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Use of sentinel lymph node biopsy may aid in identifying patients with occult metastases who might benefit from central neck dissection.[23] Diffuse, intense immunostaining for vascular endothelial growth factor in patients with papillary cancer has been associated with a high rate of local recurrence and distant metastases.[24] An elevated serum thyroglobulin level correlates strongly with recurrent tumor when found in patients with differentiated thyroid cancer during postoperative evaluations.[25,26] Serum thyroglobulin levels are most sensitive when patients are hypothyroid and have elevated serum thyroid-stimulating hormone levels.[27] Expression of the TP53 tumor suppressor gene has also been associated with an adverse prognosis for patients with thyroid cancer.[28] For more information, see the Clinical Features and Prognosis section of the Medullary Thyroid Cancer section and the Clinical Features and Prognosis section of the Anaplastic Thyroid Cancer section
