title: Follow-up of low risk patients with papillary thyroid cancer: role of neck ultrasonography in detecting lymph node metastases.
abstract: Persistent or recurrent disease is rare in low risk patients with papillary thyroid cancer, and follow-up of these patients is a matter of debate. Neck ultrasonography (US), serum thyroglobulin (Tg), and whole body scan (WBS) after T(4) withdrawal were performed in 456 patients, followed up to 5 yr. At the end of the first year, 335 patients were Tg negative, and 121 were Tg positive; 65 of 96 patients with Tg levels between 1 and 10 ng/ml became spontaneously Tg negative after 2 yr. During follow-up, WBS discovered node metastases in 13 subjects, and US discovered node metastases in 38 subjects (31 Tg positive and 7 Tg negative). WBS did not add any information, because all WBS-positive patients were also US and Tg positive. Fifty percent of metastases were less than 1 cm and not palpable. Finally, the negative predictive value of both negative Tg and US at first follow-up was 98.8%. We suggest a first follow-up based upon US assessment and stimulated (after T(4) withdrawal or recombinant human TSH) serum Tg determination; subsequently, 1) US should not be mandatory at each examination in initially Tg- and US-negative subjects, but is strongly suggested in all other cases; 2) Tg determination should be repeated 1 yr later, after exogenous or endogenous TSH stimulation only in initially Tg-positive patients without any other evidence of residual disease; and 3) Tg measurement during therapy should be sufficient in all other cases.
authors.affiliation: Unit of Endocrinology, Scientific Institute Casa Sollievo della Sofferanza, 71013 S. Giovanni Rotondo, Foggia, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Torlontano
authors.forename: Marco
authors.initials: M
authors.lastname: Attard
authors.forename: Umberto
authors.initials: U
authors.lastname: Crocetti
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tumino
authors.forename: Rocco
authors.initials: R
authors.lastname: Bruno
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costante
authors.forename: Girolamo
authors.initials: G
authors.lastname: D'Azzò
authors.forename: Domenico
authors.initials: D
authors.lastname: Meringolo
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Ferretti
authors.forename: Rosario
authors.initials: R
authors.lastname: Sacco
authors.forename: Franco
authors.initials: F
authors.lastname: Arturi
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Filetti
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002291:Carcinoma, Papillary / Q000097:blood / Q000000981:diagnostic imaging* / Q000556:secondary* / Q000628:therapy; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D009333:Neck / Q000000981:diagnostic imaging*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000628:therapy; D013974:Thyroxine / Q000008:administration & dosage; D014463:Ultrasonography
chemical_list: D007457:Iodine Radioisotopes; D013954:Thyroglobulin; D013974:Thyroxine