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"Sun's Seven-Step Technique" for Endoscopic En-Bloc Resection of Thyroid Cancer via the Chest-Breast Approach
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Recurrence in the thyroidectomy bed: sonographic findings.

Aya Kamaya1, Megan Gross, Haruko Akatsu

  • 1Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr., H1307, Stanford, CA 94105, USA. kamaya@stanford.edu

AJR. American Journal of Roentgenology
|December 24, 2010
PubMed
Summary

Ultrasound is highly sensitive for detecting differentiated thyroid cancer recurrence after thyroidectomy. Hypoechoic lesions with vascularity greater than 6 mm strongly predict recurrence, outperforming serum thyroglobulin levels.

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Area of Science:

  • Radiology
  • Oncology
  • Endocrinology

Background:

  • Differentiated thyroid cancer (DTC) recurrence after thyroidectomy requires accurate detection.
  • Sonography is a key imaging modality for surveillance in the thyroidectomy bed.

Purpose of the Study:

  • To characterize the sonographic features of recurrent DTC in the thyroidectomy bed.
  • To evaluate the diagnostic performance of ultrasound compared to serum thyroglobulin levels.

Main Methods:

  • Retrospective review of patients undergoing biopsy for thyroidectomy bed lesions.
  • Analysis of gray-scale and color Doppler ultrasound features of identified lesions.
  • Correlation of sonographic findings with biopsy results and serum thyroglobulin levels.

Main Results:

  • Of 25 diagnostic biopsies, 22 indicated recurrence. Recurrent lesions were predominantly hypoechoic (95%) and showed internal vascularity (100%). Microcalcifications were present in 36% and coarse calcifications in 23%.
  • Nondiagnostic lesions were often hypoechoic with some vascularity. Benign lesions were hypoechoic with coarse calcifications and less vascularity.
  • Elevated serum thyroglobulin (Tg) or anti-Tg antibodies were found in 63% of patients with recurrence.

Conclusions:

  • A hypoechoic thyroidectomy bed lesion with internal vascularity and a size greater than 6 mm is highly sensitive for predicting DTC recurrence.
  • Ultrasound is more sensitive than serum Tg levels for detecting recurrence in the thyroidectomy bed.