Luying Gao1, Yuxin Jiang2, Zhiyong Liang3, Lei Zhang4, Xinxin Mao5, Xiao Yang6, Ying Wang7, Jingzhu Xu8, Ruyu Liu9, Shenling Zhu10, Ruina Zhao11, Xingjian Lai12, Xiaoyan Zhang13, Bo Zhang14. 1. Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: gaoluying@pumch.cn. 2. Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: jiangyuxinxh@163.com. 3. Department of Pathology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: liangzhiyong1220@yahoo.com. 4. Department of Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: zhanglei_tj@163.com. 5. Department of Pathology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: pumchmaoxinxin@126.com. 6. Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: yang_smile@163.com. 7. Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: wangying41@pumch.cn. 8. Department of Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: jingzhuxu1989@126.com. 9. Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: liuruyu921021@sina.com. 10. Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: zhushenling@sina.com. 11. Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: zrnzy8804@163.com. 12. Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: xingjianlai@qq.com. 13. Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: xyanzhang@126.com. 14. Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: thyroidus@163.com.
Abstract
BACKGROUND: We investigated cervical soft tissue recurrence of differentiated thyroid carcinoma (DTC) after thyroidectomy, and these lesions exhibited no evidence that they were lymph nodes (LNs). METHODS: Between January 2012 and April 2016, consecutive 6308 patients underwent thyroid surgery for DTC at our center. Among them, we encountered 21 patients with recurrent cervical soft tissue lesions, none of whom had previously undergone fine needle aspiration biopsy (FNAB). RESULTS: The 21 patients accounted for 0.33% of all 6308 patients, including twenty cases of papillary thyroid carcinoma and one case of follicular thyroid cancer. Approximately half (52.3%) of the recurrence were first detected by ultrasound (US). Eighteen lesions underwent complete preoperative US, but 6 lesions were misdiagnosed as metastatic LNs by US. Therefore, 54 age- and gender-matched recurrent or persistent LNs derived from DTC were randomly selected from the same database. The soft tissue lesions (mean size, 2.30 cm) were larger than the LNs. Fewer hyperechogenic hila and punctuations were found in the group of soft tissue recurrence (P < 0.05). During follow-up, distant metastasis was detected in 38.1% of patients in the soft tissue recurrence group. The distant metastasis rates showed that local soft tissue recurrence led to a poorer prognosis than cervical LN persistence or recurrence (P = 0.00). CONCLUSIONS: Although the incidence of DTC recurrence in cervical soft tissue was low, it may be a predictor for distant recurrence. To minimize the risk, a long-term postoperative evaluation, preferably with US, should be performed.
BACKGROUND: We investigated cervical soft tissue recurrence of differentiated thyroid carcinoma (DTC) after thyroidectomy, and these lesions exhibited no evidence that they were lymph nodes (LNs). METHODS: Between January 2012 and April 2016, consecutive 6308 patients underwent thyroid surgery for DTC at our center. Among them, we encountered 21 patients with recurrent cervical soft tissue lesions, none of whom had previously undergone fine needle aspiration biopsy (FNAB). RESULTS: The 21 patients accounted for 0.33% of all 6308 patients, including twenty cases of papillary thyroid carcinoma and one case of follicular thyroid cancer. Approximately half (52.3%) of the recurrence were first detected by ultrasound (US). Eighteen lesions underwent complete preoperative US, but 6 lesions were misdiagnosed as metastatic LNs by US. Therefore, 54 age- and gender-matched recurrent or persistent LNs derived from DTC were randomly selected from the same database. The soft tissue lesions (mean size, 2.30 cm) were larger than the LNs. Fewer hyperechogenic hila and punctuations were found in the group of soft tissue recurrence (P < 0.05). During follow-up, distant metastasis was detected in 38.1% of patients in the soft tissue recurrence group. The distant metastasis rates showed that local soft tissue recurrence led to a poorer prognosis than cervical LN persistence or recurrence (P = 0.00). CONCLUSIONS: Although the incidence of DTC recurrence in cervical soft tissue was low, it may be a predictor for distant recurrence. To minimize the risk, a long-term postoperative evaluation, preferably with US, should be performed.
Authors: Kai Guo; Lili Chen; Yunjun Wang; Kai Qian; Xiaoke Zheng; Wenyu Sun; Tuanqi Sun; Yi Wu; Zhuoying Wang Journal: Cancer Med Date: 2019-05-01 Impact factor: 4.452