Management of the Neck in Well-Differentiated Thyroid Cancer
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HEAD AND NECK CANCERS (EY HANNA, SECTION EDITOR)
Management of the Neck in Well-Differentiated Thyroid Cancer Panagiotis Asimakopoulos 1 & Ashok R. Shaha 1 & Iain J. Nixon 2 & Jatin P. Shah 1 & Gregory W. Randolph 3 & Peter Angelos 4 & Mark E. Zafereo 5 & Luiz P. Kowalski 6,7 & Dana M. Hartl 8,9 & Kerry D. Olsen 10 & Juan P. Rodrigo 11,12,13 & Vincent Vander Poorten 14,15 & Antti A. Mäkitie 16 & Alvaro Sanabria 17,18 & Carlos Suárez 19 & Miquel Quer 20,21 & Francisco J. Civantos 22 & K. Thomas Robbins 23 & Orlando Guntinas-Lichius 24 & Marc Hamoir 25 & Alessandra Rinaldo 26 & Alfio Ferlito 27 Accepted: 5 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review In this narrative review, we discuss the indications for elective and therapeutic neck dissections and the postoperative surveillance and treatment options for recurrent nodal disease in patients with well-differentiated thyroid cancer. Recent Findings Increased availability of advanced imaging modalities has led to an increased detection rate of previously occult nodal disease in thyroid cancer. Nodal metastases are more common in young patients, large primary tumors, specific genotypes, and certain histological types. While clinically evident nodal disease in the lateral neck compartments has a significant oncological impact, particularly in the older age group, microscopic metastases to the central or the lateral neck in well-differentiated thyroid cancer do not significantly affect outcome. Summary As patients with clinically evident nodal disease are associated with worse outcomes, they should be treated surgically in order to reduce rates of regional recurrence and improve survival. The benefit of elective neck dissection remains unverified as the impact of microscopic disease on outcomes is not significant. Keywords Lymphatic metastasis . Neck dissection . Thyroid neoplasms
Introduction Well-differentiated thyroid cancer (WDTC), which includes papillary and follicular cancer, comprises the vast majority (> 90%) of all thyroid cancers [1]. Thyroid cancer frequently metastasizes to the central and lateral nodal compartments of the neck. The rate of occult nodal metastases in elective central neck dissections performed for papillary thyroid carcinoma has been reported to be as high as 80% by some authors [2, 3]. Patients with clinically positive nodes in the lateral neck have an 83–86% rate of occult positive nodes in the ipsilateral central neck and 34% occult positivity rate in the contralateral central neck compartment [4–6]. This article is part of the Topical Collection on Head and Neck Cancers This article was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com). * Panagiotis Asimakopoulos [email protected] Extended author information available on the last page of the article
Increased availability of advanced imaging modalities and widespread use of thyroglobulin assays have led to an increased detection rate of occult nodal disease in
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