title: Post-operative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement.
abstract: OBJECTIVE
  Cervical ultrasound (US) scan is a key tool for detecting metastatic lymph nodes (N1) in patients with papillary thyroid cancer (PTC). N1-PTC patients are stratified as intermediate-risk and high-risk (HR) patients, according to the American Thyroid Association (ATA) and European Thyroid Association (ETA) respectively. The aim of this study was to assess the value of post-operative cervical US (POCUS) in local persistent disease (PD) diagnosis and in the reassessment of risk stratification in N1-PTC patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Between 1997 and 2010, 638 N1-PTC consecutive patients underwent a systematic POCUS. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of POCUS for the detection of PD were evaluated and a risk reassessment using cumulative incidence functions was carried out.
  
  
  RESULTS
  After a median follow-up of 41.6 months, local recurrence occurred in 138 patients (21.6%), of which 121 were considered to have PD. Sensitivity, specificity, NPV, and PPV of POCUS for the detection of the 121 PD were 82.6, 87.4 95.6, and 60.6% respectively. Cumulative incidence of recurrence at 5 years was estimated at 26% in ETA HR patients, 17% in ATA intermediate-risk patients, and 35% in ATA HR patients respectively. This risk fell to 9, 8, and 11% in the above three groups when the POCUS result was normal and to <6% when it was combined with thyroglobulin results at ablation.
  
  
  CONCLUSIONS
  POCUS is useful for detecting PD in N1-PTC patients and for stratifying individual recurrence risk. Its high NPV could allow clinicians to tailor follow-up recommendations to individual needs.
authors.affiliation: Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lepoutre-Lussey
authors.affiliation: Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France.
authors.forename: Dina
authors.initials: D
authors.lastname: Maddah
authors.affiliation: Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Golmard
authors.affiliation: Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Russ
authors.affiliation: Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Tissier
authors.affiliation: Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Trésallet
authors.affiliation: Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Menegaux
authors.affiliation: Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France.
authors.forename: André
authors.initials: A
authors.lastname: Aurengo
authors.affiliation: Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France laurence.leenhardt@psl.aphp.fr.
authors.forename: Laurence
authors.initials: L
authors.lastname: Leenhardt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology*; D002291:Carcinoma, Papillary; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging*; D009367:Neoplasm Staging; D011184:Postoperative Period; D012189:Retrospective Studies; D012306:Risk; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000473:pathology*; D013965:Thyroidectomy; D014463:Ultrasonography; D055815:Young Adult