Int J Thyroidol.  2020 Nov;13(2):142-149. 10.11106/ijt.2020.13.2.142.

Annual Neck Ultrasonography Surveillance between 3 to 12 Years after Thyroid Lobectomy for Papillary Thyroid Microcarcinoma

• Kang JG
• Choi JE
• Lee SJ
• Kang SH

• KMID: 2509193
• DOI: http://doi.org/10.11106/ijt.2020.13.2.142

Abstract

Background and Objectives
In South Korea, neck ultrasonography (US) has been used widely at 1- or 2-year intervals to detect recurrence after thyroidectomy. The aim of this study is to assess the prevalence and pattern of recurrence and to establish a proper frequency of follow-up neck US after thyroid lobectomy for papillary thyroid microcarcinoma (PTMC).
Materials and Methods
We retrospectively reviewed 262 consecutive patients who had undergone thyroid lobectomy for PTMC from January 2005 to October 2009. They were divided into two groups based on the presence of recurrence (240 patients in group 1 and 22 patients in group 2). The comparison between the two groups involved clinical and pathological characteristics.
Results
Recurrences were found in 22 (8.4%) of 262 patients with 132.5 months follow-up (range, 120-180 months). There was a significant difference in the mean number of follow-up neck US after 5 years postoperatively, shortened interval, total number of follow-up neck US (p=0.002, p＜0.001, p＜0.001). All recurrences were found between 2-3 to 11-12 years. Recurrences after 5 years were found in 16 (72.7%) of 22 patients.
Conclusion
Recurrence after thyroid lobectomy for PTMC occurred with various times during follow up. The minimum frequency of follow-up neck US was not enough for detecting tumor recurrence, especially after 5 years postoperatively. Our results suggest that annual neck US may be appropriate between 3 to 12 years after thyroid lobectomy for PTMC.

Keyword

Papillary thyroid microcarcinoma; Recurrence; Ultrasonography

Figure

• 

  Fig. 1 Frequency of recur-rence during follow up.

Reference

References

1. Ito Y, Miyauchi A, Kihara M, Higashiyama T, Kobayashi K, Miya A. 2014; Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid. 24(1):27–34. DOI: 10.1089/thy.2013.0367. PMID: 24001104. PMCID: PMC3887422.

2. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2016; 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 26(1):1–133. DOI: 10.1089/thy.2015.0020. PMID: 26462967. PMCID: PMC4739132.

3. Kim DW. 2016; Long-term follow-up ultrasonography after lobectomy in papillary thyroid microcarcinoma patients: a single-center study. Endocr Res. 41(3):213–7. DOI: 10.3109/07435800.2015.1137583. PMID: 26864682.

4. Baek HJ, Kim DW, Lee CY, Huh JY, Sung JY, Choi YJ. 2017; Analysis of postoperative ultrasonography surveillance after hemi-thyroidectomy in patients with papillary thyroid microcarcinoma: a multicenter study. Endocr Pract. 23(7):794–802. DOI: 10.4158/EP161723.OR. PMID: 28448763.

5. Choi YS, Kim DW, Lee YJ, Ha TK, Jung SJ, Baek HJ. 2019; Appropriate neck ultrasonography surveillance during the first 10 years after hemithyroidectomy in papillary thyroid microcarcinoma patients: a single-center study. Ultrasound Q. 35(3):275–80. DOI: 10.1097/RUQ.0000000000000429. PMID: 30789488.

6. Piersanti M, Ezzat S, Asa SL. 2003; Controversies in papillary micro-carcinoma of the thyroid. Endocr Pathol. 14(3):183–91. DOI: 10.1007/s12022-003-0011-5. PMID: 14586064.

7. Davies L, Welch HG. 2006; Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 295(18):2164–7. DOI: 10.1001/jama.295.18.2164. PMID: 16684987.

8. Leenhardt L, Grosclaude P, Cherie-Challine L. Thyroid Cancer Committee. 2004; Increased incidence of thyroid carcinoma in France: a true epidemic or thyroid nodule management effects? Report from the French Thyroid Cancer Committee. Thyroid. 14(12):1056–60. DOI: 10.1089/thy.2004.14.1056. PMID: 15650358.

9. Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al. 2014; Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf). 81 Suppl 1:1–122. DOI: 10.1111/cen.12515. PMID: 24989897.

