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Intraoperative ultrasonography is useful in surgical management of neck metastases in differentiated thyroid cancers

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Abstract

Differentiated thyroid carcinomas are the most common malignancies of endocrine organs. Metastases to cervical lymph nodes occur in 20–50 % of cases. Recurrence and survival rates are closely related to the type of surgery performed. High-resolution ultrasonography (USG) is a sensitive imaging method used to detect occult lymph node metastases in patients with thyroid cancer. We evaluated how intraoperative USG affected surgical success. This was a retrospective study comparing two groups of patients with thyroid carcinoma who underwent cervical lymph node dissection. A total of 101 patients (33 males and 68 females) were included. Group 1 included 53 patients who underwent surgery with intraoperative USG guidance. Group 2 included 48 patients who underwent surgery without the use of USG. All patients were followed up (mean 23 months; range 5–44 months) with thyroglobulin measurements and USG evaluations. Group 1 (intraoperative USG) had a residual/recurrent tumor rate of 1.9 % (1/53 patients). Group 2 had a residual/recurrent tumor rate of 12.5 % (6/48 patients). A statistically significant difference appeared between the residual/recurrent tumor rates in Groups 1 and 2 (p < 0.05). In addition to its classical use in diagnosis and follow-up, intraoperative use of high-resolution USG can improve surgical success and may decrease the number of residual/recurrent tumors encountered during follow-up.

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References

  1. T. Farrag, F. Lin, N. Brownlee, M. Kim, S. Sheth, R.P. Tufano, Is routine dissection of level II-B and V-A necessary in patients with papillary thyroid cancer undergoing lateral neck dissection for FNA-confirmed metastases in other levels. World J. Surg. 33, 1680–1683 (2009)

    Article  PubMed  Google Scholar 

  2. A. Jemal, T. Murray, E. Ward, A. Samuels, R.C. Tiwari, A. Ghafoor et al., Cancer statistic. CA Cancer J. Clin. 55, 10–30 (2005)

    Article  PubMed  Google Scholar 

  3. B. Cady, C.E. Sedgwick, W.A. Meissner, M.S. Wool, F.A. Salzman, J. Werber, Risk factor analysis in differentiated thyroid cancer. Cancer 43, 810–820 (1979)

    Article  CAS  PubMed  Google Scholar 

  4. R.S. Sippel, D.M. Elaraj, L. Poder, Q.Y. Duh, E. Kebebew, O.H. Clark, Localization of recurrent thyroid cancer using intraoperative ultrasound-guided dye injection. World J. Surg. 33, 434–439 (2009)

    Article  PubMed  Google Scholar 

  5. O. Agcaoglu, S. Aliyev, H.E. Taskin, E. Aksoy, A. Siperstein, E. Berber, The utility of intraoperative ultrasound in modified radical neck dissection: a pilot study. Surg. Innov. 21, 166–169 (2014)

    Article  PubMed  Google Scholar 

  6. E.L. Mazzaferri, Management of a solitary thyroid nodule. N. Engl. J. Med. 328, 553–559 (1993)

    Article  CAS  PubMed  Google Scholar 

  7. S.M. Chow, S.C. Law, J.K. Chan, S.K. Au, S. Yau, W.H. Lau, Papillary microcarcinoma of the thyroid: prognostic significance of lymph node metastasis and multifocality. Cancer 98, 31–40 (2003)

    Article  PubMed  Google Scholar 

  8. D.S. Cooper, G.M. Doherty, B.R. Haugen, R.T. Kloos, S.L. Lee, S.J. Mandel et al., Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16, 109–142 (2006)

    Article  PubMed  Google Scholar 

  9. H.J. Shin, E.K. Kim, H.J. Moon, J.H. Yoon, K.H. Han, J.Y. Kwak, Can increased tumoral vascularity be a quantitative predicting factor of lymph node metastasis in papillary thyroid microcarcinoma? Endocrine (2013) [Epub ahead of print]. doi:10.1007/s12020-013-0131-8

