Routine pre-operative ultrasonography for papillary thyroid cancer: effects on cervical recurrence. Surgery 2009 Dec;146(6):1063-72
Date
12/05/2009Pubmed ID
19958933DOI
10.1016/j.surg.2009.09.027Scopus ID
2-s2.0-70549086805 (requires institutional sign-in at Scopus site) 31 CitationsAbstract
BACKGROUND: Pre-operative ultrasonography (US) is now part of published treatment guidelines for papillary thyroid carcinoma (PTC), despite the lack of long-term data on its potential value in preventing neck recurrence. We report the follow-up of patients with PTC in whom pre-operative US was used to accurately stage the extent of neck disease.
METHODS: Patients with PTC who underwent pre-operative US and surgery were evaluated by indication for surgery (primary surgery, surgery for persistent PTC, and surgery for recurrent PTC). Patients who underwent their primary surgery at our institution were further evaluated by time period in which their pre-operative US was performed. Primary outcome studied was cervical recurrence.
RESULTS: A total of 275 patients underwent pre-operative US; median follow-up was 41 months. Neck recurrence occurred in 6% of primary surgery patients, 5% of persistent-disease patients, and 23% of recurrent-disease patients (P < .001). By multivariate analysis, the era in which US was performed appeared to be an independent predictor of disease-free survival, with less cervical recurrences in the recent eras during which there was more US specialization.
CONCLUSION: Once a patient with PTC experiences neck recurrence, they are at an increased risk for subsequent neck recurrence. Pre-operative US followed by compartment-oriented surgery may decrease recurrence rates in patients if performed before their primary operation.
Author List
Marshall CL, Lee JE, Xing Y, Perrier ND, Edeiken BS, Evans DB, Grubbs EGAuthor
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Carcinoma, Papillary
Child
Child, Preschool
Disease-Free Survival
Female
Head and Neck Neoplasms
Humans
Kaplan-Meier Estimate
Lymphatic Metastasis
Male
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local
Preoperative Care
Reoperation
Thyroid Neoplasms
Thyroidectomy
Ultrasonography
Young Adult