Arch. Endocrinol. Metab. 2024;68: e230436
Cervical lymph node metastases in patients with differentiated thyroid cancer: A new (and more relevant) indication of active surveillance?
DOI: 10.20945/2359-4292-2023-0436
The timeless saying “medicine is an ever-changing science” remains as true as ever. Within the realm of thyroid cancer, recent years have witnessed a significant accumulation of evidence that has ushered in remarkable transformations in the principles that guide management decisions. We are evolving to achieve care that aligns proportionality (administering treatments according to the tumor’s aggressiveness), enhancing value-based and integrating patient preferences to prioritize patient-centered outcomes.
Despite the generally positive outlook for patients with differentiated thyroid carcinoma (DTC), approximately 30% of individuals experience persistent or recurrent disease, frequently found in cervical lymph nodes (). Traditionally, the primary approach to managing cervical disease in these patients has been surgical intervention, with some patients undergoing multiple procedures in pursuit of disease control or cure. Unfortunately, these objectives are not consistently met, and surgery carries the risk of potential complications such as hypoparathyroidism and voice disturbances and imposes significant emotional, time, and financial burdens (,). Nevertheless, the 2015 American Thyroid Association (ATA) Management Guidelines for Adult Patients with Thyroid Nodules and DTC strongly recommended therapeutic compartmental central or lateral neck dissection for patients with biopsy-proven persistent or recurrent disease in cervical lymph nodes based on specific size criteria. These criteria include a minimum size of ≥ 8 mm in the central compartment and ≥ 10 mm in the lateral compartment ().
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