J Korean Surg Soc.  2013 Sep;85(3):97-103. 10.4174/jkss.2013.85.3.97.

Malignant thyroid bed mass after total thyroidectomy

• Park DS
• Cho JS
• Park MH
• Ryu YJ
• Hwang MJ
• Shin SH
• Kim HK
• Lim HS
• Lee JS
• Yoon JH

• KMID: 1426340
• DOI: http://doi.org/10.4174/jkss.2013.85.3.97

Abstract

PURPOSE
Ultrasonographic (US) criteria on malignant thyroid bed mass have been suggested, including taller than wide shape, loss of echogenic hilum, abnormal vascularity, and microcalcification. The relationship between fine-needle aspiration (FNA) cytology findings and US findings on thyroid bed mass is unknown. We have retrospectively assessed the malignant thyroid bed mass after total thyroidectomy due to papillary thyroid carcinoma (PTC).
METHODS
We retrospectively evaluated 2,048 patients who underwent total thyroidectomy due to PTC. FNA was performed in 97 patients on the thyroid bed under US surveillance. The 97 suspicious thyroid bed masses were divided into two groups: metastatic thyroid bed group (n = 34) and nonmetastatic group (n = 63). The groups were evaluated according to various clinical, serologic, and US findings.
RESULTS
Within a median 47.0 months of follow-up, the proportion of malignant thyroid bed mass was high in large tumor size (1.37 cm vs. 1.03 cm), isthmic position (10.3% vs. 3.9%), and previous N1a (55.9% vs. 34.9%). US findings revealed that the presence of microcalcification or macrocalcification (47.1% vs. 19.0%) and thyroid bed mass height (5.4 mm vs. 3.9 mm) were the only discriminable criteria for central compartment recurrence. But, degree of echogenicity, loss of hilum, and irregularity of margin failed to discriminate malignant thyroid bed mass.
CONCLUSION
US findings on malignant thyroid bed mass were different from previously reported general criteria on lateral metastatic nodes. Additional FNA cytology should be performed on patients, even low-risk patients, who present the above findings.

Keyword

Ultrasonography; Fine-needle biopsy; Thyroidectomy; Papillary thyroid cancer

MeSH Terms

Biopsy, Fine-Needle
Carcinoma
Factor IX
Follow-Up Studies
Humans
Recurrence
Retrospective Studies
Thyroid Gland
Thyroid Neoplasms
Thyroidectomy
Carcinoma
Factor IX
Thyroid Neoplasms

Figure

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  Fig. 1 Time course of thyroid bed metastasis after total thyroidectomy.

Reference

1. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19:1167–1214.

2. Mazzaferri EL, Kloos RT. Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab. 2001; 86:1447–1463.

3. Hay ID, Thompson GB, Grant CS, Bergstralh EJ, Dvorak CE, Gorman CA, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940-1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg. 2002; 26:879–885.

4. Fish SA, Langer JE, Mandel SJ. Sonographic imaging of thyroid nodules and cervical lymph nodes. Endocrinol Metab Clin North Am. 2008; 37:401–417.

5. Rosario PW, de Faria S, Bicalho L, Alves MF, Borges MA, Purisch S, et al. Ultrasonographic differentiation between metastatic and benign lymph nodes in patients with papillary thyroid carcinoma. J Ultrasound Med. 2005; 24:1385–1389.

6. Takashima S, Sone S, Nomura N, Tomiyama N, Kobayashi T, Nakamura H. Nonpalpable lymph nodes of the neck: assessment with US and US-guided fine-needle aspiration biopsy. J Clin Ultrasound. 1997; 25:283–292.

7. Ying M, Ahuja A, Metreweli C. Diagnostic accuracy of sonographic criteria for evaluation of cervical lymphadenopathy. J Ultrasound Med. 1998; 17:437–445.

8. Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Hiraoka M, et al. Cervical lymph node metastases: diagnosis at sonoelastography: initial experience. Radiology. 2007; 243:258–267.

9. Kuna SK, Bracic I, Tesic V, Kuna K, Herceg GH, Dodig D. Ultrasonographic differentiation of benign from malignant neck lymphadenopathy in thyroid cancer. J Ultrasound Med. 2006; 25:1531–1537.

10. Leboulleux S, Girard E, Rose M, Travagli JP, Sabbah N, Caillou B, et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab. 2007; 92:3590–3594.

11. Kim JH, Lee JH, Shong YK, Hong SJ, Ko MS, Lee DH, et al. Ultrasound features of suture granulomas in the thyroid bed after thyroidectomy for papillary thyroid carcinoma with an emphasis on their differentiation from locally recurrent thyroid carcinomas. Ultrasound Med Biol. 2009; 35:1452–1457.

12. Shin JH, Han BK, Ko EY, Kang SS. Sonographic findings in the surgical bed after thyroidectomy: comparison of recurrent tumors and nonrecurrent lesions. J Ultrasound Med. 2007; 26:1359–1366.

13. Lee JH, Lee HK, Lee DH, Choi CG, Gong G, Shong YK, et al. Ultrasonographic findings of a newly detected nodule on the thyroid bed in postoperative patients for thyroid carcinoma: correlation with the results of ultrasonography-guided fine-needle aspiration biopsy. Clin Imaging. 2007; 31:109–113.

14. Frates MC. Ultrasound in recurrent thyroid disease. Otolaryngol Clin North Am. 2008; 41:1107–1116.

15. Sohn YM, Kwak JY, Kim EK, Moon HJ, Kim SJ, Kim MJ. Diagnostic approach for evaluation of lymph node metastasis from thyroid cancer using ultrasound and fine-needle aspiration biopsy. AJR Am J Roentgenol. 2010; 194:38–43.

16. Ahuja AT, Chow L, Chick W, King W, Metreweli C. Metastatic cervical nodes in papillary carcinoma of the thyroid: ultrasound and histological correlation. Clin Radiol. 1995; 50:229–231.

17. Ahuja AT, Ying M, Yuen HY, Metreweli C. Power Doppler sonography of metastatic nodes from papillary carcinoma of the thyroid. Clin Radiol. 2001; 56:284–288.

18. Antonelli A, Miccoli P, Ferdeghini M, Di Coscio G, Alberti B, Iacconi P, et al. Role of neck ultrasonography in the follow-up of patients operated on for thyroid cancer. Thyroid. 1995; 5:25–28.

19. Frasoldati A, Pesenti M, Gallo M, Caroggio A, Salvo D, Valcavi R. Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma. Cancer. 2003; 97:90–96.

20. Kamaya A, Gross M, Akatsu H, Jeffrey RB. Recurrence in the thyroidectomy bed: sonographic findings. AJR Am J Roentgenol. 2011; 196:66–70.

21. Yoon SJ, Yoon DY, Chang SK, Seo YL, Yun EJ, Choi CS, et al. "Taller-than-wide sign" of thyroid malignancy: comparison between ultrasound and CT. AJR Am J Roentgenol. 2010; 194:W420–W424.