title: Management of recurrent/persistent nodal disease in patients with differentiated thyroid cancer: a critical review of the risks and benefits of surgical intervention versus active surveillance.
abstract: BACKGROUND
  The primary goals of this interdisciplinary consensus statement are to define the eligibility criteria for management of recurrent and persistent cervical nodal disease in patients with differentiated thyroid cancer (DTC) and to review the risks and benefits of surgical intervention versus active surveillance.
  
  
  METHODS
  A writing group was convened by the Surgical Affairs Committee of the American Thyroid Association and was tasked with identifying the important clinical elements to consider when managing recurrent/persistent nodal disease in patients with DTC based on the available evidence in the literature and the group's collective experience.
  
  
  CONCLUSIONS
  The decision on how best to manage individual patients with suspected recurrent/persistent nodal disease is challenging and requires the consideration of a significant number of variables outlined by the members of the interdisciplinary team. Here we report on the consensus opinions that were reached by the writing group regarding the technical and clinical issues encountered in this patient population.
  
  
  CONCLUSIONS
  Identification of recurrent/persistent disease requires a team decision-making process that includes the patient and physicians as to what, if any, intervention should be performed to best control the disease while minimizing morbidity. Several management principles and variables involved in the decision making for surgery versus active surveillance were developed that should be taken into account when deciding how best to manage a patient with DTC and suspected recurrent or persistent cervical nodal disease.
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Tufano
authors.forename: Gary
authors.initials: G
authors.lastname: Clayman
authors.forename: Keith S
authors.initials: KS
authors.lastname: Heller
authors.forename: William B
authors.initials: WB
authors.lastname: Inabnet
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
authors.forename: Ashok
authors.initials: A
authors.lastname: Shaha
authors.forename: David L
authors.initials: DL
authors.lastname: Steward
authors.forename: R Michael
authors.initials: RM
authors.lastname: Tuttle
mesh_terms: D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000601:surgery / Q000628:therapy*; D018570:Risk Assessment; D013961:Thyroid Gland / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000601:surgery / Q000628:therapy*; D057832:Watchful Waiting