Q:

Whether in the above patient the lymph node or the nodule should have been biopsied?

waelhammad
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2022-11-18
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• A 42-year-old male with no active medical problem noticed a thyroid nodule 1 year back and was told by ENT specialist not to worry about it. Now he has come as he feels that the nodule is becoming more prominent. 

• Physical examination: 1 × 2 cm right lower pole nodule. There is also a lymph node which is hard and about 2 cm in size in the upper cervical chain in the right lateral neck region. An ultrasound is done which shows features of multinodular goiter. The FNA is done from the lymph node which showed metastatic papillary thyroid cancer. The patient was subjected to total thyroidectomy with radical neck dissection.

Whether in the above patient the lymph node or the nodule should have been biopsied?

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waelhammad
2022-11-18
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For patients without a high-risk history, one should look for abnormal cervical lymph nodes if present, detected by either physical examination or ultrasound study. If so, biopsy samples should be obtained from the lymph nodes themselves, with or without biopsy of any suspicious thyroid nodules present. In the above-mentioned patient, biopsy sample is collected from the lymph node which shows metastatic thyroid cancer.

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