plucking
or limited retrieval of nodes.
