Follow-Up of Low Risk Patients with Papillary Thyroid Cancer: Role of Neck Ultrasonography in Detecting Lymph Node Metastases
Massimo Torlontano,
Marco Attard,
Umberto Crocetti,
Salvatore Tumino,
Rocco Bruno,
Giuseppe Costante,
Girolamo D’Azzò,
Domenico Meringolo,
Elisabetta Ferretti,
Rosario Sacco,
Franco Arturi and
Sebastiano Filetti
Unit of Endocrinology, Scientific Institute Casa Sollievo della Sofferenza (M.T., U.C.), 71013 S. Giovanni Rotondo, Foggia, Italy; Cervello Hospital (M.A., G.D’A.), 90100 Palermo, Italy; Tinchi-Pisticci Hospital (R.B.), 75020 Matera, Italy; Bentivoglio Hospital (D.M.), 40010 Bologna, Italy; Department of Biomedical Sciences, University of Catania (S.T.), 95100 Catania, Italy; Department of Experimental and Clinical Medicine, University Magna Graecia (G.C., R.S., F.A.), 88100 Catanzaro, Italy; and Department of Experimental Medicine and Pathology (E.F.) and Clinical Sciences (S.F.), University La Sapienza, 00161 Rome, Italy
Address all correspondence and requests for reprints to: Dr. Sebastiano Filetti, 2a Clinica Medica, Dipartimento di Scienze Cliniche, Universita’ degli Studi di Roma, La Sapienza, v.le del Policlinico, 155, 00161 Rome, Italy. E-mail:sebastiano.filetti{at}uniroma1.it.
Persistent or recurrent disease is rare in low risk patientswith papillary thyroid cancer, and follow-up of these patientsis a matter of debate. Neck ultrasonography (US), serum thyroglobulin(Tg), and whole body scan (WBS) after T4 withdrawal were performedin 456 patients, followed up to 5 yr. At the end of the firstyear, 335 patients were Tg negative, and 121 were Tg positive;65 of 96 patients with Tg levels between 1 and 10 ng/ml becamespontaneously Tg negative after 2 yr. During follow-up, WBSdiscovered node metastases in 13 subjects, and US discoverednode metastases in 38 subjects (31 Tg positive and 7 Tg negative).WBS did not add any information, because all WBS-positive patientswere also US and Tg positive. Fifty percent of metastases wereless than 1 cm and not palpable. Finally, the negative predictivevalue of both negative Tg and US at first follow-up was 98.8%.We suggest a first follow-up based upon US assessment and stimulated(after T4 withdrawal or recombinant human TSH) serum Tg determination;subsequently, 1) US should not be mandatory at each examinationin initially Tg- and US-negative subjects, but is strongly suggestedin all other cases; 2) Tg determination should be repeated 1yr later, after exogenous or endogenous TSH stimulation onlyin initially Tg-positive patients without any other evidenceof residual disease; and 3) Tg measurement during therapy shouldbe sufficient in all other cases.
This work was supported by the Italian Ministry of Health anda grant from Ministero dell’Istruzione dell’Universitàe della Ricerca (to S.F.).
M Chianelli, V Todino, F M Graziano, C Panunzi, D Pace, R Guglielmi, A Signore, and E Papini Low-activity (2.0 GBq; 54 mCi) radioiodine post-surgical remnant ablation in thyroid cancer: comparison between hormone withdrawal and use of rhTSH in low-risk patients
Eur. J. Endocrinol.,
March 1, 2009;
160(3):
431 - 436.
[Abstract][Full Text][PDF]
R. T. Kloos Approach to the Patient with a Positive Serum Thyroglobulin and a Negative Radioiodine Scan after Initial Therapy for Differentiated Thyroid Cancer
J. Clin. Endocrinol. Metab.,
May 1, 2008;
93(5):
1519 - 1525.
[Abstract][Full Text][PDF]
H. T T Phan, P. L Jager, J. E van der Wal, W. J Sluiter, J. T M Plukker, R. A J O Dierckx, B. H R Wolffenbuttel, and T. P Links The follow-up of patients with differentiated thyroid cancer and undetectable thyroglobulin (Tg) and Tg antibodies during ablation
Eur. J. Endocrinol.,
January 1, 2008;
158(1):
77 - 83.
[Abstract][Full Text][PDF]
M. G. Castagna, L. Brilli, T. Pilli, A. Montanaro, C. Cipri, C. Fioravanti, F. Sestini, M. Capezzone, and F. Pacini Limited Value of Repeat Recombinant Human Thyrotropin (rhTSH)-Stimulated Thyroglobulin Testing in Differentiated Thyroid Carcinoma Patients with Previous Negative rhTSH-Stimulated Thyroglobulin and Undetectable Basal Serum Thyroglobulin Levels
J. Clin. Endocrinol. Metab.,
January 1, 2008;
93(1):
76 - 81.
[Abstract][Full Text][PDF]
S. Leboulleux, E. Girard, M. Rose, J. P. Travagli, N. Sabbah, B. Caillou, D. M. Hartl, N. Lassau, E. Baudin, and M. Schlumberger Ultrasound Criteria of Malignancy for Cervical Lymph Nodes in Patients Followed Up for Differentiated Thyroid Cancer
J. Clin. Endocrinol. Metab.,
September 1, 2007;
92(9):
3590 - 3594.
