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Reoperations for structurally persistent or recurrent disease after thyroidectomy: analysis via preoperative CT.

Hyeung Kyoo Kim¹, Eun Ju Ha², Miran Han³

¹Department of Surgery, Ajou University School of Medicine, Wonchon-Dong, Yeongtong-Gu, Suwon, 443-380, Korea.

Scientific Reports

|July 25, 2020

Summary

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Most differentiated thyroid cancer reoperations address persistent disease (PD), not recurrent disease (RD). Persistent disease is more common in non-dissected necks, highlighting the need for improved preoperative CT scans and initial surgical strategies.

Area of Science:

Oncology
Radiology
Surgical Pathology

Background:

Differentiated thyroid cancer (DTC) management involves surgery, but persistent disease (PD) and recurrent disease (RD) rates and characteristics require further elucidation.
Understanding clinicoradiological (CT) features of PD and RD is crucial for optimizing patient care and reoperation strategies.

Purpose of the Study:

To characterize differentiated thyroid cancer patients undergoing reoperation for persistent or recurrent disease.
To analyze clinicoradiological features, particularly preoperative CT findings, associated with PD and RD after initial thyroidectomy.

Main Methods:

Retrospective analysis of 9,173 DTC patients, identifying 121 who underwent reoperation for PD or RD.
Classification of disease status based on persistence/recurrence and neck dissection status.

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Review of preoperative neck CT scans to assess disease characteristics and identify potential imaging discrepancies.

Main Results:

81% of reoperations were for PD, while 19% were for RD, with mean times to reoperation of 25.5 months for PD and 54.1 months for RD.
Persistent disease was more frequently observed in non-dissected necks compared to recurrent disease.
Non-dissected necks showed higher tumor multiplicity and a greater number of pathologically positive lymph nodes than dissected necks.
CT scans revealed more false-negative findings in 60-s-delay scans compared to 30-40-s-delay scans for PD in non-dissected necks.

Conclusions:

The majority of reoperations in DTC patients are necessitated by persistent disease.
Improved preoperative CT assessment and initial surgical planning, informed by clinicoradiological characteristics, are essential for better management of DTC patients and reducing the need for reoperation.