Papillary Thyroid Carcinoma Recurrence: Low Yield of Neck Ultrasound With an Undetectable Serum Thyroglobulin Level

McEachern, Rachel O.; Khot, Rachita; Padia, Shetal H.; Patrie, James T.; Itri, Jason N.

doi:10.1002/jum.14580

Cited by 10 publications

(4 citation statements)

References 26 publications

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“…However, we considered it a false positive finding, as the subsequent neck US was normal. This result is consistent with previous studies that showed high rates of false positives from neck USs ( 12 - 14 ) and low probability of detecting clinically relevant structural recurrence ( 12 - 16 , 24 ). Moreover, a recent study by Sek and cols.…”

Section: Discussionsupporting

confidence: 93%

“…Three recently conducted studies reported false-positives in 67% ( 12 ), 57% ( 13 ) and 43.9% ( 14 ) of the patients, but only 1.2% ( 12 ) to 10% ( 13 ) of patients had a true recurrence. Similarly, two other studies have shown that a routine neck US for patients with reduced risk of recurrence has a very low probability of identifying recurrence ( 15 , 16 ), even if initially suspicious findings were detected ( 16 ).…”

Section: Introductionmentioning

confidence: 77%

“…Nevertheless, patients' disease burden is growing due to the increasingly accessible and capable diagnostic procedures, namely the neck US (10,(20)(21)(22). Various studies have already shown that neck USs have a greater likelihood of detecting non-actionable or incorrect sonographic suspicious findings than recurrence of clinically significant structural disease (12)(13)(14)(15)(16), which can lead to unnecessary additional interventions for a disease that would have no impact on patients' quality of life or survival rates (11)(12)(13)(14). Current guidelines are assertive regarding the use of Tg, TgAb and TSH measurements for the long-term management of DTC, but they are gradually suggesting that neck USs should be reserved for selected cases and not be performed as a routine exam (14,18,19) despite their high sensitivity and ability, in some cases, to detect recurrence before the elevation of Tg levels (18,23).…”

Section: Discussionmentioning

confidence: 99%

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The role of neck ultrasound in the follow-up of low- and intermediate- risk papillary thyroid cancer

Lopes¹,

Ferreira²,

Fernandes³

et al. 2022

Archives of Endocrinology and Metabolism

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Objective:The optimal time for a neck ultrasound (US) in the follow-up of papillary thyroid cancer (PTC) after the first year is undetermined. We aimed to verify the utility of routine neck US in the surveillance of patients diagnosed with low-and intermediate-risk PTC with no evidence of disease at the one-year assessment. Materials and methods: We conducted a retrospective longitudinal study of patients with low-and intermediate-risk PTC with normal neck US, unstimulated serum thyroglobulin (Tg) < 1 ng/mL and negative anti-Tg antibodies at the one-year follow-up. Patients were divided into group 1 [undetectable Tg (<0.20 ng/mL)] and group 2 [detectable Tg but < 1 ng/mL]. The negative predictive value (NPV) of the one-year unstimulated Tg at the five-year and last follow-up visits was calculated. Results: We included n = 88 patients in group 1 and n = 8 patients in group 2. No patient from group 1 presented suspicious US findings at the five-year evaluation [NPV: 100.0% (95% confidence interval (CI): 95.5%-100.0%)], and at the last visit, only one patient had developed a lymph node classified as suspicious [NPV: 98.8% (95% CI: 93.2%-100.0%); mean follow-up: 6.7 years]. In group 2, two patients' USs presented suspicious findings at the five-year evaluation [NPV: 75.0% (95% CI: 34.9%-96.8%)]. At the last visit, only one patient persisted with suspicious findings in the US [NPV: 87.5% (95% CI: 47.4%-99.7%); mean follow-up: 6.5 years]. Conclusion: Low-and intermediaterisk PTC with an excellent response to treatment at the one-year assessment can be safely monitored with regular unstimulated Tg assessments. Conclusions should not be drawn for Tg levels between 0.20-0.99 ng/mL.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The role of neck ultrasound in the follow-up of low- and intermediate- risk papillary thyroid cancer

Lopes¹,

Ferreira²,

Fernandes³

et al. 2022

Archives of Endocrinology and Metabolism

View full text Add to dashboard Cite

show abstract

“…In this study, 8.3 % of patients in the image group had cervical structural disease during follow-up. Nonspecific lesions can be difficult to distinguish between recurrent thyroid cancer and non-recurrent benign lesions with neck US alone [18][19][20][21][22]. Recent studies have proposed to restrict US to patients with basal Tg ≥ 1 ng/ml after treatment with RAI because this imaging method revealed ▶Fig.…”

Section: Discussionmentioning

confidence: 99%

Thyroglobulin Antibodies as a Prognostic Factor in Papillary Thyroid Carcinoma Patients with Indeterminate Response After Initial Therapy

et al. 2020

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The clinical outcome of papillary thyroid carcinoma (PTC) patients with an indeterminate response after initial therapy is reported to be intermediate, between incomplete and excellent responses. This study evaluated the outcomes of PTC patients with indeterminate response after initial therapy. It was further determined whether the indeterminate findings predicted outcomes more precisely. Patients were further classified into 3 groups based on risk of structural persistence/recurrence: Tg group: detectable thyroglobulin, negative antithyroglobulin antibody, regardless nonspecific imaging findings; TgAb group: positive antithyroglobulin antibody, regardless thyroglobulin levels and nonspecific imaging findings, and Image group: nonspecific findings on neck ultrasonography or faint uptake in the thyroid bed on whole-body scan, undetectable thyroglobulin and negative antithyroglobulin antibody. Sixty-six patients aged 44.1±12.7 years were studied, of whom 58 (87.9%) were females. All patients underwent total thyroidectomy, and 52 patients (78.8%) received radioiodine. After 5.7 years (P25–75 2.6–9.75 years) of follow-up, most patients (89.4%) were reclassified as having an excellent response or remained in the indeterminate response to therapy. Structural recurrence/persistence disease was detected in 7 (10.6%) patients. The persistence/recurrence rate in groups were as follow: Tg, 2.63%; TgAb, 31.25%; Image, 8.3% (p=0.007). The 10-years disease-free survival rate in the TgAb group was significantly reduced (p=0.022). Our results suggest that patients with PTC and indeterminate response due to positive serum antithyroglobulin antibody have more risk of development of structural disease. These findings suggest a more individualized follow-up strategy for patients with an indeterminate response.

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Ultrasonography surveillance in papillary thyroid carcinoma patients after total thyroidectomy according to dynamic risk stratification

Yoon

Han

et al. 2020

Endocrine

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Papillary Thyroid Carcinoma Recurrence: Low Yield of Neck Ultrasound With an Undetectable Serum Thyroglobulin Level

Cited by 10 publications

References 26 publications

The role of neck ultrasound in the follow-up of low- and intermediate- risk papillary thyroid cancer

The role of neck ultrasound in the follow-up of low- and intermediate- risk papillary thyroid cancer

Thyroglobulin Antibodies as a Prognostic Factor in Papillary Thyroid Carcinoma Patients with Indeterminate Response After Initial Therapy

Ultrasonography surveillance in papillary thyroid carcinoma patients after total thyroidectomy according to dynamic risk stratification

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