Management Issues in Recurrent and Metastatic Thyroid Cancer

David L. Steward, MD, Associate Professor of Otolaryngology at the University of Cincinnati, concurred. Neck ultrasound is increasingly used by endocrinologists and surgeons in thyroid cancer surveillance and is becoming the standard of care at larger medical centers with a large number of thyroid cancer patients, he said.

In another study presented at a recent Triological Society Meeting, Dr. Steward presented data that, he says, confirm the utility of ultrasound to detect and localize persistent or recurrent thyroid cancer in the neck.

In the retrospective study, Dr. Steward and colleagues compared outcomes of 18 patients with sonographically localized and pathology-confirmed recurrent differentiated thyroid cancer who underwent lymph node dissection (n = 15) or no dissection (n = 3). Lymph node dissection included lateral (levels II-V) and/or central (level VI) compartments, and was performed by the same surgeon in all 15 patients.3

Jonas Johnson, MD

The study found that none of the patients who underwent lymph node dissection had sonographic evidence of lymph node disease. Furthermore, 67% of those patients had undetectable thyroglobulin or thyroglobulin antibody levels. The three patients who did not undergo a reoperation had persistently detectable sonographic nodal disease as well as positive thyroglobulin and/or thyroglobulin antibody levels.

Our study suggests that sonographically directed compartmental neck dissection sparing cranial and cervical nerves can be associated with low morbidity and result in resolution of sonographically detectable neck disease with about two-thirds of patients becoming thyroglobulin-negative postoperatively, said Dr. Steward.

For Dr. Steward, the study also highlights the importance of a surgeon experienced in neck ultrasound for optimal outcomes with minimal morbidity.

The study further suggests that when a surgeon performs the ultrasound personally, he said, it is a valuable tool to guide the dissection to the central and lateral nodal compartments with disease, potentially limiting morbidity from reoperation exploration of a nodal compartment without detectable disease.

References

1. Fialkowski E et al. Outcomes of central neck dissection in thyroid cancer. Poster 161. Presented at the Society of Surgical Oncology 61st Annual Meeting, March 2008.
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2. Davidson HC et al. Papillary thyroid cancer: controversies in the management of neck metastasis. Presented at the Triological Society Meeting, January 2008.
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3. Lee L et al. Effectiveness of sonographically localized and directed compartmental neck dissection for recurrent differentiated thyroid carcinoma. Presented at the Triological Society Meeting, January 2008.
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©2008 The Triological Society