J Korean Thyroid Assoc.  2015 May;8(1):8-13. 10.11106/cet.2015.8.1.8.

Postoperative Surveillance of Thyroid Cancer: In View of a Radiologist

• Kwak JY

• KMID: 2149615
• DOI: http://doi.org/10.11106/cet.2015.8.1.8

Abstract

Postoperative surveillance in patients with thyroid cancer is very important for radiologist to help the clinician manage the patient. The role of ultrasound is important but small volume tumor recurrence may not affect survival as well as its treatment may, at times, cause more morbid than its natural disease progression. In this review, I discuss postoperative surveillance in patients with thyroid cancer in the view of a radiologist.

Keyword

Thyroid cancer; Recurrence; Ultrasonography; Surveillance

MeSH Terms

Disease Progression
Humans
Recurrence
Thyroid Neoplasms*
Ultrasonography

Figure

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  Fig. 1. Several suspicious US features suggesting pathologic lymph nodes (arrows). (A) Hyperechogenicity. (B) Round shape. (C) Internal cystic change and calcifications.

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  Fig. 2. Suture granuloma. Ill-defined ovoid hypoechoic nodules (arrows) with multiple internal echogenic foci (A, transverse scan and B, longitudinal scan).

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  Fig. 3. A remnant thyroid tissue. After right thyroidectomy due to Hashimoto's thyroiditis, a heterogeneous oval hypoechoic lesion (arrows) was seen inferior to the inferior horn of a thyroid cartilage (arrowheads, A, transverse scan and B, longitudinal scan).

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  Fig. 4. A traumatic neuroma. US shows a nodule with oval, heterogeneous, isochoic mass (arrows) with internal hyperechoic strands.

Reference

References

1. Pacini F, Molinaro E, Castagna MG, Agate L, Elisei R, Ceccarelli C. et al. Recombinant human thyrotropin-stimulated serum thyroglobulin combined with neck ultrasonography has the highest sensitivity in monitoring differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2003; 88(8):3668–73.

2. Filesi M, Signore A, Ventroni G, Melacrinis FF, Ronga G. Role of initial iodine-131 whole-body scan and serum thyroglobulin in differentiated thyroid carcinoma metastases. J Nucl Med. 1998; 39(9):1542–6.

3. Ronga G, Filesi M, Ventroni G, Vestri AR, Signore A. Value of the first serum thyroglobulin level after total thyroidectomy for the diagnosis of metastases from differentiated thyroid carcinoma. Eur J Nucl Med. 1999; 26(11):1448–52.

4. Aygun N. Imaging of recurrent thyroid cancer. Otolaryngol Clin North Am. 2008; 41(6):1095–106. viii.

5. Sippel RS, Chen H. Controversies in the surgical management of newly diagnosed and recurrent/residual thyroid cancer. Thyroid. 2009; 19(12):1373–80.

6. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL. et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19(11):1167–214.

7. Rondeau G, Fish S, Hann LE, Fagin JA, Tuttle RM. Ultrasonographically detected small thyroid bed nodules identified after total thyroidectomy for differentiated thyroid cancer seldom show clinically significant structural progression. Thyroid. 2011; 21(8):845–53.

8. Robenshtok E, Fish S, Bach A, Dominguez JM, Shaha A, Tuttle RM. Suspicious cervical lymph nodes detected after thyroidectomy for papillary thyroid cancer usually remain stable over years in properly selected patients. J Clin Endocrinol Metab. 2012; 97(8):2706–13.

9. Johnson NA, LeBeau SO, Tublin ME. Imaging surveillance of differentiated thyroid cancer. Radiol Clin North Am. 2011; 49(3):473–87. vi.

10. Johnson NA, Tublin ME. Postoperative surveillance of differentiated thyroid carcinoma: rationale, techniques, and controversies. Radiology. 2008; 249(2):429–44.

11. Park JS, Son KR, Na DG, Kim E, Kim S. Performance of preoperative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC/UICC TNM classification system. AJR Am J Roentgenol. 2009; 192(1):66–72.

12. Kim E, Park JS, Son KR, Kim JH, Jeon SJ, Na DG. Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography. Thyroid. 2008; 18(4):411–8.

13. Choi JS, Kim J, Kwak JY, Kim MJ, Chang HS, Kim EK. Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol. 2009; 193(3):871–8.

14. Sohn YM, Kwak JY, Kim EK, Moon HJ, Kim SJ, Kim MJ. Diagnostic approach for evaluation of lymph node metastasis from thyroid cancer using ultrasound and fine-needle aspiration biopsy. AJR Am J Roentgenol. 2010; 194(1):38–43.

15. Shin JH, Han BK, Ko EY, Kang SS. Sonographic findings in the surgical bed after thyroidectomy: comparison of recurrent tumors and nonrecurrent lesions. J Ultrasound Med. 2007; 26(10):1359–66.

16. Suh YJ, Son EJ, Moon HJ, Kim EK, Han KH, Kwak JY. Utility of thyroglobulin measurements in fine-needle aspirates of space occupying lesions in the thyroid bed after thyroid cancer operations. Thyroid. 2013; 23(3):280–8.

