Role of surgery in anaplastic carcinoma of the thyroid Anaplastic carcinoma of the thyroid accounts for < 1% of thyroid cancers but is one of the most aggressive solid tumors known and is rarely curable. Median survival is about 6 months. At the time of diagnosis, 50% of patients harbor distant metastases, and 95% have …
Appropriate surgical management for medullary thyroid carcinoma (MTC) MTC accounts for < 5% of thyroid cancers but occurs as part of an inherited syndrome in 20% to 25% of cases. Thus, all patients with MTC should be considered for genetic testing. If the patient has multiple endocrine neoplasia type 2 (MEN 2) syndrome, a prophylactic …
What is a central and modified radical neck dissection? A central neck dissection removes all the perithyroidal and tracheoesophageal groove nodes (level VI) from the hyoid bone superiorly down to the sternal notch. Laterally, the dissection extends from carotid to carotid artery. The lateral spread of disease usually involves the jugular lymph nodes (levels II–IV) …
What is the incidence of lymph node metastases in differentiated thyroid cancer (DTC), and when is a neck dissection indicated? DTC (predominantly papillary) involves cervical lymph nodes in 30% to 80% of cases. In the majority of cases, the metastatic nodes are not clinically evident; therefore, all patients should undergo preoperative full-neck ultrasonography to assess …
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What is the role for molecular testing of thyroid nodules? About 15% to 30% of thyroid nodules are cytologically indeterminate on FNA (Bethesda III and IV), and the majority (60%–85%) of these nodules are benign. The goal of molecular diagnostic testing of thyroid nodules is to further stratify the risk of malignancy in those with …
Why not just do an intraoperative frozen section on indeterminate thyroid nodules to help guide the extent of surgery? Unfortunately, the accuracy of frozen section for most thyroid nodules is not much better than FNA and is, therefore, not routinely used. To distinguish a benign from malignant follicular thyroid lesion requires a detailed assessment for …
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Using the bethesda system, list the possible results of fine-needle aspiration (FNA) of thyroid nodules and describe the appropriate surgical intervention. • Nondiagnostic: Repeat FNA with ultrasound guidance. Thyroid lobectomy if still non-diagnostic. • Benign: Risk of cancer is < 5%. Clinical follow-up is appropriate. • Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS): Risk of cancer …