Intraoperative ultrasonography improves identification of recurrent thyroid cancer

Surgical resection is the only curative treatment option for locoregional recurrence of well-differentiated thyroid cancer that does not trap radioiodine. We hypothesized that intraoperative ultrasonography would aid in the localization of recurrent thyroid cancer and would enhance the ability to perform a complete resection.

Between June 2000 and October 2001, 13 patients with recurrent, scan-negative, papillary thyroid cancer were explored by using intraoperative ultrasonography.

All patients had identification and resection of recurrent papillary thyroid cancer. Eleven patients had a complete resection, and 2 patients had incomplete resection as a result of local invasion. Ultrasound was required for identification of tumor in 7 patients and included all patients with a history of external beam radiotherapy. In 6 of these 7 patients, the tumor was paratracheal or invasive into the trachea or thyroid cartilage. In 11 patients with detectable serum thyroglobulin preoperatively, the level demonstrated a decline in 10 patients and became undetectable in 7 patients.

Intraoperative ultrasonography is a useful method to identify nonpalpable, locoregional recurrences of thyroid cancer. Ultrasound was particularly helpful in patients who had previous external beam radiotherapy and in the identification of tumor nodules of 20 mm or less that were invasive or adherent to the airway.