Current controversies in the management of neck node metastasis in differentiated thyroid cancer

Abstract

The incidence of nodal metastasis is quite common in well-differentiated thyroid cancer. However, its clinical significance is generally quite minimal. The adverse pathological features need to be recognized. The debate continues over prophylactic central compartment dissection. However, it needs to be re-evaluated in terms of complications of elective procedure. The extent of lateral neck dissection is standardized from level II through level V. Recurrent nodal disease is more likely to be persistent nodal disease. Appropriate preoperative imaging is very crucial. Surgery for recurrent disease needs to be considered based on nodal prognostic factors and location of the disease. The approach of using active surveillance and continuous monitoring is reasonable, especially for recurrence below 1 cm.