An True Example On What Can Go Wrong:
A 39 year old female has a lump found below her right ear.
Problem #1: An excision biopsy was done by an ENT without any ultrasound, or fine needle biopsy. It was a papillary thyroid cancer in a level 2 node. The patient was then referred to an endocrinologist. He saw the results of the node biopsy, and told her she needed her thyroid out.
Problem #2: There was no detailed lymph node mapping done before the referral to the surgeon.
Problem #3: The surgeon,knowing there was a proven cancer node high up in the neck removed by the ENT, did not include a modified radical neck on the side of the cancerous node removed.
Problem #4: When the surgeon took out the thyroid cancer, he was confronted with 3 lateral neck nodes that were next to the thyroid. This was his second chance to do a modified neck on that side, but he decided to take the easy way out and only cherry picked the 3 abnormal nodes.
Problem #5: While removing the thyroid with the cancer, he came across 2 very abnormal nodes in the thyroid bed. They were positive for cancer, and again he failed to do the right thing and do a complete central compartment node removal.
Problem #6: After 100 MCI Radioiodine, and a negative whole body scan, she returned with elevated cancer marker, and finally the endocrinologist did an ultrasound lymph node mapping. Surprise, there were more nodes on the side of the twice cherry picked ones.
Problem #7: There was no mention of the central compartment, but we already know the surgeon did not do a good job the first time only taking 2 nodes. There was surely more nodes that were crying out to make the surgeon do a central compartment along with the lateral neck.
Problem #8: Our gun shy surgeon, takes out the lateral nodes, but again fails to address the central compartment.
Problem #9: She returns to the thyroid challenged endocrinologist, and recommends another dose of RAI/131, even though the last one was negative when she had all that cancer in her neck even before the first surgery.