Samantha Peiling Yang1, Ariadne M Bach, R Michael Tuttle, Stephanie A Fish. 1. Endocrinology Service (S.P.Y., R.M.T., S.A.F.), Department of Medicine, and Department of Radiology (A.M.B.), Memorial Sloan Kettering Cancer Center, New York, New York 10021; and Endocrinology Division (S.P.Y.), Department of Medicine, National University Hospital, Singapore 119228.
Abstract
CONTEXT: American Thyroid Association (ATA) intermediate-risk thyroid cancer patients who achieve an excellent treatment response demonstrate a low risk of structural disease recurrence. Despite this fact, most patients undergo frequent surveillance neck ultrasound (US) during follow-up. OBJECTIVE: The objective of the study was to evaluate the clinical utility of routine screening neck US in ATA intermediate-risk patients documented to have a nonstimulated thyroglobulin less than 1.0 ng/mL and a neck US without suspicious findings after therapy. PATIENTS AND DESIGN: Retrospective review of 90 ATA intermediate-risk papillary thyroid carcinoma patients treated with total thyroidectomy and radioactive iodine ablation in a tertiary referral center. MAIN OUTCOME MEASURES: A comparison between the frequency of finding false-positive US abnormalities and the frequency of identifying structural disease recurrence in the study cohort was measured. RESULTS: Over a median of 10 years, 90 patients had a median of six US (range 2-16). Structural disease recurrence was identified in 10% (9 of 90) at a median of 6.3 years. Recurrence was associated with other clinical indicators of disease in 5 of the 90 patients (5.6%, 5 of 90) and was detected without other signs of recurrence in four patients (4.8%, 4 of 84). False-positive US abnormalities were identified in 57% (51 of 90), leading to additional testing, which failed to identify clinically significant disease. CONCLUSIONS: In ATA intermediate-risk patients who have a nonstimulated thyroglobulin less than 1.0 ng/mL and a neck US without suspicious findings after therapy, frequent US screening during follow-up is more likely to identify false-positive abnormalities than clinically significant structural disease recurrence.
CONTEXT: American Thyroid Association (ATA) intermediate-risk thyroid cancerpatients who achieve an excellent treatment response demonstrate a low risk of structural disease recurrence. Despite this fact, most patients undergo frequent surveillance neck ultrasound (US) during follow-up. OBJECTIVE: The objective of the study was to evaluate the clinical utility of routine screening neck US in ATA intermediate-risk patients documented to have a nonstimulated thyroglobulin less than 1.0 ng/mL and a neck US without suspicious findings after therapy. PATIENTS AND DESIGN: Retrospective review of 90 ATA intermediate-risk papillary thyroid carcinomapatients treated with total thyroidectomy and radioactive iodine ablation in a tertiary referral center. MAIN OUTCOME MEASURES: A comparison between the frequency of finding false-positive US abnormalities and the frequency of identifying structural disease recurrence in the study cohort was measured. RESULTS: Over a median of 10 years, 90 patients had a median of six US (range 2-16). Structural disease recurrence was identified in 10% (9 of 90) at a median of 6.3 years. Recurrence was associated with other clinical indicators of disease in 5 of the 90 patients (5.6%, 5 of 90) and was detected without other signs of recurrence in four patients (4.8%, 4 of 84). False-positive US abnormalities were identified in 57% (51 of 90), leading to additional testing, which failed to identify clinically significant disease. CONCLUSIONS: In ATA intermediate-risk patients who have a nonstimulated thyroglobulin less than 1.0 ng/mL and a neck US without suspicious findings after therapy, frequent US screening during follow-up is more likely to identify false-positive abnormalities than clinically significant structural disease recurrence.
Authors: Syed Ali Imran; Karen Chu; Murali Rajaraman; Drew Rajaraman; Sunita Ghosh; Sarah De Brabandere; Stephanie M Kaiser; Stan Van Uum Journal: Eur Thyroid J Date: 2018-11-22
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