title: Postoperative surveillance of differentiated thyroid carcinoma: a selective approach.
abstract: This review was conducted to evaluate the selective use of 131I whole-body scanning (WBS) and radioablation (RA) after thyroidectomy for patients with differentiated thyroid carcinoma (DTC). A review of patients undergoing thyroidectomy for DTC between July 1, 1980 and December 31, 1999 was performed. Postoperative surveillance involved a selective RA protocol based on a modification of the AMES criteria (age, metastases, extent of cancer, size, and multifocality of tumor). Lower-risk patients were followed by yearly thyroglobulin (Tg) levels and physical examinations (PE) whereas higher-risk patients additionally underwent WBS and RA when appropriate. Three hundred forty-three patients were identified; of these 27 per cent had positive lymph nodes or metastatic disease at their initial operation. Two hundred thirteen (64%) patients underwent postoperative WBS with 174 (82%) requiring RA. One hundred thirty (36%) low-risk patients were followed with yearly Tg and PE that when abnormal led to WBS and RA. No additional patient morbidity or mortality resulted from this protocol. Factors identified during multivariate analyses as being predictive of occult metastasis and recurrence (P < 0.05) included tumor size and lymph node status. These data support a selective approach to the postoperative surveillance of DTC using Tg and PE to monitor low-risk patients and WBS for those with a higher risk of recurrence.
authors.affiliation: Department of Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Conrad
authors.forename: Keshav K
authors.initials: KK
authors.lastname: Pandurangi
authors.forename: Manesh
authors.initials: M
authors.lastname: Parikshak
authors.forename: Eduardo D
authors.initials: ED
authors.lastname: Castillo
authors.forename: Gary B
authors.initials: GB
authors.lastname: Talpos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011184:Postoperative Period; D011379:Prognosis; D011877:Radionuclide Imaging; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013965:Thyroidectomy