[Abstract][Full Text][PDF]
N. Cunha, F. Rodrigues, F. Curado, O. Ilheu, C. Cruz, P. Naidenov, M. J. Rascao, J. Ganho, I. Gomes, H. Pereira, et al. Thyroglobulin detection in fine-needle aspirates of cervical lymph nodes: a technique for the diagnosis of metastatic differentiated thyroid cancer
Eur. J. Endocrinol.,
July 1, 2007;
157(1):
101 - 107.
[Abstract][Full Text][PDF]
M. Schlumberger, A. Hitzel, M. E. Toubert, C. Corone, F. Troalen, M. H. Schlageter, F. Claustrat, S. Koscielny, D. Taieb, M. Toubeau, et al. Comparison of Seven Serum Thyroglobulin Assays in the Follow-Up of Papillary and Follicular Thyroid Cancer Patients
J. Clin. Endocrinol. Metab.,
July 1, 2007;
92(7):
2487 - 2495.
[Abstract][Full Text][PDF]
K. S. Heller Do All Cancers Need to Be Treated? The Role of Thyroglobulin in the Management of Thyroid Cancer: The 2006 Hayes Martin Lecture
Arch Otolaryngol Head Neck Surg,
July 1, 2007;
133(7):
639 - 643.
[Full Text][PDF]
A. Shammas, B. Degirmenci, J. M. Mountz, B. M. McCook, B. Branstetter, B. B. Bencherif, J. M. Joyce, S. E. Carty, H. A. Kuffner, and N. Avril 18F-FDG PET/CT in Patients with Suspected Recurrent or Metastatic Well-Differentiated Thyroid Cancer
J. Nucl. Med.,
February 1, 2007;
48(2):
221 - 226.
[Abstract][Full Text][PDF]
F. Triponez, L. Poder, R. Zarnegar, R. Goldstein, K. Roayaie, V. Feldstein, J. Lee, E. Kebebew, Q.-Y. Duh, and O. H. Clark Hook Needle-Guided Excision of Recurrent Differentiated Thyroid Cancer in Previously Operated Neck Compartments: A Safe Technique for Small, Nonpalpable Recurrent Disease
J. Clin. Endocrinol. Metab.,
December 1, 2006;
91(12):
4943 - 4947.
[Abstract][Full Text][PDF]
F. Pacini, M. Schlumberger, H. Dralle, R. Elisei, J. W A Smit, W. Wiersinga, and the European Thyroid Cancer Taskforce European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium.
Eur. J. Endocrinol.,
June 1, 2006;
154(6):
787 - 803.
[Full Text][PDF]
M. Torlontano, U. Crocetti, G. Augello, L. D'Aloiso, N. Bonfitto, A. Varraso, F. Dicembrino, S. Modoni, V. Frusciante, A. Di Giorgio, et al. Comparative Evaluation of Recombinant Human Thyrotropin-Stimulated Thyroglobulin Levels, 131I Whole-Body Scintigraphy, and Neck Ultrasonography in the Follow-Up of Patients with Papillary Thyroid Microcarcinoma Who Have Not Undergone Radioiodine Therapy
J. Clin. Endocrinol. Metab.,
January 1, 2006;
91(1):
60 - 63.
[Abstract][Full Text][PDF]
F. Pacini, M. Schlumberger, C. Harmer, G. G Berg, O. Cohen, L. Duntas, F. Jamar, B. Jarzab, E. Limbert, P. Lind, et al. Post-surgical use of radioiodine (131I) in patients with papillary and follicular thyroid cancer and the issue of remnant ablation: a consensus report
Eur. J. Endocrinol.,
November 1, 2005;
153(5):
651 - 659.
[Abstract][Full Text][PDF]
S. Leboulleux, C. Rubino, E. Baudin, B. Caillou, D. M. Hartl, J.-M. Bidart, J.-P. Travagli, and M. Schlumberger Prognostic Factors for Persistent or Recurrent Disease of Papillary Thyroid Carcinoma with Neck Lymph Node Metastases and/or Tumor Extension beyond the Thyroid Capsule at Initial Diagnosis
J. Clin. Endocrinol. Metab.,
October 1, 2005;
90(10):
5723 - 5729.
[Abstract][Full Text][PDF]
R. T. Kloos and E. L. Mazzaferri A Single Recombinant Human Thyrotropin-Stimulated Serum Thyroglobulin Measurement Predicts Differentiated Thyroid Carcinoma Metastases Three to Five Years Later
J. Clin. Endocrinol. Metab.,
September 1, 2005;
90(9):
5047 - 5057.
[Abstract][Full Text][PDF]
E. L. Mazzaferri Empirically Treating High Serum Thyroglobulin Levels
J. Nucl. Med.,
July 1, 2005;
46(7):
1079 - 1088.
[Full Text][PDF]
T. Y. Kim, W. B. Kim, E. S. Kim, J. S. Ryu, J. S. Yeo, S. C. Kim, S. J. Hong, and Y. K. Shong Serum Thyroglobulin Levels at the Time of 131I Remnant Ablation Just after Thyroidectomy Are Useful for Early Prediction of Clinical Recurrence in Low-Risk Patients with Differentiated Thyroid Carcinoma
J. Clin. Endocrinol. Metab.,
March 1, 2005;
90(3):
1440 - 1445.
[Abstract][Full Text][PDF]
