Preoperative Lateral Neck Ultrasonography as a Long-term Outcome Predictor in Papillary Thyroid Cancer

Moreno, Mauricio A.; Agarwal, Garima; Luna, Rolando De; Siegel, Eric R.; Sherman, Steven I.; Edeiken-Monroe, Beth S; Clayman, Gary L.

doi:10.1001/archoto.2010.254

Cited by 46 publications

(40 citation statements)

References 28 publications

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“…In that study, preoperative ultrasound was found to be an excellent outcome predictor for lateral neck disease-free interval and diseasespecific survival (33).…”

Section: Addendummentioning

confidence: 87%

In Papillary Thyroid Cancer, Preoperative Central Neck Ultrasound Detects Only Macroscopic Surgical Disease, But Negative Findings Predict Excellent Long-Term Regional Control and Survival

Moreno

Edeiken-Monroe

Siegel

et al. 2012

Thyroid

Self Cite

102

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Background: Ultrasound (US) of the central neck compartment (CNC) is considered of limited sensitivity for nodal spread in papillary thyroid cancer (PTC); elective neck dissection is commonly advocated even in the absence of sonographic abnormalities. We hypothesized that US is an accurate predictor for long-term diseasefree survival, regardless of the use of elective central neck dissection in patients with PTC. Methods: A retrospective chart review of 331 consecutive PTC patients treated with total thyroidectomy at M.D. Anderson Cancer Center between 1996 and 2003 was performed. Information retrieved included preoperative sonographic status of the CNC, surgical treatment of the neck, demographics, cancer staging, histopathological variables and use of adjuvant treatment. The endpoints for the study were nodal recurrence and survival. Results: There were 112 males and 219 females with a median age of 44 years (range 11-87). The median followup time for the series was 71.5 months (range 12.7-148.7). There were 151 (45.6%) patients with a T1, 58 (17.5%) with a T2, 70 (21.1%) with a T3, and 52 (15.7%) with a T4. Preoperative sonographic abnormalities were present in the CNC in 79 (23.9%) patients. During the surveillance period, 11 (3.2%) patients recurred in the central neck, with an average time for recurrence of 22.8 months. Advanced T stage (T3/T4) and abnormal US were independent prognostic factors for recurrence in the central neck ( p = 0.013 and p = 0.005 respectively). There were 119 (35%) patients with a sonographically negative central compartment who underwent elective central neck dissection; 85 of them (71.4%) were found to be histopathologically N( + ) while 34 (28.6%) were pN0. There were no differences in overall survival ( p = 0.32), disease specific survival (DSS; p = 0.49), and recurrence-free survival ( p = 0.32) between these two groups. Preoperative US of the CNC was an age-independent predictor for overall survival ( p < 0.001), DSS ( p = 0.0097), and disease-free survival ( p = 0.0005) on bivariate Cox regression. Conclusions: US of the central compartment is an age-independent predictor for survival and CNC recurrencefree survival in PTC. Prophylactic neck dissection of the central compartment does not improve long-term disease control, regardless of the histopathological status of the lymph nodes retrieved. Our findings emphasize the ability of US to clinically detect relevant nodal disease and support conservative management of the CNC in the absence of abnormal findings.

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“…In that study, preoperative ultrasound was found to be an excellent outcome predictor for lateral neck disease-free interval and diseasespecific survival (33).…”

Section: Addendummentioning

confidence: 87%

In Papillary Thyroid Cancer, Preoperative Central Neck Ultrasound Detects Only Macroscopic Surgical Disease, But Negative Findings Predict Excellent Long-Term Regional Control and Survival

Moreno

Edeiken-Monroe

Siegel

et al. 2012

Thyroid

Self Cite

102

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“…If the enlargement of lymph nodes implied by preoperative B-ultrasonic, the lymph node metastasis rate increase to 21% and 6.9% respectively, however without lymph node exploration and enlargement by B-ultrasonic, the rate were2.6% and 0%. Moreno et al (2011) found that preoperative B-ultrasound can predict PTC's tumor-free interval at lateral neck and the tumor-free survival. Shen et al (2010) reported the central lymph node dissection after initial or recurrent tumor, except for a higher temporary hypocalcemia of initial dissection, both of their post-operative complications are similar.…”

Section: Discussionmentioning

confidence: 91%

Clinical Features and Prognosis of Patients with Benign Thyroid Disease Accompanied by an Incidental Papillary Carcinoma

Wang¹,

Zhao²,

Wang³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Purpose: To investigate the clinical features and prognosis of papillary thyroid carcinoma (PTC) with a background of benign disease. Method: A total of 709 patients with papillary thyroid carcinoma undergoing surgical resection were analyzed retrospectively. In 147 patients who underwent surgery for benign thyroid disease, incidental PTC (IPC group) were identified by intraoperative or postoperative pathological examination of surgical specimens but were not detected by preoperative imaging studies. In the other group, according to the pathological examination with or without co-existing benign thyroid disease, 253 cases were clarified as concomitant PTC and 309 cases were clarified as dominant PTC. Results: Incidental PTC was more common in women, about 85.7%, the mean age was 47.6±11.3 years old. Average tumor diameter was 4.4±2.2 mm, multiple lesions accounted for 12.9% (19/147), and the cervical lymph node metastasis rate was 6.1% (9/147). After radical resection 8 cases recurred, the median time of recurrence was about 12 months (0.5 to 162), there was no tumor-related death. The tumor-free survival rates were 97.3%, 95.9%, 91.5%, and 79.3% in 1, 5, 10 and 14 year respectively. Conclusion: Incidental PTC with a background of benign lesions is common, and the generally good prognosis can be attributed to tumor early detection and early treatment. On the intraoperative finding of incidental PTC, lobectomy (unilateral) or total thyroidectomy (bilateral) should be the first choice, but with a postoperative pathologic finding of incidental PTC, further treatment, such as completion thyroidectomy or immediate lymph dissection is not necessary. Central lymph node dissection is also not needed unless lymphadenectasis is present.

