Preoperative staging of thyroid papillary carcinoma with ultrasonography

Shimamoto, Kazuhiro; Satake, Hiroko; Sawaki, Akiko; Ishigaki, Takeo; Funahashi, Hiroomi; Imai, Tsuneo

doi:10.1016/s0720-048x(97)00184-8

Cited by 173 publications

(99 citation statements)

References 12 publications

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“…In the present series, we found that 23.9% of the patients had central compartment abnormalities at presentation which is within the range of 20%-31% frequently cited in the literature (22,23).…”

Section: Discussionsupporting

confidence: 79%

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

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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Section: Discussionsupporting

confidence: 79%

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

102

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“…The frequency of micrometastases may approach 90%, depending on the sensitivity of the detection method (81,82). Preoperative ultrasound identifies suspicious cervical adenopathy in 20%-31% of cases, potentially altering the surgical approach (83,84), although prospective studies are needed.…”

Section: Differentiated Thyroid Cancer: Initial Managementmentioning

confidence: 99%

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

Cooper

Doherty

Haugen

et al. 2006

Thyroid

1,914

938

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“…US allows for the assessment of the nodule size, composition, and characteristics. In addition, US might detect suspicious lymph nodes in the neck and eventually the compression or invasion of thyroid adjacent structures (26).…”

Section: Neck Ultrasoundmentioning

confidence: 99%

“…Preoperative US must be performed to identify the tumor multicentrality, which is supportive of the choice of total thyroidectomy as initial treatment, as well as to look for non-palpable lymph node metastases (26,68) because their presence requires modified neck dissection. Although it is not indicated for this purpose, US results may also suggest tracheal and/or esophageal invasion by the tumor (26).…”

Section: What Preoperative Assessment Is Recommended?mentioning

confidence: 99%

Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus

Rosário

Ward

Carvalho

et al. 2013

Arq Bras Endocrinol Metab

122

147

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Thyroid nodules are frequent findings, especially when sensitive imaging methods are used. Although thyroid cancer is relatively rare, its incidence is increasing, particularly in terms of small tumors, which have an uncertain clinical relevance. Most patients with differentiated thyroid cancer exhibit satisfactory clinical outcomes when treatment is appropriate, and their mortality rate is similar to that of the overall population. However, relapse occurs in a considerable fraction of these patients, and some patients stop responding to conventional treatment and eventually die from their disease. Therefore, the challenge is how to identify the individuals who require more aggressive disease management while sparing the majority of patients from unnecessary treatments and procedures. We have updated the Brazilian Consensus that was published in 2007, emphasizing the diagnostic and therapeutic advances that the participants, representing several Brazilian university centers, consider most relevant in clinical practice. The formulation of the present guidelines was based on the participants' experience and a review of the relevant literature. Arq Bras Endocrinol Metab. 2013;57(4):240-64 Keywords Thyroid nodules; thyroid cancer; Brazilian consensus; update RESUMO Nódulos tireoidianos são muito frequentes, sobretudo quando se empregam métodos sensí-veis de imagem. Embora o câncer seja proporcionalmente raro, sua incidência vem aumentando, especialmente de tumores pequenos, cuja evolução clínica é incerta. A maioria dos pacientes com carcinoma diferenciado de tireoide evolui bem quando adequadamente tratada, com índices de mortalidade similares à população geral. Por outro lado, um percentual não desprezível apresenta recidivas e alguns eventualmente não respondem às terapias convencionais, evoluindo para óbito. Assim, o desafio é distinguir os pacientes merecedores de condutas mais agressivas e, ao mesmo tempo e não menos importante, poupar a maioria de tratamentos e procedimentos desnecessários. Atualizamos o Consenso Brasileiro publicado em 2007, ressaltando os avanços diagnósticos e terapêuticos que os participantes, de diferentes Centros Universitários do Brasil, consideram mais relevantes para prática clínica. A elaboração dessas diretrizes foi baseada na experiência dos participantes e revisão da literatura pertinente. Arq Bras Endocrinol Metab. 2013;57(4):240-64 Descritores

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Preoperative staging of thyroid papillary carcinoma with ultrasonography

Cited by 173 publications

References 12 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

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus

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