Researchers discovered a statistical correlation between nerve invasion and aggressive histopathological subtypes of thyroid cancer and published their results in Cancers.

The retrospective study consisted of 52 patients who underwent resection of the recurrent nerve for primary or recurrent follicular cell-derived or medullary thyroid carcinoma (MTC) from 2005 to 2020. Nerve involvement has been shown to impact recurrence-free survival, and current guidelines emphasize nerve preservation to maintain quality of life.

However, invasion of the recurrent nerve alone is yet to be shown as a factor for disease-specific survival. According to the American Thyroid Association, tumors encasing the recurrent nerve are high-risk lesions, with up to 40%-50% recurrence rate.


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Invasion of the nerve was seen more often in aggressive variants and MTC when compared to papillary thyroid carcinoma, at 100% and 82%, respectively, the authors said. While papillary thyroid carcinoma is classically responsive to radioactive iodine (RAI), preservation of the nerve with residual tumor and adjuvant RAI might not be feasible, considering short- and long-term toxicity.

Furthermore, many aggressive variants are RAI refractory, and the exact pathological subtype is often not known before resection, thus limiting the use of RAI in nerve preservation.

While the retrospective nature of the study and the small, heterogeneous nature of the cohort limits the ability to draw precise conclusions, the team emphasizes on the determination of pathological subtypes to aid the decision between nerve resection or preservation if effective adjuvant therapy is available.

Reference

Dahan A, Al Ghuzlan A, Chehab R, et al. Pathological analysis of encased resected recurrent nerves in locally invasive thyroid cancerCancers (Basel). 2022;14(12):2961. doi:10.3390/cancers14122961