Frequent Screening With Serial Neck Ultrasound Is More Likely to Identify False-Positive Abnormalities Than Clinically Significant Disease in the Surveillance of Intermediate Risk Papillary Thyroid Cancer Patients Without Suspicious Findings on Follow-Up Ultrasound Evaluation

Yang, Samantha Peiling; Bach, Ariadne M.; Tuttle, R. Michael; Fish, Stephanie

doi:10.1210/jc.2014-3651

Cited by 37 publications

(23 citation statements)

References 17 publications

(26 reference statements)

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“…Similar conclusions were reached in the study cited above by Peiling Yang et al (49). The 90 intermediate-risk patients they retrospectively reviewed were followed with routine cervical US and Tg assays at 6-12 month intervals, and structural recurrence emerged in only 9 (10%).…”

Section: Post-treatment Staging and Surveillancesupporting

confidence: 82%

“…In these cases, Tg assays provide reliable information on the presence of persistent/ recurrent disease only later, when serial measurements are available, and can be analyzed to identify increases in Tg production over time (44,45,46,47). Substantial rises are an indication for additional imaging work-up (US and/or second-line studies) ( The rate of structural disease recurrence during follow-up (median 10 years) was 8% (4/49) in the subgroup whose initial US findings were negative (as opposed to 12% (5/41) in the group with indeterminate scan results) (49). In many facilities, neck sonography is still done routinely, once or even twice a year, even when the risk of recurrence is low (12, 50).…”

Section: Post-treatment Staging and Surveillancementioning

confidence: 99%

“…In 51 (57%) of the cohort patients, the routine scans yielded new or persistently atypical findings, which led to a host of additional diagnostic procedures (first-and second-line imaging procedures, FNA), none of which disclosed any clinically significant structural disease. On the basis of these findings, these authors suggest that in intermediate-risk DTC patients whose initial post-treatment assessment reveals no structural or biochemical evidence of disease, sonographic surveillance can be discontinued if the second assessment is also negative (49).…”

Section: Post-treatment Staging and Surveillancementioning

confidence: 99%

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ENDOCRINE TUMOURS: Imaging in the follow-up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach

Lamartina¹,

Deandreis

Durante³

et al. 2016

European Journal of Endocrinology

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The clinical and epidemiological profiles of differentiated thyroid cancers (DTCs) have changed in the last three decades. Today's DTCs are more likely to be small, localized, asymptomatic papillary forms. Current practice is, though, moving toward more conservative approaches (e.g. lobectomy instead of total thyroidectomy, selective use of radioiodine). This evolution has been paralleled and partly driven by rapid technological advances in the field of diagnostic imaging. The challenge of contemporary DTCs follow-up is to tailor a risk-of-recurrence-based management, taking into account the dynamic nature of these risks, which evolve over time, spontaneously and in response to treatments. This review provides a closer look at the evolving evidence-based views on the use and utility of imaging technology in the post-treatment staging and the short-and long-term surveillance of patients with DTCs. The studies considered range from cervical US with Doppler flow analysis to an expanding palette of increasingly sophisticated second-line studies (cross-sectional, functional, combined-modality approaches), which can be used to detect disease that has spread beyond the neck and, in some cases, shed light on its probable outcome.

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Section: Post-treatment Staging and Surveillancesupporting

confidence: 82%

Section: Post-treatment Staging and Surveillancementioning

confidence: 99%

Section: Post-treatment Staging and Surveillancementioning

confidence: 99%

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ENDOCRINE TUMOURS: Imaging in the follow-up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach

Lamartina¹,

Deandreis

Durante³

et al. 2016

European Journal of Endocrinology

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“…The incidence of recurrence was low and occurred at a median of 6.3 years after the last surgery (range 3.0–14.5 years) over a median follow-up of 10 years (range 2–15 years). We also showed that routine screening with neck US in these ATA intermediate-risk patients was more likely to identify false-positive abnormalities than clinically significant disease (5). The results of the current study with low-risk patients are similar.…”

Section: Discussionmentioning

confidence: 69%

“…We previously described that neck US was more likely to identify false-positive abnormalities than clinically significant disease in ATA intermediate-risk papillary thyroid cancer (PTC) patients treated with total thyroidectomy and RAI ablation with no evidence of disease on their initial postsurgical evaluation (5). However, the utility of routine surveillance neck US and the frequency of finding false-positive US abnormalities in ATA low-risk thyroid cancer patients treated with total thyroidectomy, with or without RAI, has not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

