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.
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Article info
Footnotes
Presented at the 30th Annual Meeting of the American Association of Endocrine Surgeons, Madison, Wisconsin, May 2–5, 2009.
Identification
Copyright
© 2009 Published by Elsevier Inc.
