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Ultrasonography surveillance in papillary thyroid carcinoma patients after total thyroidectomy according to dynamic risk stratification

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Abstract

Purpose

To investigate the role of neck US surveillance in patients with papillary thyroid carcinoma (PTC) after total thyroidectomy according to dynamic risk stratification (DRS) based on response to initial therapy.

Methods

This retrospective study included 812 patients with PTC who underwent total thyroidectomy with prophylactic central neck dissection from January 2003 through February 2007. The relative risk of recurrence/persistence according to DRS was evaluated with the multivariable Cox regression proportional hazard model.

Results

There were 132 men and 680 women. The mean age at surgery was 45.2 years. Postoperative US was used for DRS. According to DRS, 676 patients had excellent response, 78 indeterminate response, 40 biochemical incomplete response, and 18 structural incomplete response to initial therapy. Neck US was performed during follow-up and detected locoregional recurrences in 21 patients (2.6%): 12 with excellent response, 2 with biochemical incomplete response, and 7 with structural incomplete response according to DRS. Only 1 patient (0.1%) with excellent response had a locoregional recurrence that exceeded 8 mm in its shortest diameter, which is the size cut-off for diagnostic US fine-needle aspiration in suspicious lymph nodes. This patient did not develop biochemical abnormalities during follow-up.

Conclusions

Postoperative neck US surveillance after total thyroidectomy with prophylactic central neck dissection is not essential in PTC patients who show excellent response to initial therapy. Future studies are needed to verify the role of US surveillance in patients who receive variable degrees of treatments.

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Abbreviations

LN:

lymph node

PTC:

papillary thyroid carcinoma

Tg:

thyroglobulin

ATA:

American Thyroid Association

FNA:

fine-needle aspiration

DRS:

dynamic risk stratification

RAI:

radioiodine ablation

TSH:

thyroid-stimulating hormone

DFS:

disease free survival

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea

    Jiyoung Yoon, Jung Hyun Yoon, Kyunghwa Han, Eun-Kyung Kim, Hee Jung Moon, Vivian Youngjean Park & Jin Young Kwak

  2. Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, 03722, Korea

    Jandee Lee

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  1. Jiyoung Yoon
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Yoon, J., Yoon, J.H., Han, K. et al. Ultrasonography surveillance in papillary thyroid carcinoma patients after total thyroidectomy according to dynamic risk stratification. Endocrine 69, 347–357 (2020). https://doi.org/10.1007/s12020-020-02347-9

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