Abstract
Background. Patients with well-differentiated thyroid cancer (WDTC) regularly have an excellent
prognosis. However, tumor recurrence either involving the thyroid bed or the regional
lymph nodes, or both, can be associated with significant morbidity and even mortality.
The aim of the follow-up after primary surgery is to detect recurrent disease at its
earliest stage. We assessed the value of different diagnostic methods in detecting
locoregional recurrence in patients with WDTC. Methods. We prospectively identified 150 patients with WDTC. Of those, 43 (28.7%) presented
with recurrent disease. Ultrasonography -guided fine needle biopsy (US-FNB), iodine
131 (131I) wholebody scintigraphy, thyroglobulin (Tg) measurement, and fluorine-18 fluorodeoxyglucose
positron emission tomography (FDG-PET) were carried out. Results. Ultrasonography detected malignant lesions in 95.3% of the patients. The true positive
rate of US-FNB was 95.3%. 131 I scanning had true positive, false negative, and false positive results in 54.2%,
40.0%, and 5.7% of the cases, respectively. In 85.7% of the patients, Tg levels were
within pathologic range. Among the 13 patients who underwent FDG-PET, 84.6% showed
pathologic uptake indicating malignancy. US and US-FNB provided the highest specificity
for detecting recurrence (P <.001). Conclusions. In patients with WDTC and locoregional recurrence, US and US-FNB are the most sensitive
methods in detecting local recurrence or regional lymph node metastases. FDG-PET is
valuable in case of negative 131I scanning results and elevated serum Tg levels. The method has limitations in finding
minimal disease. (Surgery 2000;128:1067-74.)
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Article info
Footnotes
*Reprint requests: A. Frilling, MD, Professor of Surgery, Department of General and Transplantation Surgery, University Hospital Essen, Hufelandstr 55, 45122 Essen, Germany.
**Surgery 2000;128:1067-74.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
