Ultrasonography of the neck is the best
test for recurrent tumor in patients with a papillary microcarcinoma
(March 2006)
The background of the study. Papillary microcarcinomas
are by definition small (≤1 cm), and the prognosis of patients
with these tumors is excellent. In this study, the value of several
tests for detecting recurrent tumor was evaluated in patients with
papillary microcarcinoma.
How the study was done. The study subjects were
80 patients with a papillary microcarcinoma. Eleven had a solitary
thyroid nodule, with a biopsy positive for papillary carcinoma.
The other 69 had a multinodular goiter, and the carcinoma was detected
incidentally at surgery. The average tumor size was 0.6 cm. All
the patients were treated by near-total thyroidectomy and then thyroxine.
Six to 12 months after surgery, the patients were evaluated by
clinical examination, ultrasonography of the neck, and whole-body
radioiodine (I-131) scan and measurements of serum thyroglobulin
(Tg) before and after the intramuscular administration of recombinant
thyrotropin (TSH).
The results of the study. Basal serum Tg values
were ≤1 ng/ml in 76 patients (95 percent) and >1 ng/ml
in 4 (5 percent). After TSH administration, serum Tg values were
≤1 ng/ml in 45 patients (56 percent) and >1 ng/ml in 35
(44 percent). The 48-hour uptake of I-131 in the neck (thyroid bed)
ranged from 0.1 to 10.2 percent.
Ultrasonography of the neck revealed findings suspicious for lymph-node
metastases, confirmed by biopsy, in 3 patients (4 percent). The
results of the other tests were not different in these patients,
as compared with those in whom ultrasonography did not reveal recurrent
tumor.
Seventy-four patients were followed for 10 to 72 months (mean,
32) after surgery. Follow-up ultrasound studies revealed no evidence
of tumor in any of these patients.
The conclusions of the study. Among patients with
papillary microcarcinoma, ultrasonography of the neck is a more
sensitive test for detecting recurrent tumor.
The original article. Torlontano M, Crocetti U,
Augello G, D’Aloiso L, Bonfitto N, Varraso A, Dicembrino F,
Modoni S, Frusciante V, Di Giorgio A, Bruno R, Filetti S, Trischitta
V. Comparative evaluation of recombinant human thyrotropin-stimulated
thyroglobulin levels, 131I whole-body scintigraphy, and neck ultrasonography
in the follow-up of patients with papillary thyroid microcarcinoma
who have not undergone radioiodine therapy. J Clin Endocrinol Metab
2006;91:60-3
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