Serial Neck Ultrasound is More Likely to Identify False-Positive Abnormalities than Clinically Significant Disease in Low-Risk Papillary Thyroid Cancer Patients

et al. 2015

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Objective American Thyroid Association (ATA) low-risk papillary thyroid cancer (PTC) patients without structural evidence of disease on initial posttreatment evaluation have a low risk of recurrence. Despite this, most patients undergo frequent surveillance neck ultrasound (US). The objective of the study was to evaluate the clinical utility of routine neck US in ATA low-risk PTC patients with no structural evidence of disease after their initial thyroid surgery. Methods We performed a retrospective review of 171 ATA low-risk PTC patients after total thyroidectomy, with or without radioactive iodine (RAI) ablation, who had a neck US without suspicious findings after therapy. The main outcome measure was a comparison of the frequency of finding false-positive US abnormalities and the frequency of identifying structural disease recurrence. Results Over a median follow-up of 8 years, 171 patients underwent a median of 5 neck US (range 2–17). Structural recurrence with low-volume disease (≤1 cm) was identified in 1.2% (2/171) of patients at a median of 2.8 years (range 1.6–4.1 years) after their initial diagnosis. Recurrence was associated with rising serum thyroglobulin (Tg) level in 1 of the 2 patients and was detected without signs of biochemical recurrence in the other patient. Conversely, false-positive US abnormalities were identified in 67% (114/171) of patients after therapy, leading to additional testing without identifying clinically significant disease. Conclusion In ATA low-risk patients without structural evidence of disease on initial surveillance evaluation, routine screening US is substantially more likely to identify false-positive results than clinically significant structural disease recurrence.

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Physician Confidence in Neck Ultrasonography for Surveillance of Differentiated Thyroid Cancer Recurrence

Kovatch

Reyes‐Gastelum

Sipos

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Neck ultrasonography, a mainstay of long-term surveillance for recurrence of differentiated thyroid cancer (DTC), is routinely used by endocrinologists, general surgeons, and otolaryngologists; however, physician confidence in their ability to use ultrasonography to identify lymph nodes suggestive of cancer recurrence remains unknown.OBJECTIVE To evaluate physicians' posttreatment surveillance practices for DTC recurrence, specifically their use of and confidence in ultrasonography. DESIGN, SETTING, AND PARTICIPANTSCross-sectional study of 448 physicians in private and academic hospitals who completed a survey on DTC posttreatment practices from October 2018 to August 2019 (response rate, 69%) and self-reported involvement in long-term surveillance for thyroid cancer recurrence. Physicians were identified by patients affiliated with the Surveillance, Epidemiology, and End Results Program registries in Georgia State and Los Angeles County. Of the respondents, 320 physicians who reported involvement with DTC surveillance were included in the analysis.MAIN OUTCOMES AND MEASURES Physician-reported long-term surveillance practices for DTC, including frequency of use and level of confidence in ultrasonography for detecting lymph nodes suggestive of cancer recurrence. RESULTSIn the cohort of 320 physicians who reported involvement with DTC surveillance, 186 (60%) had been in practice for 10 years to less than 30 years; 209 (68%) were White; and 212 (66%) were men. The physicians included 170 (56%) endocrinologists, 67 (21%) general surgeons, and 75 (23%) otolaryngologists. Just 84 (27%) physicians reported personally performing bedside ultrasonography. Only 57 (20%) had high confidence (rated quite or extremely confident) in their ability to use bedside ultrasonography to identify lymph nodes suggestive of recurrence; 94 (33%) did not report high confidence in either their ability or a radiologist's ability to use ultrasonography to detect recurrence. Higher confidence in ultrasonography was associated with the general surgery subspecialty (odds ratio [OR], 5.7; 95% CI, 2.2-14.4; reference endocrinology) and with treating a higher number of patients per year (>50 patients: OR, 14.4; 95% CI,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] 8.4; 95% CI,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] 4.3; 95% CI,.1; reference 0-10 patients).CONCLUSIONS AND RELEVANCE Given the importance of neck ultrasonography in long-term surveillance for thyroid cancer, these findings of physicians' low confidence in their own ability and that of radiologists to use ultrasonography to detect recurrence point to a major obstacle to standardizing long-term DTC surveillance practices.

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Frequent Screening With Serial Neck Ultrasound Is More Likely to Identify False-Positive Abnormalities Than Clinically Significant Disease in the Surveillance of Intermediate Risk Papillary Thyroid Cancer Patients Without Suspicious Findings on Follow-Up Ultrasound Evaluation

Cited by 37 publications

References 17 publications

ENDOCRINE TUMOURS: Imaging in the follow-up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach

ENDOCRINE TUMOURS: Imaging in the follow-up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach

Serial Neck Ultrasound is More Likely to Identify False-Positive Abnormalities than Clinically Significant Disease in Low-Risk Papillary Thyroid Cancer Patients

Physician Confidence in Neck Ultrasonography for Surveillance of Differentiated Thyroid Cancer Recurrence

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