(655) Thyroglossal Duct Cyst Carcinoma: Metastatic Patterns and the Role of Preoperative Fine-Needle Aspiration

Introduction: Thyroglossal duct cyst carcinomas (TGDCC) are rare malignancies arising from persistent thyroglossal duct remnants and are frequently diagnosed incidentally after excision of presumed benign lesions. Although the Sistrunk procedure is standard treatment, limited understanding of metastatic patterns and challenges in preoperative diagnosis may result in staged or additional surgery. This systematic review aims to characterize regional metastasis in TGDCC and evaluate the role of preoperative ultrasound-guided fine-needle aspiration (US-FNA) in identifying malignancy and guiding initial management.

Methods: A literature search of PubMed and Embase was performed on June 30, 2025. Additional studies were identified through reference review. Primary research articles consisting of case reports and case series were included. The review followed PRISMA guidelines.

Results: Sixty-six articles comprising 161 patients were analyzed. Median age at diagnosis was 40 years (range, 10–80), with a female predominance (61%). Malignancy was discovered incidentally in 66.1% of cases. Preoperative US-FNA was performed in 50 patients; malignancy was suspected in 66% of these cases, with a diagnostic accuracy of 86.8% among those with malignant findings. Regional lymph node metastases were identified in 29.7% of patients with available data, most commonly involving level I and central compartment nodes. Nearly half of patients (49.1%) required multiple, separate surgical procedures.

Conclusions: TGDCC frequently presents incidentally, with regional lymph node metastasis occurring in nearly one-third of patients. Preoperative US-FNA displays high sensitivity for detecting malignancy and should be considered to guide initial surgical management. Early recognition may reduce reoperation rates and improve metastatic control.