Clinical outcomes of a conservative approach in cervical lymph node metastases of thyroid cancer.

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Lymph node metastases (LNM) can be present in 35% of patients with differentiated thyroid cancer (DTC) and the management of persistent/recurrent nodal disease has been controversial. Watchful waiting maybe a reasonable approach in selected patients, but uncertainty about clinical outcomes remains a concern.To investigate the outcomes of patients with DTC with recurrent/persistent confirmed LNM under surveillance.Patients with LNM from DTC were selected from databases of needle washout thyroglobulin measurements and fine needle aspiration biopsies performed in our institution. Patients with confirmed metastases, in whom active surveillance was initially proposed, were selected. Main clinical outcomes were analyzed.We found 89 patients with LNM under surveillance. Classic papillary was the most frequent variant (44%). During a median follow-up of 3 (0.5-17.2) years, different treatments were needed in 35 (39.3%) patients: radioactive iodine (RAI) in 23 (25.8%), surgery in 9 (10.1%), and radiotherapy (RT) in 3 (3.4%) . From those submitted initially to RAI, progression of disease was observed in 8 patients, 4 requiring other treatment modalities: surgery (n=2), RT (n=1), and RAI (n=1). The remaining 54 (60.7%) patients maintained surveillance. In this group, progression of disease was observed in 26 (48.1%), due to increase in the number and/or volume of metastases, but further treatments were not required.In a group of patients with cervical LNM under active surveillance only 16.9% (n=15) required invasive intervention (surgery or RT).


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