DIFFERENTIATED
THYROID CANCER; MANAGEMENT OF NODAL RECURRENCE FOLLOWING PRIMARY TREATMENT
Neck
ultrasonography, performed with a high-frequency probe (≥ 10 MHz), is highly sensitive in detecting cervical nodal recurrence.
Ultrasonographically suspicious lymph nodes ≥ 8 – 10 mm in
the smallest diameter should be biopsied for cytology with thyroglobulin (Tg)
measurement in the needle washout fluid. US guidance is necessary to improve diagnostic
accuracy of FNA, in particular for small lymph nodes and for those located deep
in the neck. However, it should be remembered that FNA cytology misses thyroid
cancer in a significant proportion (up to 20 – 30 %) of patients. The
combination of cytology and Tg measurement in the aspirate fluid increases sensitivity.
Increased Tg levels (> 10 ng/mL) are highly suspicious. Suspicious lymph
nodes < 8 – 10 mm in smallest diameter may be followed without biopsy, with
consideration for FNA or therapeutic intervention if there is growth or if the
node threatens vital structures.
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