title: Preoperative ultrasonography findings predict the need for repeated surgery in papillary thyroid cancer.
abstract: OBJECTIVE
  To determine the impact of neck ultrasonography in predicting papillary thyroid cancer persistence or recurrence.
  
  
  METHODS
  Between March 2005 and March 2009, we identified patients with a preoperative diagnosis of papillary thyroid cancer. Exclusion criteria included no documented preoperative ultrasonography and initial surgery at an outside institution. Patients with positive preoperative ultrasonography were compared with patients who had negative preoperative ultrasonography by assessing rates of neck dissection, complications, disease persistence or recurrence, and the need for repeated surgery.
  
  
  RESULTS
  Of 127 patients initially identified, 16 did not have preoperative ultrasonography and 4 did not have their initial surgery at our institution, leaving 107 patients in our cohort. Twenty-two patients had positive preoperative ultrasonography and 85 patients had negative preoperative ultrasonography. Patients with positive preoperative ultrasonography had a higher rate of repeated surgery than those with negative preoperative ultrasonography (27% vs 4.7%, P = .003). There was no difference in postoperative complication rates. No patients with negative preoperative ultrasonography and an ultrasound report stating specifically "no suspicious lymph nodes" required repeated surgery.
  
  
  CONCLUSIONS
  Negative preoperative ultrasonography with specific lymph node evaluation predicts a low risk of needing early reoperation. Positive preoperative ultrasonography may be a marker for more aggressive disease and the best predictor of the need for additional surgery in the future.
authors.affiliation: Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Wisconsin, Madison, Wisconsin 53792, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Poehls
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
mesh_terms: D000328:Adult; D002277:Carcinoma; D002291:Carcinoma, Papillary; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000601:surgery*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000601:surgery*; D059351:Organ Sparing Treatments / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012086:Reoperation / Q000009:adverse effects; D012306:Risk; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000000981:diagnostic imaging* / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects; D014463:Ultrasonography; D014922:Wisconsin / Q000453:epidemiology