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“…There was no case of death due to the disease. (9)(10)(11)(12)(13)(14), the presence of more than 5 positive LN (11,(15)(16)(17)(18), metastases ≥ 3 cm (11,16,19), and extranodal extension (15,16,(18)(19)(20)(21) are also associated with a poor prognosis (4,5,7,22). In these cases, there is little controversy about the need for a more aggressive initial approach.…”

Section: Evolution Of Patients With Persistent Disease or Tumor Recurmentioning

confidence: 99%

“…In fact, extranodal invasion was observed in only 7/466 patients with LNM < 3 cm and up to 5 positive LN in a previous series (16) and in only 1/87 patients with negative US and up to 5 positive LN in the present study (data not shown). A possible poor prognosis related to the location of LNM in the lateral compartments (N1b) also seems to be minimized when US is negative (9)(10)(11)(12). Finally, the efficacy of initial LN dissection, based on the persistence or not of LNM after surgery (39), is an important prognostic factor.…”

Section: Evolution Of Patients With Persistent Disease or Tumor Recurmentioning

confidence: 99%

“…Furthermore, the risk of persistent disease [defined as metastases on initial posttherapy whole body scanning (RxWBS) or detected by the imaging methods until one year after ablation] and tumor recurrence (defined as strutural disease diagnosed more than one year after ablation) is significantly increased when LNM are detected by preoperative US (9)(10)(11)(12)(13)(14), in the presence of numerous [> 5 positive LN (11,(15)(16)(17)(18)] and large LNM [≥ 3 cm (11,16,19)], or in the presence of extranodal tumor extension (15,16,18-21).…”

Section: Introductionmentioning

confidence: 99%

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Persistent and recurrent disease in patients with papillary thyroid carcinoma with clinically apparent (cN1), but not extensive, lymph node involvement and without other factors for poor prognosis

Furtado

Rosário

Calsolari

2015

Arch. Endocrinol. Metab.

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Objective: Lymph node metastases (LNM) are frequent in patients with papillary thyroid cancer (PTC). The risk of persistent disease (PD) and tumor recurrence (TR) is increased when factors for poor prognosis other than LNM exist, when LNM are numerous, large, detected by preoperative ultrasonography (US), or exhibit extranodal extension. This study evaluated the risk of PD and TR in patients with LNM not exhibiting these characteristics. Subjects and methods: Eighty-six patients with 5 or fewer LNM detected during intraoperative inspection, but not by preoperative US, who had no other factors for poor prognosis [tumors > 4 cm, extensive extrathyroid invasion, vascular invasion, aggressive histological subtype, distant metastases, incomplete tumor resection], were studied. All patients underwent total thyroidectomy followed by radioiodine ablation. PD was defined as metastases on initial post-therapy whole-body scans (RxWBS) or detected by imaging methods up to 12 months after ablation. TR was defined as structural disease diagnosed more than one year after ablation in patients without PD. Results: PD was diagnosed in 3/86 patients (3.5%). TR was observed in 2/83 patients (2.5%) after 62 months of follow-up. There was no case of death due to the disease. A correlation was observed between pre-ablation Tg and PD or TR [1/48 (2%) with Tg ≤ 2 ng/mL versus 2/22 (9%) with Tg > 2 ≤ 10 ng/mL versus 2/7 (28.5%) with Tg ≥ 10 ng/ml)]. It is noteworthy that 38 patients had up to 3 positive LN and pre-ablation Tg ≤ 2 ng/ml, and none of them had PD or TR. Conclusions: The frequency of PD and TR was low in patients with PTC with 5 or fewer LNM and without other factors for poor prognosis. Low postoperative stimulated Tg was predictive of the absence of PD and TR in these patients. Arch Endocrinol Metab. 2015;59(4):285-91

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Preoperative Lateral Neck Ultrasonography as a Long-term Outcome Predictor in Papillary Thyroid Cancer

Abstract: Preoperative US is an excellent outcome predictor for lateral neck disease-free interval and for disease-specific survival in PTC. Sonographically based surgical approach provides excellent long-term regional control and validates current treatment guidelines.

Cited by 46 publications

References 28 publications

In Papillary Thyroid Cancer, Preoperative Central Neck Ultrasound Detects Only Macroscopic Surgical Disease, But Negative Findings Predict Excellent Long-Term Regional Control and Survival

In Papillary Thyroid Cancer, Preoperative Central Neck Ultrasound Detects Only Macroscopic Surgical Disease, But Negative Findings Predict Excellent Long-Term Regional Control and Survival

Clinical Features and Prognosis of Patients with Benign Thyroid Disease Accompanied by an Incidental Papillary Carcinoma

Persistent and recurrent disease in patients with papillary thyroid carcinoma with clinically apparent (cN1), but not extensive, lymph node involvement and without other factors for poor prognosis

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