Routine pre-operative ultrasonography for papillary thyroid cancer: effects on cervical recurrence.
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.


CONCLUSIONS
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.
Marshall
Christy L
CL
Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Lee
Jeffrey E
JE
Xing
Yan
Y
Perrier
Nancy D
ND
Edeiken
Beth S
BS
Evans
Douglas B
DB
Grubbs
Elizabeth G
EG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000517:prevention & control; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000517:prevention & control* / Q000601:surgery; D011300:Preoperative Care; D012086:Reoperation; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D013965:Thyroidectomy; D014463:Ultrasonography; D055815:Young Adult