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Shaha. J Cancer Metastasis Treat 2023;9:22 Journal of Cancer
DOI: 10.20517/2394-4722.2022.101
Metastasis and Treatment

Review Open Access

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

Ashok R. Shaha

Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
Correspondence to: Ashok R. Shaha, MD, Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer
Center, 1275 York Avenue, New York, NY 10065, USA. E-mail: shahaa@MSKCC.ORG

How to cite this article: Shaha AR. Current controversies in the management of neck node metastasis in differentiated thyroid
cancer. J Cancer Metastasis Treat 2023;9:22. https://dx.doi.org/10.20517/2394-4722.2022.101

Received: 8 Mar 2022 First Decision: 17 Apr 2023 Revised: 27 Apr 2023 Accepted: 29 May 2023 Published: 1 Jun 2023

Academic Editors: Fausto Chiesa, Rafat A. Siddiqui Copy Editor: Fangling Lan Production Editor: Fangling Lan

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.

Keywords: Thyroid cancer, well-differentiated thyroid cancer, nodal metastasis, active surveillance, continuous
monitoring, management

INTRODUCTION
The incidence of thyroid cancer has rapidly risen around the world, particularly in the United States and
other countries where incidentalomas are commonly found during routine evaluation of the neck both with
clinical examination and imaging studies such as ultrasound, computed tomography (CT) scan, and PET
scan. For example, in South Korea, where ultrasound is part of routine oncologic screening evaluation, it

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
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