  10. D.W. Kim, S.J. Jeon, C.G. Kim, Usefulness of thyroglobulin measurement in needle washouts of fine-needle aspiration biopsy for the diagnosis of cervical lymph node metastases from papillary thyroid cancer before thyroidectomy. Endocrine 42, 399–403 (2012)

    Article  CAS  PubMed  Google Scholar 

  11. B. Cady, Staging in thyroid carcinoma. Cancer 83, 844–847 (1998)

    Article  CAS  PubMed  Google Scholar 

  12. I.D. Hay, E.J. Bergstralh, J.R. Goellner, J.R. Ebersold, C.S. Grant, Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 114, 1050–1057 (1993)

    CAS  PubMed  Google Scholar 

  13. A.R. Shaha, T.R. Loree, J.P. Shah, Prognostic factors and risk group analysis in follicular carcinoma of the thyroid. Surgery 118, 1131–1136 (1995)

    Article  CAS  PubMed  Google Scholar 

  14. E. Bocca, Conservative neck dissection. Laryngoscope 85, 1511–1515 (1975)

    Article  CAS  PubMed  Google Scholar 

  15. J.K. Karwowski, R.B. Jeffrey, I.R. McDougall, R.J. Weigel, Intraoperative ultrasonography improves identification of recurrent thyroid cancer. Surgery 132, 924–928 (2002)

    Article  PubMed  Google Scholar 

  16. J.I. Lew, C.C. Solorzano, Use of ultrasound in the management of thyroid cancer. Oncologist 15, 253–258 (2010)

    Article  PubMed Central  PubMed  Google Scholar 

  17. A. Harari, R.S. Sippel, R. Goldstein, S. Aziz, W. Shen, J. Gosnell et al., Successful localization of recurrent thyroid cancer in reoperative neck surgery using ultrasound-guided methylene blue dye injection. J. Am. Coll. Surg. 215, 555–561 (2012)

    Article  PubMed  Google Scholar 

  18. J.H. Yim, W.B. Kim, E.Y. Kim, W.G. Kim, T.Y. Kim, J.S. Ryu et al., The outcomes of first reoperation for locoregionally recurrent/persistent papillary thyroid carcinoma in patients who initially underwent total thyroidectomy and remnant ablation. J. Clin. Endocrinol. Metab. 96, 2049–2056 (2011)

    Article  CAS  PubMed  Google Scholar 

  19. C.H. Huang, T.C. Chao, C. Hseuh, Therapeutic outcome and prognosis in young patients with papillary and follicular thyroid cancer. Pediatr. Surg. Int. 28, 489–494 (2012)

    Article  PubMed  Google Scholar 

  20. A. Khafif, J.E. Medina, K.T. Robbins, C.E. Silver, R.S. Weber, A. Rinaldo et al., Level V in therapeutic neck dissections for papillary thyroid carcinoma. Head Neck 35, 605–607 (2012)

    Article  PubMed  Google Scholar 

  21. W. Zhu, M. Zhong, Z. Ai, Systematic evaluation of prophylactic neck dissection for the treatment of papillary thyroid carcinoma. J. Clin. Oncol. 43, 883–888 (2013)

    Google Scholar 

  22. J.L. Roh, J.Y. Park, L.M. Kim, C.J. Song, Use of preoperative ultrasonography as guidance for neck dissection in patients with papillary thyroid carcinoma. J. Surg. Oncol. 99, 28–31 (2009)

    Article  PubMed  Google Scholar 

  23. J.C. Watkinson, J.A. Franklyn, J.F. Olliff, Detection and surgical treatment of cervical lymph nodes in differentiated thyroid cancer. Thyroid 16, 187–194 (2006)

