Ultrasonographic Differentiation of Cervical Lymph Nodes in Patients with Papillary Thyroid Carcinoma After Thyroidectomy and Radioiodine Ablation: A Prospective Study

Rosário, Pedro Weslley; Tavares, Wilson Campos; Borges, Mariane; Santos, Juan Bernard Nascimento dos; Calsolari, Maria Regina

doi:10.4158/ep13307.or

Cited by 37 publications

(22 citation statements)

References 24 publications

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“…The differential diagnosis of thyroid papillary cancer metastasis as a rare cause should be kept in mind before these interventions are applied to these patients. One study reported that microcalcification and cystic degeneration in cervical lymph nodes are highly suggestive of metastases [8]. In our case, the presence of cystic degeneration and micro-macrocalcifications arose suspicion that the mass could be malignant.…”

Section: Discussionsupporting

confidence: 46%

Occult Multifocal Thyroid Papillary Carcinoma with Cystic Lymph Nodes Metastases

Uçan¹,

Kızılgül²,

Özbek³

et al. 2017

Endocrinol Metab Syndr

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Section: Discussionsupporting

confidence: 46%

Occult Multifocal Thyroid Papillary Carcinoma with Cystic Lymph Nodes Metastases

Uçan¹,

Kızılgül²,

Özbek³

et al. 2017

Endocrinol Metab Syndr

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“…The absence of US abnormalities was defined when no lymph nodes with any of the following findings were detected: (i) microcalcification, (ii) cystic degeneration, (iii) peripheral hypervascularization, and (iv) absence of a hilum with a long axis/short axis ratio < 2 and no vascularized nodule in the thyroid bed [9, 10]. US/Doppler was performed by a radiologist experienced in thyroid imaging.…”

Section: Methodsmentioning

confidence: 99%

Repeat Ultrasonography in the First Years after Therapy with Radioiodine Is Not Necessary in Most Patients with Papillary Thyroid Carcinoma when Postoperative Ultrasonography Is Negative: A Reduction of Costs and False-Positives

2018

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Background: Periodic ultrasonography (US) examination is recommended in many patients with papillary thyroid carcinoma (PTC) after treatment with radioactive iodine (RAI), but recurrences are confirmed in few cases. This study determined whether the indication of US in the first years after treatment with RAI can be selective when postoperative US and posttherapy whole-body scanning (RxWBS) ruled out persistent neck disease. Methods: This was a prospective study. Two hundred and fifty-four patients with PTC (242 of intermediate risk) undergoing thyroidectomy and RAI, who had no apparent disease at the time of initial therapy (including negative postoperative US and RxWBS), were studied. The patients were followed up for 5 years after treatment with RAI by annual US. Results: At the end of 5 years, 47 patients (18.5%) had at least one suspicious US, but neck recurrence was confirmed in only 4 patients (1.5% of all patients and 8.5% of those with suspicious US). The remaining cases were considered false-positives. US did not reveal disease in the first or second year after treatment with RAI in any patient. In the third, fourth, and fifth year after treatment with RAI, considering only patients with unstimulated Tg < 1 ng/mL in these assessments, US revealed disease in 0, 1 (0.4%), and 1 (0.4%) patient, respectively. Conclusion: The results suggest that low- or intermediate-risk patients with PTC without persistent disease after thyroidectomy (including negative postoperative US and RxWBS) do not require repeat US examination in the first two years after treatment with RAI. In the following years until the fifth year, US can be restricted to patients with Tg ≥1 ng/mL.

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“…All suspected lesions apparent on the scans (Rosario et al 2005(Rosario et al , 2014b were evaluated by US-guided fine-needle aspiration biopsy. RxWBS was obtained 7 days after 131 I administration (3.7 GBq) with L-T4 withdrawal for 4 weeks.…”

Section: Imaging Methodsmentioning

confidence: 99%

Low postoperative nonstimulated thyroglobulin as a criterion to spare radioiodine ablation

Mourão¹,

Rosário²,

Calsolari³

2015

Endocrine-Related Cancer

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This study evaluated the recurrence rate in patients with papillary thyroid carcinoma (PTC) who had low nonstimulated thyroglobulin (Tg), measured with a second-generation assay, after total thyroidectomy and who were not submitted to ablation with 131 I. The objective was to define whether low postoperative nonstimulated Tg can be used as a criterion to spare patients with PTC from therapy with 131 I. This was a prospective study including 222 patients with PTC (except for microcarcinoma restricted to the thyroid and tumor with extensive extrathyroid invasion (pT4), aggressive histology, extensive lymph node (LN) involvement, or known residual disease). After thyroidectomy, all patients had nonstimulated Tg!0.3 ng/ml, negative antithyroglobulin antibodies (TgAb) and neck ultrasonography (US) showing no anomalies. Because of this finding, the patients were not submitted to ablation with 131 I. The time of follow-up ranged from 15 to 102 months (median 62 months). Of the 222 patients, 217 (97.7%) continued to have nonstimulated Tg !0.3 ng/ml and negative US. Tg was undetectable in the last assessment in 185 of these patients and detectable in 32. Five patients (2.2%) exhibited an increase in Tg, and LN metastases were detected in 4 (structural recurrence). One patient progressed to an increase in Tg, but disease was not detected by the imaging methods (biochemical recurrence). The results obtained here suggest that patients with PTC who have low nonstimulated Tg (measured with a second-generation assay and in the absence of TgAb) and negative neck US after thyroidectomy do not require ablation with 131 I.

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Ultrasonographic Differentiation of Cervical Lymph Nodes in Patients with Papillary Thyroid Carcinoma After Thyroidectomy and Radioiodine Ablation: A Prospective Study

Cited by 37 publications

References 24 publications

Occult Multifocal Thyroid Papillary Carcinoma with Cystic Lymph Nodes Metastases

Occult Multifocal Thyroid Papillary Carcinoma with Cystic Lymph Nodes Metastases

Repeat Ultrasonography in the First Years after Therapy with Radioiodine Is Not Necessary in Most Patients with Papillary Thyroid Carcinoma when Postoperative Ultrasonography Is Negative: A Reduction of Costs and False-Positives

Low postoperative nonstimulated thyroglobulin as a criterion to spare radioiodine ablation

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