title: Recurrence in the thyroidectomy bed: sonographic findings.
abstract: OBJECTIVE
  The purpose of this article is to characterize sonographic features of differentiated thyroid cancer recurrence in the thyroidectomy bed.
  
  
  METHODS
  Patients referred for biopsy of thyroidectomy bed lesions between February 2006 and December 2009 were identified. Patient data and gray-scale and color Doppler features were recorded.
  
  
  RESULTS
  Results of ultrasound-guided biopsies of 30 nodules in 27 patients were reviewed. Twenty-five lesions yielded diagnostic findings, including 22 recurrences in 19 patients and three benign lesions in three patients. Five biopsies were nondiagnostic. Among the 22 recurrences, 21 (95%) were hypoechoic and one (5%) was mixed hypoechoic and hyperechoic on gray-scale imaging. On Doppler imaging, 100% of recurrences had detectable vascularity. Eight lesions (36%) had microcalcifications, and five (23%) had coarse calcifications; the average long-axis dimension was 1.5 cm. Of the five nondiagnostic lesions, four (80%) were hypoechoic, one (20%) was isoechoic, one (20%) had microcalcifications, none had coarse calcifications, and two (40%) had vascularity; the average long-axis dimension was 0.6 cm. Of the negative lesions, three (100%) were hypoechoic, two (66%) had vascularity, and two (66%) had coarse calcifications. No microcalcifications were seen, and the average long-axis dimension was 2 cm. Serum thyroglobulin (Tg) or anti-Tg antibodies were elevated in 12 (63%) of 19 patients with recurrence (eight [42%] with elevated Tg levels and four [21%] with elevated anti-Tg antibody levels).
  
  
  CONCLUSIONS
  An ultrasound finding of a hypoechoic thyroidectomy bed lesion with internal vascularity and size greater than 6 mm is highly sensitive in predicting recurrence. Serum Tg levels were less sensitive than ultrasound in detection of recurrence in the thyroidectomy bed.
authors.affiliation: Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr., H1307, Stanford, CA 94105, USA. kamaya@stanford.edu
authors.forename: Aya
authors.initials: A
authors.lastname: Kamaya
authors.forename: Megan
authors.initials: M
authors.lastname: Gross
authors.forename: Haruko
authors.initials: H
authors.lastname: Akatsu
authors.forename: R Brooke
authors.initials: RB
authors.lastname: Jeffrey
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D013965:Thyroidectomy; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional
chemical_list: D001323:Autoantibodies; C006606:anti-thyroglobulin; D013954:Thyroglobulin