17. Kim JH, Lee JH, Shong YK, Hong SJ, Ko MS, Lee DH. et al. Ultrasound features of suture granulomas in the thyroid bed after thyroidectomy for papillary thyroid carcinoma with an emphasis on their differentiation from locally recurrent thyroid carcinomas. Ultrasound Med Biol. 2009; 35(9):1452–7.

18. Hahn SY, Shin JH, Han BK, Ko EY, Kang SS, Chung JH. et al. Predictive factors related to the recurrence at US-guided fine needle aspiration in postoperative patients with differentiated thyroid cancer. Clin Endocrinol (Oxf). 2011; 74(2):270–5.

19. Ko MS, Lee JH, Shong YK, Gong GY, Baek JH. Normal and abnormal sonographic findings at the thyroidectomy sites in postoperative patients with thyroid malignancy. AJR Am J Roentgenol. 2010; 194(6):1596–609.

20. Torlontano M, Attard M, Crocetti U, Tumino S, Bruno R, Costante G. et al. Follow-up of low risk patients with papillary thyroid cancer: role of neck ultrasonography in detecting lymph node metastases. J Clin Endocrinol Metab. 2004; 89(7):3402–7.

21. Leboulleux S, Girard E, Rose M, Travagli JP, Sabbah N, Caillou B. et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab. 2007; 92(9):3590–4.

22. Pelttari H, Laitinen K, Schalin-Jantti C, Valimaki MJ. Long-term outcome of 495 TNM stage I or II patients with differentiated thyroid carcinoma followed up with neck ultrasonography and thyroglobulin measurements on T4 treatment. Clin Endocrinol (Oxf). 2008; 69(2):323–31.

23. Tuttle RM, Tala H, Shah J, Leboeuf R, Ghossein R, Gonen M. et al. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid. 2010; 20(12):1341–9.

24. Yoon JH, Kim JY, Moon HJ, Youk JH, Son EJ, Kim EK. et al. Contribution of computed tomography to ultrasound in predicting lateral lymph node metastasis in patients with papillary thyroid carcinoma. Ann Surg Oncol. 2011; 18(6):1734–41.

25. Noguchi S, Noguchi A, Murakami N. Papillary carcinoma of the thyroid. I. Developing pattern of metastasis. Cancer. 1970; 26(5):1053–60.

26. Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T. et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003; 237(3):399–407.

27. Kim BY, Jung CH, Kim JW, Lee SW, Kim CH, Kang SK. et al. Impact of clinicopathologic factors on subclinical central lymph node metastasis in papillary thyroid microcarcinoma. Yonsei Med J. 2012; 53(5):924–30.

28. Durante C, Attard M, Torlontano M, Ronga G, Monzani F, Costante G. et al. Identification and optimal postsurgical follow-up of patients with very low-risk papillary thyroid microcarcinomas. J Clin Endocrinol Metab. 2010; 95(11):4882–8.

29. Chung YE, Kim EK, Kim MJ, Yun M, Hong SW. Suture granuloma mimicking recurrent thyroid carcinoma on ultrasonography. Yonsei Med J. 2006; 47(5):748–51.

30. Yabuuchi H, Kuroiwa T, Fukuya T, Tomita K, Hachitanda Y. Traumatic neuroma and recurrent lymphadenopathy after neck dissection: comparison of radiologic features. Radiology. 2004; 233(2):523–9.

31. Huang LF, Weissman JL, Fan C. Traumatic neuroma after neck dissection: CT characteristics in four cases. AJNR Am J Neuroradiol. 2000; 21(9):1676–80.

32. Iida S, Shirasuna K, Kogo M, Matsuya T. Amputation neuroma following radical neck dissection–report of 3 cases. J Osaka Univ Dent Sch. 1995; 35:1–4.

33. Lee EJ, Calcaterra TC, Zuckerbraun L. Traumatic neuromas of the head and neck. Ear Nose Throat J. 1998; 77(8):670–4. 676.

34. Beggs I. Sonographic appearances of nerve tumors. J Clin Ultrasound. 1999; 27(7):363–8.

35. Fornage BD. Peripheral nerves of the extremities: imaging with US. Radiology. 1988; 167(1):179–82.

36. Kwak JY, Kim EK, Kim MJ, Son E. Sonographic features of traumatic neuromas after neck dissection. J Clin Ultrasound. 2009; 37(4):189–93.

37. Ha EJ, Baek JH, Lee JH, Kim YJ, Kim JK, Kim TY. et al. Characteristic ultrasound feature of traumatic neuromas after neck dissection: direct continuity with the cervical plexus. Thyroid. 2012; 22(8):820–6.

38. David A, Blotta A, Rossi R, Zatelli MC, Bondanelli M, Roti E. et al. Clinical value of different responses of serum thyroglobulin to recombinant human thyrotropin in the follow-up of patients with differentiated thyroid carcinoma. Thyroid. 2005; 15(3):267–73.