Most patients with papillary thyroid carcinoma (PTC) have excellent disease-specific survival (DSS). Even with lymph node metastatic recurrence, the 10-year survival is 85%, and 15-year survival 73%. There is a growing trend of minimising morbidity in differentiated thyroid carcinoma (DTC) with more watchful waiting rather than surgery. This retrospective study from Japan, where the serial monitoring of patients with DTC has been common for many years, looks to assess how best to manage individual patients with lymph node recurrence. This trial assessed 83 consecutive patients with PTC and at least one metastatic lymph node on postoperative US FNAC or thyroglobulin needle washes. Patients were not offered serial monitoring if they had poorly differentiated disease, grossly PET positive disease or cervical lymph nodes greater than 3cm in size.
The study found that patients over 45 and lymph nodes that grew at more than 3mm/year had significantly worse DSS, and as such, intervention rather than monitoring appears to be the preferred option.
Of note, the National Comprehensive Cancer Network guidelines state that surgery is the preferred option for locoregional recurrence.
