Is it normal to have a neck dissection just by suspicion?

Question

Hi doctor,

I have 4 enlarged cervical lymph nodes in my neck. Two are cystic and have calcification inside. There are also 3 small nodules on my thyroid. Two are about the size of a tiny dot, and one is 0.25 inch. All blood and thyroid tests came back normal. A full-body PET-CT showed no abnormal activity in the thyroid or lymph nodes or anywhere else in my body. FNA biopsy of the largest lymph node came back as suspicious for metastatic papillary thyroid cancer.

My ENT wants to do a selective neck dissection, removing the lymph nodes in regions 2-4, having them cold tested, and removing my thyroid if positive. My question is, is it normal to have a neck dissection with only suspicion of malignancy? Or should I opt for further testing to confirm cancer before I decide to have the dissection?

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I have reviewed your query and understand your health concern.

Papillary thyroid carcinoma is the most common type of thyroid cancer, which, if detected in an early stage, has a good prognosis. It spreads locally mostly to adjacent structures, including lymph nodes. The small size of the nodules and the patient's younger age also indicate a good prognosis. Fine needle aspiration (FNA) biopsy of the lymph nodes is more sensitive and specific for detecting papillary thyroid cancer.

After surgical removal of lymph nodes and their microscopic examination, it will become clear. Surgery allows accurate histological diagnosis, determination of the extent of the disease, and staging of the cancer, along with removal of the primary lesion. So, I suggest that, if on FNA biopsy it came as a malignancy, you can go with a neck dissection. If you do not opt for surgery, another option is a thyroid scan. However, it will not provide a correct diagnosis and will only indicate whether malignancy is present or not.

I hope this helps.

Thank you.