Preoperative Neck Ultrasonographic Mapping for Persistent/Recurrent Papillary Thyroid Cancer

Abstract

Surgical resection of persistent/recurrent (P/R) papillary thyroid cancer (PTC), when localized to the neck, is generally recommended; however, its impact on the course of the disease is not clear. We introduced a new technique in the form of preoperative neck ultrasonographic mapping (US-M) to improve the outcome of the surgical resection of P/R PTC. A total of 19 patients had undergone regional (central, lateral, or both) neck dissection before introducing the current technique (group 1, or G1), and 26 patients (group 2, or G2) had limited lymph node resection guided by US-M with findings accurately plotted on a standard diagram. All of the operations were performed by a single surgeon. The surgical outcomes of the two groups were compared. The resected lesions were positive for PTC in 17 patients (89.5%) in G1 and in 25 patients (96.2%) in G2. In G2, the intraoperative findings exactly matched the US-M in 23 patients (88.5%). Postoperatively, neck US became negative in 50% in G1 and in 83.3% in G2 (p = 0.02). Thyroglobulin (Tg) became undetectable in 37.5% in G1 and 52.3% in G2 (p = 0.37). Whole-body iodine scans (WBS) became negative in one of six patients (16.7%) in G1, and in three of four patients (75%) in G2, (p = 0.06). After a mean follow-up of 23.8+/-7.1 months in G1 and 9.8+/-4.7 months in G2, 6 patients (31.6%) in G1 and 15 patients (62.5%) in G2 were in remission (p = 0.04), whereas the disease persisted in 13 cases (68.4%) in G1 and 9 (37.5%) in G2 (p = 0.04). In conclusion, US-M improved the surgical outcome, as evidenced by the postoperative US, Tg, and WBS findings and the higher remission rate for the G2 patients than for the G1 patients.

The relevance of preoperative ultrasound cervical mapping in patients with thyroid cancer

“…12,25 Nevertheless, such micrometastases are not clincially relevant, as palpable lymphadenopathies do not develop in most patients with PTC. On the contrary, patients presenting with macrometastases (> 2 mm) have 5%-40% persistent/recurrent (P/R) disease after surgery, 26,27 which has a tremendous impact on quality of life, and despite the additional therapeutic interventions, 10% of patients die from the disease. 28 Reoperation of P/R disease involves many difficulties because the extensive scarring from previous surgery can obscure normal anatomy, which in turn contributes to longer surgeries and increased morbidity.…”

Operative bed recurrence of thyroid cancer: utility of a preoperative needle localization technique

“…Binyousef et al analyzed outcomes in patients undergoing regional neck dissection for recurrent papillary carcinoma before and after implementing routine preoperative ultrasound neck mapping (10). The authors found that in patients who underwent routine preoperative ultrasound neck mapping, significantly fewer demonstrated signs of recurrent disease postoperatively.…”

“…Recently, the concept of needle localization typically employed for nonpalpable breast tumors has been extrapolated to head and neck tumors (7)(8)(9). In addition, several perioperative techniques to aid in reoperative head and neck surgery have been described in the literature, with varying results (7)(8)(9)(10)(11)(12)(13)(14). In this report, we describe our institutional experience utilizing preoperative ultrasoundguided needle localization of recurrent operative bed tumors.…”

Detection and Surgical Treatment of Cervical Lymph Nodes in Differentiated Thyroid Cancer

“…Others recommend the detection of recurrent papillary cell cancer by thyroglobulin assessment in the needle washout after US-guided fine-needle aspiration of suspicious lymph nodes (65,66). Neck US mapping has also been recommended as a preoperative test in persistent/recurrent papillary thyroid cancer evident during follow-up to help improve surgical outcomes (67).…”