In patients with differentiated thyroid cancer, preoperative imaging of the neck through ultrasound yields better detection of disease in lateral neck nodes, leading to increases in lateral neck dissections and response to treatment, according to recent findings.
In the retrospective review, researchers evaluated data of 465 patients with differentiated thyroid cancer (DTC) who underwent surgery at Memorial Sloan Kettering Cancer Center between January 2009 and December 2010. Fifty percent of participants underwent preoperative ultrasound of cervical neck lymph nodes, and 231 were not imaged preoperatively with ultrasound. The median follow-up was 29 months.
The management of the patients was stratified by preoperative ultrasound status, and the study’s primary outcome was initial response to therapy (RTT). RTT was defined as having no evidence of disease (NED). Patients were considered to have NED based on suppressed serum thyroglobulin (Tg) 1 ng/mL, no identifiable Tg antibodies, and no structural signs of disease on postoperative ultrasound imaging.
No significant differences were found for patient age, tumor histology, stage of the primary tumor, the dose of postoperative radioactive iodine (RAI) needed, American Joint Committee on Cancer stage, American Thyroid Association risk category, or duration of follow-up between the ultrasound group and the no ultrasound cohort.
There was a greater likelihood of lateral neck dissection (LND) among those in the ultrasound group (13.2%, n=31) vs. those in the no ultrasound group (0.9%, n=2; p<.001). Those who had ultrasounds had significantly better RTT than those who did not (p=.005), were more likely to be NED, and had a lower risk of incomplete response (biochemical or structural) or return for postponed neck dissection. Additionally, the ultrasound group had fewer recurrences, with only two of these patients (0.9%) returning for surgery vs. 10 patients (4.3) in the no ultrasound group (p=.018)
The researchers said the routine use of postoperative ultrasound in patients with DTC could be valuable in optimizing surgery and subsequent response, but its survival benefits are not yet known.
“Such a policy is beneficial for patient counseling, limits subsequent follow up tests and allows for early patient discharge,” the researchers wrote. “However, although this
policy results in improved response to therapy, it remains unclear if there is any impact on survival.”
Disclosure: The researchers report no relevant disclosures.