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Preoperative Imaging Modalities to Predict the Risk of Regional Nodal Recurrence in Well-Differentiated Thyroid Cancers
19 August 2014
04 November 2014
08 December 2014 (online)
Introduction Thyroid cancer incidence has increased in the previous 2 decades. Preoperative identification of lymph node metastasis is a suggested risk factor associated with recurrence following thyroidectomy.
Objectives We aimed to evaluate the accuracy of preoperative radiologic investigations of nodal status in determining the postoperative risk of regional nodal recurrence in cases of well-differentiated thyroid cancer.
Methods This is a case series. We retrospectively reviewed data, including preoperative ultrasonography and/or computed tomography results, on patients who underwent total thyroidectomy for thyroid cancer at our hospital between 2006 and 2012. Prognostic factors for predicting recurrence, including age, sex, tumor diameter, and nodal diameter, were evaluated.
Results Total thyroidectomy was performed on 24 male and 74 female patients (median age, 43 years). The median follow-up time was 21 months. Sixty-eight patients had papillary thyroid cancer, and 30 had follicular cancer. Nodal recurrence was evident in 30% of patients, and 4% of patients died. Identification of lymph node involvement during preoperative radiologic investigations was strongly prognostic for recurrence: 35.3% of patients with positive preoperative ultrasonography findings and 62.5% of those with positive preoperative computed tomography findings had recurrence (p = 0.01).
Conclusions Preoperative identification of lymph node metastasis on radiologic studies was correlated with an increased risk of regional nodal recurrence in well-differentiated thyroid cancer. Computed tomography was superior to ultrasonography in detecting metastatic nodal involvement preoperatively and is therefore recommended for preoperative assessment and postoperative follow-up.
- 1 Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 2006; 295 (18) 2164-2167
- 2 Gilliland FD, Hunt WC, Morris DM, Key CR. Prognostic factors for thyroid carcinoma. A population-based study of 15,698 cases from the Surveillance, Epidemiology and End Results (SEER) program 1973–1991. Cancer 1997; 79 (3) 564-573
- 3 Mazzaferri EL, Kloos RT. Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 2001; 86 (4) 1447-1463
- 4 Johnson NA, LeBeau SO, Tublin ME. Imaging surveillance of differentiated thyroid cancer. Radiol Clin North Am 2011; 49 (3) 473-487 , vi
- 5 Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery 1988; 104 (6) 947-953
- 6 Hay ID, Thompson GB, Grant CS , et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg 2002; 26 (8) 879-885
- 7 Simon D, Goretzki PE, Witte J, Röher HD. Incidence of regional recurrence guiding radicality in differentiated thyroid carcinoma. World J Surg 1996; 20 (7) 860-866 , discussion 866
- 8 Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994; 97 (5) 418-428. Erratum in: Am J Med 1995;98:215
- 9 Pacini F, Molinaro E, Castagna MG , et al. Recombinant human thyrotropin-stimulated serum thyroglobulin combined with neck ultrasonography has the highest sensitivity in monitoring differentiated thyroid carcinoma. J Clin Endocrinol Metab 2003; 88 (8) 3668-3673
- 10 Schlumberger M, Berg G, Cohen O , et al. Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective. Eur J Endocrinol 2004; 150 (2) 105-112
- 11 Torlontano M, Crocetti U, Augello G , et al. Comparative evaluation of recombinant human thyrotropin-stimulated thyroglobulin levels, 131I whole-body scintigraphy, and neck ultrasonography in the follow-up of patients with papillary thyroid microcarcinoma who have not undergone radioiodine therapy. J Clin Endocrinol Metab 2006; 91 (1) 60-63
- 12 Saggiorato E, Aversa S, Deandreis D , et al. Galectin-3: presurgical marker of thyroid follicular epithelial cell-derived carcinomas. J Endocrinol Invest 2004; 27 (4) 311-317
- 13 Marshall CL, Lee JE, Xing Y , et al. Routine pre-operative ultrasonography for papillary thyroid cancer: effects on cervical recurrence. Surgery 2009; 146 (6) 1063-1072
- 14 Greene FL, Page DL, Fleming ID , et al , eds. American Joint Committee on Cancer; American Cancer Society. AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer-Verlag; 2002
- 15 González HE, Cruz F, O'Brien A , et al. Impact of preoperative ultrasonographic staging of the neck in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 2007; 133 (12) 1258-1262
- 16 Shaha AR. Prognostic factors in papillary thyroid carcinoma and implications of large nodal metastasis. Surgery 2004; 135 (2) 237-239
- 17 Shaha A. Treatment of thyroid cancer based on risk groups. J Surg Oncol 2006; 94 (8) 683-691
- 18 Pacini F, Schlumberger M, Dralle H, Ilisea R, Smith Y, Viersinga V. [European consensus on the management of patients with differentiated carcinoma of the thyroid from follicular epithelium]. Vestn Khir Im I I Grek 2008; 167 (1) 52-56 [Article in Russian]
- 19 Londero SC, Krogdahl A, Bastholt L , et al; Danish Thyroid Cancer Group. Papillary thyroid microcarcinoma in Denmark 1996–2008: a national study of epidemiology and clinical significance. Thyroid 2013; 23 (9) 1159-1164
- 20 Dionigi G, Dionigi R, Bartalena L, Boni L, Rovera F, Villa F. Surgery of lymph nodes in papillary thyroid cancer. Expert Rev Anticancer Ther 2006; 6 (9) 1217-1229
- 21 Caraci P, Aversa S, Mussa A, Pancani G, Ondolo C, Conticello S. Role of fine-needle aspiration biopsy and frozen-section evaluation in the surgical management of thyroid nodules. Br J Surg 2002; 89 (6) 797-801
- 22 Schlumberger M, Pacini F, Wiersinga WM , et al. Follow-up and management of differentiated thyroid carcinoma: a European perspective in clinical practice. Eur J Endocrinol 2004; 151 (5) 539-548
- 23 Wada N, Masudo K, Nakayama H , et al. Clinical outcomes in older or younger patients with papillary thyroid carcinoma: impact of lymphadenopathy and patient age. Eur J Surg Oncol 2008; 34 (2) 202-207
- 24 Ito Y, Tomoda C, Uruno T , et al. Ultrasonographically and anatomopathologically detectable node metastases in the lateral compartment as indicators of worse relapse-free survival in patients with papillary thyroid carcinoma. World J Surg 2005; 29 (7) 917-920
- 25 Hay ID, Grant CS, van Heerden JA, Goellner JR, Ebersold JR, Bergstralh EJ. Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery 1992; 112 (6) 1139-1146 , discussion 1146–1147
- 26 Spires JR, Robbins KT, Luna MA, Byers RM. Metastatic papillary carcinoma of the thyroid: the significance of extranodal extension. Head Neck 1989; 11 (3) 242-246
- 27 Poehls JL, Chen H, Sippel RS. Preoperative ultrasonography findings predict the need for repeated surgery in papillary thyroid cancer. Endocr Pract 2012; 18 (3) 403-409
- 28 Roh JL, Park JY, Kim JM, Song CJ. Use of preoperative ultrasonography as guidance for neck dissection in patients with papillary thyroid carcinoma. J Surg Oncol 2009; 99 (1) 28-31