Routine pre-operative ultrasonography for papillary thyroid cancer: Effects on cervical recurrence
Background
Pre-operative ultrasonography (US) is now part of published treatment guidelines for papillary thyroid carcinoma (PTC), despite the lack of long-term data on its potential value in preventing neck recurrence. We report the follow-up of patients with PTC in whom pre-operative US was used to accurately stage the extent of neck disease.
Methods
Patients with PTC who underwent pre-operative US and surgery were evaluated by indication for surgery (primary surgery, surgery for persistent PTC, and surgery for recurrent PTC). Patients who underwent their primary surgery at our institution were further evaluated by time period in which their pre-operative US was performed. Primary outcome studied was cervical recurrence.
Results
A total of 275 patients underwent pre-operative US; median follow-up was 41 months. Neck recurrence occurred in 6% of primary surgery patients, 5% of persistent-disease patients, and 23% of recurrent-disease patients (P < .001). By multivariate analysis, the era in which US was performed appeared to be an independent predictor of disease-free survival, with less cervical recurrences in the recent eras during which there was more US specialization.
Conclusion
Once a patient with PTC experiences neck recurrence, they are at an increased risk for subsequent neck recurrence. Pre-operative US followed by compartment-oriented surgery may decrease recurrence rates in patients if performed before their primary operation.
aDepartment of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, TX
bDepartment of Radiology, University of Texas, M. D. Anderson Cancer Center, Houston, TX
cDepartment of Surgery, Medical College of Wisconsin, Milwaukee, WI
Reprint requests: Elizabeth G. Grubbs, MD, Assistant Professor, Department of Surgical Oncology, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030.
Presented at the 30th Annual Meeting of the American Association of Endocrine Surgeons, Madison, Wisconsin, May 2–5, 2009.
ABSTRACT