Thyroid Research Thyroid Research Archive Thyroid Cancer

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