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 2 mm and one is 6 mm. All blood and thyroid tests came back normal. Full body PET-CT showed no abnormal activity in 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, have them cold tested and remove 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?
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I have gone through your query and can understand your health concern. Papillary thyroid carcinoma is the most common type of thyroid cancer which if detected in early stage has good prognosis. It spreads locally mostly to adjacent structures including lymph nodes. Small size of the nodules and lesser age of patient also have good prognosis. FNA (fine needle aspiration) biopsy of the lymph nodes is more sensitive and specific for detection of papillary thyroid cancer. After surgical removal of lymph nodes and their microscopic examination, it will become clear. Surgery allows accurate histological diagnosis, extent of the disease and staging of the cancer along with removal of the primary lesion. So. I suggest you that, if on FNA biopsy it came as malignancy you can go with neck dissection.
If you do not opt for surgery, other option is thyroid scan. But, it will not give you the correct diagnosis and will tell you only malignancy is present or not.
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