Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma

Abstract

BACKGROUND The follow‐up of patients with differentiated thyroid carcinoma (DTC) is traditionally carried out with 131I whole body scan (131I WBS) and serum thyroglobulin (Tg) measurement. Neck ultrasonography (US) is also used. METHODS We compared the roles of Tg measurement (IRMA assay) after l‐thyroxine (T4) withdrawal, 131I WBS, and US in the diagnosis of DTC neck recurrences. Diagnosis of DTC neck recurrences was based on fine‐needle aspiration biopsy (FNAB) or on histologic results. Four hundred ninety‐four DTC patients (120 males, 374 females; mean age, 49.3 years), submitted to total thyroidectomy and subsequent radioablative 131I treatment, underwent serum Tg measurement off T4 therapy, 131I WBS, and neck US at our institution. Mean (± SD) follow‐up time was 55.1 ± 37.7 months. Neck DTC recurrences were detected in 51 (10.3%) patients (34 females, 17 males; mean age, 49.5 years). RESULTS Neck recurrences occurred after 44.6 ± 21.4 months from initial treatment. Serum Tg levels increased (≥ 2 ng/mL) off T4 therapy in 29 patients (sensitivity 56.8%), 131I WBS showed neck uptake in 23 patients (sensitivity 45.1%) and coexisting distant metastases were detected in 9 of 23 patients, and US identified neck recurrence in 48 patients (sensitivity 94.1%). Of these 48 neck recurrences, 19 were found in the laterocervical compartment and 29 in the central neck compartment. CONCLUSIONS Traditional techniques for the surveillance of DTC patients are not as sensitive as US in the detection of neck recurrences. Neck US detects recurrences in patients with undetectable serum Tg levels and negative IWBS and should be performed as the first‐line test in the follow‐up of all DTC patients. Cancer 2003;97:90–6. © 2003 American Cancer Society. DOI 10.1002/cncr.11031

Importance of Postoperative Stimulated Thyroglobulin Level at the Time of131I Ablation Therapy for Differentiated Thyroid Cancer

“…DxWBS may be insufficient to show the small tissue. Besides ultrasonography is high sensitive for detection of neck recurrence but this examination is operator dependent (Frasoldati et al, 2003;Leenhardt et al, 2013). Despite this, the entire body can be viewed with DxWBS.…”

Implications of mediastinal uptake of 131I with regard to surgery in patients with differentiated thyroid carcinoma

“…At the time of the study, we considered it acceptable not to treat these patients and either to repeat the WBS, as suggested by Baudin et al, 22 or to perform ultrasonography of the neck. 23 Two patients (Patients 12 and 13) underwent mediastinal dissection, and their pathology reports revealed the presence of thymus tissue only. In retrospect, mediastinal dissection was not necessary for either patient.…”

Diagnóstico de metástases de carcinoma papilífero de tiróide através da dosagem de tiroglobulina no líquido obtido da lavagem da agulha utilizada na punção aspirativa

“…A partir de 1992, alguns grupos começaram a dosar a Tg no lavado da agulha utilizada para a punção de linfonodo suspeito, a fim de discriminar se o linfonodo seria reacional ou metastático (19)(20)(21)(22)(23)(24)(25). Pacini e cols.…”

“…Vários estudos têm mostrado que altos níveis de Tg-PAAF indicam a presença de metástase de CDT, enquanto que níveis indetectáveis de Tg-PAAF afastam essa possibilidade (19)(20)(21)(22)(23)(24)(25).…”