A 38-year-old woman undergoes total thyroidectomy for a 2.5 cm papillary thyroid carcinoma with a single cervical lymph node metastasis (N1a, no extrathyroidal extension). According to ATA 2015 guidelines, her risk stratification is:
- A Low risk
- B Intermediate risk ✓
- C High risk
- D Very low risk — active surveillance is preferred
Explanation
The ATA 2015 Risk Stratification classifies papillary thyroid carcinoma with microscopic lymph node metastases (N1a, ≤5 nodes, all <0.2 cm) in the central compartment as low risk. However, clinical N1a disease (macroscopic node metastasis, as described here with a 'single cervical lymph node metastasis' at a clinically significant level) generally places the patient in the intermediate-risk category. Intermediate risk includes patients with microscopic extrathyroidal extension OR macroscopic nodal metastases, and this patient's single clinical N1a node fulfils intermediate criteria. High risk requires gross ETE, incomplete resection, or distant metastases.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.