Thyroid Research Thyroid Research Archive Thyroid Cancer

Ultrasonography is the most sensitive test for detection of recurrent thyroid cancer in the neck

(March 2003)

The background of the study. The most common site of recurrence of papillary and follicular cancer of the thyroid gland is in the thyroid bed or in lymph nodes in the neck. In this study the efficacy of iodine-131 scanning, ultrasonography, and measurement of serum thyroglobulin for the detection of recurrent tumor in the neck was compared.

How the study was done. The study subjects were 494 patients with thyroid cancer, of whom 86 percent had papillary cancer and 14 percent had follicular cancer. All the patients had been treated by total thyroidectomy and then 50 to 100 mCi (1850 to 3700 MBq) of iodine-131. All patients were then treated with thyroxine.

The patients were evaluated at 6- to 12-month intervals by ultrasonography of the neck, measurements of serum thyroglobulin, and whole-body iodine-131 scans after cessation of thyroxine therapy. Tumor recurrence in the neck was defined as a tumor mass in the neck proven to be cancer by ultrasound-guided fine-needle aspiration biopsy or surgical excision.

The results of the study. During an average follow-up period of 55 months, recurrent thyroid cancer was detected in the neck in 51 of the 494 patients (10 percent). The recurrence was detected by ultrasonography in 94 percent of these 51 patients. Biopsy revealed tumor in 85 percent. All 38 patients who underwent surgery had recurrent cancer. Tumor recurrence was detected by the other tests in fewer patients.

The results of ultrasonography were suspicious for neck recurrence in 45 patients (9 percent), but biopsies were negative, and none had evidence of recurrence by the other tests and during follow-up.

The conclusions of the study. Ultrasonography is more sensitive than iodine-131 scans or serum thyroglobulin measurements for detecting the recurrence of thyroid cancer in the neck.

The original article. Frasoldati A, Pesenti M, Gallo M, Caroggio A, Salvo D, Valcavi R. Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma. Cancer 2003;97:90-6.