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Current approach to detecting neck recurrences in patients with differentiated thyroid cancer: role of neck lymph node fine-needle aspiration biopsy

Purpose of reviewBecause of increasing dependence on neck ultrasonography in clinical practice, the spectrum of patients with differentiated thyroid cancer has changed in the recent years. This review highlights recent suggestions for guidelines in the detection of neck recurrences in patients with differentiated thyroid cancer. Recent findingsNowadays, most differentiated thyroid cancer patients are classified as low risk for death and, as a consequence, the follow-up protocols based mainly on data from high-risk patients no longer apply. Surveillance of thyroid cancer patients with serum thyroglobulin measurements has been proposed in place of diagnostic I-131 whole-body scanning. The diagnostic sensitivity of combined neck ultrasonography and serum thyroglobulin measurement has been reported as high as 98.8%. All suspicious lesions that are accessible to puncture should be subjected to the fine-needle aspiration biopsy with cytologic evaluation. Fine-needle aspiration biopsy cytology of metastatic cervical lymph nodes is a challenging diagnostic category, secondary to this location’s involvement in a variety of extrathyroidal malignancies. Moreover, cystic changes in metastatic lymph nodes from differentiated thyroid cancer may be another diagnostic alternative. The combination of cytology plus thyroglobulin measurement in the eluate from fine-needle aspiration biopsy has been reported to increase the sensitivity of fine-needle aspiration biopsy in identifying cervical lymph node metastases from differentiated thyroid cancer, especially those with cystic changes and nondiagnostic cellularity. SummaryThyroglobulin detection in cervical lymph node aspirates is recommended as an easy and reliable adjunctive modality for rapidly diagnosing metastatic thyroid cancer, especially when cervical lymph node metastases of uncertain origin display cystic features.