Active Surveillance of Recurrent Papillary Thyroid Cancer in Cervical Lymph Node Metastases

Sunday, October 18, 2026

2:48 PM - 2:54 PM PT

Location: West Exhibit Hall A, Learning Zone 6

Presenting Author(s)

Shekhar Gugnani, BA

Medical Student
University of Missouri-Kansas City School of Medicine; The University of Texas MD Anderson Cancer Center
Kansas City, MO, United States

Co-Author(s)

Ahmad Abdelhadi, BS

Medical Student
McGovern Medical School at the University of Texas Health Science Center at Houston; The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Isabelle IF Fournier, MD

Head & Cancer Neck Fellow
The University of Texas MD Anderson Cancer Center
Houston, TX, United States
Victoria E. Banuchi, MD MPH

Associate professor
Md Anderson cancer center
Houston , TX, United States
Anastasios Maniakas, MD

Physician
The University of Texas MD Anderson Cancer Center
Houston, TX, United States
JW

Jennifer Rui Wang, MD

Physician
The University of Texas MD Anderson Cancer Center, United States

Senior Author(s)

Mark E. Zafereo, MD

Professor
MD Anderson Cancer Center
Houston, TX, United States

Disclosure(s):

Mark E. Zafereo, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Papillary thyroid cancer (PTC) recurs after surgery in ~10-35% of patients, most commonly in cervical lymph nodes. While revision neck surgery is an option, thyroid oncologists have increasingly incorporated active surveillance (AS) into PTC management for both primary and recurrent disease. This study aims to evaluate outcomes of AS for recurrent or persistent PTC lymph node metastases.

Methods: We identified consecutive PTC patients at a tertiary cancer center between January 1, 2019, and July 1, 2024. Inclusion criteria were patients with PTC diagnosis with cervical lymph node recurrence or persistence identified on ultrasound and/or CT neck imaging. Patients who were dispositioned to immediate intervention (surgery, targeted therapy, radioactive iodine, etc.) or had no subsequent follow up after initial evaluation were excluded. Patients with concurrent distant disease were included. Demographics, lymph node characteristics, and treatment were collected. Annual absolute growth rates were calculated using initial and follow-up imaging.

Results: Of 1,794 patients with PTC, cervical lymph node recurrence or persistence was identified in 475 (26%) patients, of whom 19 did not have subsequent follow-up. Of the 456 with follow-up, 311 (68%) had lateral disease, 73 (16%) had central disease, and 72 (16%) had both. Of these, 202 (44%) had initial surgical intervention, 40 (9%) had nonsurgical intervention, and 214 (47%) underwent AS. The median AS time was 26.8 months (IQR: 12.7 - 56.5 months; 95% CI: 21.5 - 34.5 months), and the median absolute lymph node growth rate for the 214 patients in AS was 1.3 mm/year (IQR: -4.0 - 17.5 mm/year; 95% CI: 0.0 - 3.4 mm/year). Of the 214 patients dispositioned to AS, 71 (33%) ultimately received active treatment, either surgical (60 patients, 28%) or nonsurgical (11 patients, 5%), after a median AS of 17.7 months. One hundred and forty-three (67%) remained in AS, with a median 34.5 months in AS.

Conclusions: In the largest study to date of AS for PTC lymph node recurrence, our results demonstrate indolent growth of PTC lymph node metastases, with most patients remaining in AS beyond 2 years.