Is Routine Neck Ultrasound Necessary in Follow-Up of PTC Patients with No Evidence of Disease at the 1-Year Assessment?
- Presentation Speakers / Moderators
Purpose. Neck ultrasonography (US) is commonly used in the follow-up of thyroid cancer, as it is considered the best tool to detect recurrent disease. The study aims to clarify the usefulness of routine US in low- and intermediate-risk papillary thyroid cancer (PTC) patients with negative US findings at the initial post-thyroidectomy assessment and serum thyroglobulin (Tg) levels <1 ng/mL
Methods. During post-operative follow-up, PTC patients underwent yearly biochemical evaluation (unstimulated serum Tg, anti-thyroglobulin antibodies, and TSH levels), and neck US. Subjects with no evidence of disease at 1-year evaluation (Tg <1 ng/mL and negative US), with at least 3 years of follow-up were included. The rate of abnormal US findings at 3-year follow-up and at the last visit, and the negative predictive value (NPV) of the initial assessment were calculated.
Results. 226 patients (171 with undetectable Tg and 55 with Tg 0.20-1 ng/mL at 1 year) were included. The rate of abnormal lymph nodes in patients with undetectable Tg was 1.2% at 3 years and 1.8% at the last visit, corresponding to NPV of 98.8% (95% CI 95.8–99.9%) and 98.2% (95–99.6%), respectively. In patients with Tg 0.20-1 ng/ml, the NPV were similar: 98.2% (90.3–99.9%) and 94.5% (84.9-98.9%) at 3-year and last visit, respectively.
Discussion. Low/intermediate-risk patients whose initial assessment reveals no evidence of disease can be safely followed with clinical assessments and unstimulated serum Tg assays. Repeat neck US should be reserved for patients with rising Tg antibodies titers or Tg levels increasing above 1 ng/mL
Two Approaches to Level 5 Neck Dissection
- Jeff Blumberg