10. Park YM, Lee DY, Oh KH, Cho JG, Baek SK, Kwon SY, et al. 2017; Clinical implications of pathologic factors after thyroid lobectomy in patients with papillary thyroid carcinoma. Oral Oncol. 75:1–5. DOI: 10.1016/j.oraloncology.2017.10.012. PMID: 29224804.

11. Lo CY, Chan WF, Lang BH, Lam KY, Wan KY. 2006; Papillary microcarcinoma: is there any difference between clinically overt and occult tumors? World J Surg. 30(5):759–66. DOI: 10.1007/s00268-005-0363-8. PMID: 16680591.

12. Roti E, Rossi R, Trasforini G, Bertelli F, Ambrosio MR, Busutti L, et al. 2006; Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. J Clin Endocrinol Metab. 91(6):2171–8. DOI: 10.1210/jc.2005-2372. PMID: 16478817.

13. Ahn D, Lee GJ, Sohn JH, Jeon JH. 2020; Oncological impact of hypothyroidism and levothyroxine supplementation following hemithyroidectomy in patients with papillary thyroid carcinoma. Head Neck. 42(5):1004–13. DOI: 10.1002/hed.26075. PMID: 31930773.

14. Lee MC, Kim MJ, Choi HS, Cho SW, Lee GH, Park YJ, et al. 2019; Postoperative thyroid-stimulating hormone levels did not affect recurrence after thyroid lobectomy in patients with papillary thyroid cancer. Endocrinol Metab (Seoul). 34(2):150–7. DOI: 10.3803/EnM.2019.34.2.150. PMID: 31099202. PMCID: PMC6599911.

15. Pisanu A, Reccia I, Nardello O, Uccheddu A. 2009; Risk factors for nodal metastasis and recurrence among patients with papillary thyroid microcarcinoma: differences in clinical relevance between nonincidental and incidental tumors. World J Surg. 33(3):460–8. DOI: 10.1007/s00268-008-9870-8. PMID: 19123022.

16. Huang H, Liu S, Xu Z, Ni S, Zhang Z, Wang X. 2017; Long-term outcome of thyroid lobectomy for unilateral multifocal papillary carcinoma. Medicine (Baltimore). 96(27):e7461. DOI: 10.1097/MD.0000000000007461. PMID: 28682915. PMCID: PMC5502188.

17. Matsuzu K, Sugino K, Masudo K, Nagahama M, Kitagawa W, Shibuya H, et al. 2014; Thyroid lobectomy for papillary thyroid cancer: long-term follow-up study of 1,088 cases. World J Surg. 38(1):68–79. DOI: 10.1007/s00268-013-2224-1. PMID: 24081532.

18. Ito Y, Uruno T, Nakano K, Takamura Y, Miya A, Kobayashi K, et al. 2003; An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid. 13(4):381–7. DOI: 10.1089/105072503321669875. PMID: 12804106.

19. Park S, Jeon MJ, Oh HS, Lee YM, Sung TY, Han M, et al. 2018; Changes in serum thyroglobulin levels after lobectomy in patients with low-risk papillary thyroid cancer. Thyroid. 28(8):997–1003. DOI: 10.1089/thy.2018.0046. PMID: 29845894.

20. Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. 2005; Management of thyroid nodules detected at US: society of radiologists in ultrasound consensus conference statement. Radiology. 237(3):794–800. DOI: 10.1148/radiol.2373050220. PMID: 16304103.

21. Park HK, Kim DW, Ha TK, Heo YJ, Baek JW, Lee YJ, et al. 2018; Utility of routine ultrasonography follow-up after total thyroidectomy in patients with papillary thyroid carcinoma: a single-center study. BMC Med Imaging. 18(1):12. DOI: 10.1186/s12880-018-0253-9. PMID: 29764382. PMCID: PMC5952628.

22. Fukuoka O, Sugitani I, Ebina A, Toda K, Kawabata K, Yamada K. 2016; Natural history of asymptomatic papillary thyroid microcarcinoma: time-dependent changes in calcification and vascularity during active surveillance. World J Surg. 40(3):529–37. DOI: 10.1007/s00268-015-3349-1. PMID: 26581368.

23. Xia S, Dong Y, Kang H, Zhan W. 2018; Ultrasonography is valuable in evaluation of papillary thyroid microcarcinoma based on 5 mm tumor size. J Cancer Res Ther. 14(9):319–23. DOI: 10.4103/0973-1482.235347. PMID: 29970683.