title: Recurrences of thyroid well differentiated cancer: ultrasonography-guided surgical treatment.
abstract: OBJECTIVE
  Differentiated thyroid carcinomas (DTC) have a favourable outlook overall. Cornerstone of treatment is total thyroidectomy (TT), followed, if needed, by radiometabolic therapy. Such lesions however show a definite tendency to recur (about 35% of cases), generally in the first decade of follow-up: in 70% of patients such recurrence is local. Surgical resection is the only curative treatment option for local recurrence of well-differentiated thyroid cancer. Intraoperative ultrasonography (US) can be of significant help in facilitating localization and complete resection of lesions. The aim of the study was to review the authors' own experience with the use of such diagnostic method in the clinical setting of thyroid neoplasm recurrence.
  
  
  METHODS
  Between January 2005 and March 2008 31 patients with DTC recurrences underwent intraoperative US exploration. Recurrences were easily identified and resected in all patients. Postoperative tireoglobuline (TG) was undetectable.
  
  
  RESULTS
  In all 31 patients preoperative US confirmed the presence of the lesion. In 26 patients digital exploration of the surgical field did not yield a definitively positive finding, whereas in 5 the lesion was easily palpable. Intraoperative US revealed the presence of pathologic tissue in all cases, with examination time ranging from 4 to 14 minutes (median 8 minutes). In all cases surgical resection was complete, with pathologic confirmation of the sample, and no necessity to extend ablation.
  
  
  CONCLUSIONS
  Intraoperative US can be of significant help in the identification of DTC recurrences, in particular when lesion dimensions are smaller than 10 mm in diameter and can facilitate a more radical excision of the tumor in a surgical field were anatomical landmarks can be altered by previous surgery and/or radiometabolic therapy.
authors.affiliation: Inter-Hospital Functional Area of Endocrine Surgery, University of Perugia, Perugia, Italy. robertalucchini@alice.it
authors.forename: R
authors.initials: R
authors.lastname: Lucchini
authors.forename: E
authors.initials: E
authors.lastname: Puxeddu
authors.forename: F
authors.initials: F
authors.lastname: Calzolari
authors.forename: F
authors.initials: F
authors.lastname: Burzelli
authors.forename: M
authors.initials: M
authors.lastname: Monacelli
authors.forename: F
authors.initials: F
authors.lastname: D'Ajello
authors.forename: R
authors.initials: R
authors.lastname: Macaluso
authors.forename: C
authors.initials: C
authors.lastname: Giammartino
authors.forename: M
authors.initials: M
authors.lastname: Ragusa
authors.forename: P
authors.initials: P
authors.lastname: De Feo
authors.forename: A
authors.initials: A
authors.lastname: Cavaliere
authors.forename: N
authors.initials: N
authors.lastname: Avenia
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D014463:Ultrasonography