Reoperations for structurally persistent or recurrent disease after thyroidectomy: analysis via preoperative CT

Abstract

the incidence rates of structural persistent disease (pD) and recurrent disease (RD) after thyroidectomy, and their clinicoradiological (ct) characteristics, remain poorly understood. therefore, we characterized differentiated thyroid cancer (DTC) patients who underwent re-operations, with a focus on preoperative ct scans. We examined neck ct scans obtained prior to initial surgery and reoperation, and classified the disease into four categories according to the persistence/recurrence and neck dissection/non-dissection status. In total, 121 of 9,173 DTC patients underwent reoperations to treat PD or RD; the mean time to reoperation was 25.5 and 54.1 months, respectively. Of all reoperations, 19% (23/121) were performed to treat RD; 81% (98/121) were performed to treat PD. Compared to RD, PD was commonly detected in the non-dissected neck. Tumor multiplicity and the number of pathologically positive lymph nodes were greater in the non-dissected than dissected neck. A review of the CT data revealed more false-negative findings on the 60-s-versus 30-40-s-delay scans of PD patients with non-dissected necks. In conclusion, most of the reoperations performed on Dtc patients were for management of pD. improved preoperative ct assessments and initial surgery, based on the information of clinico-radiological characteristics, are required in the care of DTC patients.

2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations

“…Compared to venous phase scans, early (arterial) phase scans (25–40-second delay) depict early strong enhancement of metastatic LNs [ 239 240 241 ], when the contrast is injected at a rate of 3.0–3.5 mL/sec (total contrast: 75–90 mL). It accurately differentiates them from benign LNs [ 239 240 242 ]. Thin reconstruction (slice thickness: 2–3 mm) is recommended for patients with thyroid cancer.…”

Post-thyroidectomy hypocalcemia and related complications

“…Reoperation has high complication rates compared to the first surgical procedure. The main indications for reoperation are: resection of the thyroid remnant in cancer patients; recurrent thyroid carcinoma; tumor recurrence in recurrent chain lymph nodes; recurrent goiter in symptomatic patients; recurrent thyrotoxicosis; and aesthetics (Dobrinja et al, 2021;Jukic, 2017;Kazaure et al, 2021;H. K. Kim, Ha, Han, Lee, & Soh, 2020;Margolick, Chen, & Wiseman, 2018;Semrad, Keegan, Semrad, Brunson, & Farwell, 2018).…”

“…The incidence of transient hypocalcemia varies from 3.0% to 44.1% and that of permanent hypocalcemia, from 0.0% to 11.0%. According to several studies, reoperation increases the risk of iatrogenic injury to the parathyroids by ten times (Dobrinja et al, 2021;Jukic, 2017;Kazaure et al, 2021;H. K. Kim et al, 2020;Margolick et al, 2018;Semrad et al, 2018).…”

Microwave Imaging of the Neck by Means of Artificial Neural Networks for Tumor Detection

“…Finally, to obtain the neck cross section with tumor (i.e., to reproduce a pathological situation) a circle with radius 𝑟 𝑡 is inserted in the anterior part of the neck, near the trachea. In these kinds of tumors, i.e., supraglottic laryngeal carcinoma [18] and thyroid cancer [19], the cross section can be approximated as a circular inclusion [64]. Also in previous works [65]- [67], the tumor is simulated like a circle.…”

“…In addition to the neck imaging, the last medical application is focused on the microwave hyperthermia of neck tumors [15]- [17]. Malignant primary and secondary cancers in the neck region, such as supraglottic laryngeal carcinoma [18], thyroid cancer [19], cervical lymph node metastases [20], are frequently occurring, aggressive neoplasms with a 50% 5-year survival probability, which can be treated effectively by using microwave hyperthermia in synergy with radio-or chemotherapy [20]- [23]. However, to ensure a high-quality treatment and achieve an effective complete response, an accurate treatment planning phase, with numerical simulations, is required to choose the number, position and phases of the antennas [24], [25].…”