Management of the Central and Lateral Neck in Patients with Differentiated Thyroid Cancer

Abstract

The incidence of differentiated thyroid cancer, including papillary, follicular, and Hurthle cell histologies, is increasing rapidly in the United States. It is associated with significant risk of locoregional lymph node metastasis; this is especially true for papillary thyroid cancer (PTC), which now accounts for approximately 90 % of all new thyroid cancer diagnoses. Overall, differentiated thyroid cancer is associated with a good prognosis and excellent long-term survival. There is contentious debate about the merits of prophylactic central compartment lymph node dissection for this disease, as there has not been convincing evidence to support it; a randomized controlled trial is unlikely. There are nuances in best practice for management and surveillance of patients with a history of nodal disease, as they are at increased risk for recurrence. This is a comprehensive review of the literature, including the recently published American Thyroid Association (ATA) guidelines for the management of thyroid nodules and differentiated thyroid cancer in adult patients, focusing on the management of nodal disease.