How Far Should We Go in the Search and Treatment of Recurrent or Persistent Lymph Node Metastases during Follow-Up of Thyroid Cancer Patients?

摘要

'In the sub-categories of both primary intraglandular (thyroid) carcinoma... and primary extraglandular carcinoma... the presence of pathologically defined lymph nodes ameliorated the prognosis. Furthermore, the greater the number of lymph node metastases, the lesser the mortality.' This statement was reported by Cady et al. [1] (and confirmed by other authors) upon review of a series of differentiated thyroid cancer patients treated at the La-hey Clinic in 1976. Such a statement suggests two considerations: first, the indolent biological course of lymph node metastases, and, second, the low detection rate of lymph node metastases in the 1970s. At that time, neither neck ultrasound (US) nor serum thyroglobulin (Tg) measurements were available in clinical practice and, thus, microscopic lymph nodes were rarely detected and the patients were considered cured. With the introduction of serum Tg measurement, as a sensitive marker of even minimal disease, and of routine exploration of the neck by US, more and more patients show persistent disease in the neck nodes. Do we have to be concerned with these lymph nodes? Do we have to force their search and treatment? These are the questions that we are facing.