    Article  PubMed  Google Scholar 

  24. M.A. Moreno, B.S. Edeiken-Monroe, E.R. Siegel, S.I. Sherman, G.L. Clayman, In papillary thyroid cancer, preoperative central neck ultrasound detects only macroscopic surgical disease, but negative findings predict excellent long-term regional control and survival. Thyroid 22, 347–355 (2012)

    Article  PubMed Central  PubMed  Google Scholar 

  25. J.A. Sipos, Advances in ultrasound for the diagnosis and management of thyroid cancer. Thyroid 19, 1363–1372 (2009)

    Article  PubMed  Google Scholar 

  26. G. Conzo, D. Pasquali, G. Bellastella, K. Esposito, C. Carella, A. De Bellis et al., Total thyroidectomy, without prophylactic central lymph node dissection, in the treatment of differentiated thyroid cancer. Clinical retrospective study on 221 cases. Endocrine 44, 419–425 (2013)

    Article  CAS  PubMed  Google Scholar 

  27. J.A. Goddard, D.L. Steward, Prophylactic central lymph node dissection in differentiated thyroid cancer. Endocrine 44, 275–277 (2013)

    Article  CAS  PubMed  Google Scholar 

  28. J.M. Monchik, C.J. Simon, D.L. Caragacianu, A.A. Thomay, V. Tsai, J. Cohen et al., Does failure to perform prophylactic level VI node dissection leave persistent disease detectable by ultrasonography in patients with low-risk papillary carcinoma of the thyroid? Surgery 146, 1182–1187 (2009)

    Article  PubMed  Google Scholar 

  29. W.R. Ryan, L.A. Orloff, Intraoperative tumor localization with surgeon-performed ultrasound-guided needle dye injection. Laryngoscope 121, 1651–1655 (2011)

    Article  PubMed  Google Scholar 

  30. W.W. Kim, J.S. Kim, S.M. Hur, S.H. Kim, S.K. Lee, J.H. Choi et al., Radioguided surgery using an intraoperative PET probe for tumor localization and verification of complete resection in differentiated thyroid cancer: a pilot study. Surgery 149, 416–424 (2011)

    Article  PubMed  Google Scholar 

  31. S.L. Richer, D. Kamani, G.W. Randolph, Preoperative radiographic mapping of nodal disease for papillary thyroid carcinoma. Surgery of the Thyroid and Parathyroid Glands, Second Edition, G.W. Randolph. pp. 144–147 (2013)

  32. G.W. Randolph, Q.Y. Duh, K.S. Heller, V.A. Li Volsi, S.J. Mandel, D.L. Steward, et al., The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. American Thyroid Association Surgical Affairs Committee’s Task force on Thyroid Cancer Nodal Surgery. Thyroid 22, 1144–1152 (2012)

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Acibadem Maslak Hospital, Istanbul, Turkey

    Burak Ertas

  2. Department of Surgery, Acibadem Maslak Hospital, Istanbul, Turkey

    Hakan Kaya

  3. Division of Endocrinology and Metabolism Diseases, Department of Internal Medicine, Faculty of Medicine, Acibadem University, Istanbul, Turkey

    Neslihan Kurtulmus

  4. Department of Radiology, Acibadem Maslak Hospital, Istanbul, Turkey

    Abdullah Yakupoglu

  5. Department of Surgery, Florence Nightingale Group, Istanbul, Turkey

    Serdar Giray

  6. Department of Otorhinolaryngology, Faculty of Medicine, Acibadem University, Istanbul, Turkey

    Omer Faruk Unal

  7. Department of Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey

    Mete Duren

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  1. Burak Ertas
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  2. Hakan Kaya
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  4. Abdullah Yakupoglu
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Correspondence to Neslihan Kurtulmus.

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Ertas, B., Kaya, H., Kurtulmus, N. et al. Intraoperative ultrasonography is useful in surgical management of neck metastases in differentiated thyroid cancers. Endocrine 48, 248–253 (2015). https://doi.org/10.1007/s12020-014-0287-x

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  • DOI: https://doi.org/10.1007/s12020-014-0287-x

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