2013 European Thyroid Association Guidelines for Cervical Ultrasound Scan and Ultrasound-Guided Techniques in the Postoperative Management of Patients with Thyroid Cancer

Abstract

Cervical ultrasound scanning (US) is considered a key examination, by all major thyroid and endocrine specialist societies for the postoperative follow-up of thyroid cancer patients to assess the risk of recurrence. Neck US imaging is readily available, non-invasive, relatively easy to perform, cost-effective, and can guide diagnostic and therapeutic procedures with low complication rates. Its main shortcoming is its operator-dependency. Because of the pivotal role of US in the care of thyroid cancer patients, the European Thyroid Association convened a panel of international experts to review technical aspects, indications, results, and limitations of cervical US in the initial staging and follow-up of thyroid cancer patients. The main aim is to establish guidelines for both a cervical US scanning protocol and US-guided diagnostic and therapeutic procedures in patients with thyroid cancer. This report presents (1) standardization of the US scanning procedure, techniques of US-guided fine-needle aspiration, and reporting of findings; (2) definition of criteria for classification of malignancy risk based on cervical US imaging characteristics of neck masses and lymph nodes; (3) indications for US-guided fine-needle aspiration and for biological in situ assessments; (4) proposal of an algorithm for the follow-up of thyroid cancer patients based on risk stratification following histopathological and cervical US findings, and (5) discussion of the potential use of US-guided localization and ablation techniques for locoregional thyroid metastases.

Measurement of thyroglobulin, calcitonin, and PTH in FNA washout fluids

“…Specific guidelines for neck US and US-guided techniques for the management of DTC patient after treatment have been published by ETA [36]. They suggest to report the results of FNA-Tg as "ng/FNA" ("a more suitable result which reflects the quantity of Tg in the needle"), and propose to adopt value < 1 ng/FNA as normal, values between 1 and 10 ng/FNA to be compared with the results from cytology, and levels > 10 ng/FNA as positive for the presence of tumor tissue.…”

“…All in all, according to ATA, AACE/AME/ETA, ETA and AACE/ACE/AME guidelines [3,28,36,37], a relevant role of FNA-Tg in cervical lymph nodes is documented and recognized. Rarely, false-positive and false-negative cases may occur; however, the routine use of this technique in both patients before and after surgery is strongly supported by several high-quality data.…”

“…In various studies, the volume of fluid used to wash the FNA needle ranges from 0.5 to 3.0 mL, and 1.0 mL is the amount most widely utilized [17,19,21,23,36,[75][76][77]. Some authors suggest rinsing the needle several times and collecting the full amount of washout fluid in a single tube.…”

Diagnostic Accuracy of PET/MR for Evaluating Central Lymph Node Status in Patients with Papillary Thyroid Carcinoma

“…The reported sensitivity and specificity of US in assessing suspicious LNs varies between 5%-87% and 43%-100%, respectively (13) and have been shown to be different according to sonographic features. In the case of LNs with absence of hilum, the sensitivity increased to 100% and specificity decreased to 29% (4).…”

Clinical impact of thyroglobulin (Tg) and Tg autoantibody (TgAb) measurements in needle washouts of neck lymph node biopsies in the management of patients with papillary thyroid carcinoma

“…The confirmation of malignancy in lymph nodes (LNs) with a suspicious ultrasonographic (US) appearance is achieved by US-guided fine needle aspiration biopsy (FNAB) for cytological study (cyto-FNAB) and the measurement of thyroglobulin levels (Tg) in needle washouts (Tg-FNAB) (3)(4)(5)(6)(7)(8).…”