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© 2004 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 23:915-920 • 0278-4297

Sonography in the Diagnosis of Cervical Recurrence in Patients With Differentiated Thyroid Carcinoma

Pedro Weslley Souza do Rosário, MD, Tales Alvarenga Fagundes, MD, Frederico Fernandes Ribeiro Maia, MD, Ana Cristina Horta Messias Franco, Manoela Bertozzi Figueiredo, MD and Saulo Purisch, MD

Department of Thyroid, Endocrinology and Metabolism Service of Santa Casa de Belo Horizonte, Minas Gerais, Brazil.

Address correspondence and reprint requests to Pedro Weslley Souza do Rosário, MD, Centro de Estudos e Pesquisa da Clinica de Endocrinologia e Metabologia, Avenida Francisco Sales 1111, 5 Andar Ala D, Santa Efigênia, CEP 30150-221, Belo Horizonte, MG, Brazil. E-mail: cepcem.bhz{at}terra.com.br.

Objective. To determine the sensitivity of thyroglobulin (Tg), iodine scanning, and sonography in the diagnosis of cervical recurrence of thyroid cancer. Methods. This prospective study assessed 81 patients with cervical metastases or extrathyroid invasion at first appearance who underwent clinical examination, scanning, measurement of Tg after thyroxine withdrawal, and sonography about 8 months after thyroidectomy followed by radioiodine treatment. Only patients without distant metastases and without anti-Tg antibodies were included. Results. Fifty patients showed persistence of the disease in the cervical region, with only 16% of them having had a suspicion on clinical examination, 33 with Tg levels of 2 ng/mL or greater (66% sensitivity), and 29 with positive scan findings (58% sensitivity). A combination of the 2 methods detected disease in 40 (80%) of 50 patients but failed to show 20% of cases that were identified by sonography and confirmed by fine-needle aspiration. Sonography had sensitivity of 96%. Specificity values for Tg, iodine scanning, and sonography were 80.6%, 90.3%, and 87%, respectively. Conclusions. Classic follow-up methods may not detect cervical disease in some patients with differentiated thyroid carcinoma, and sonography is necessary even in patients apparently free of the disease.

Key Words: cervical recurrence • sonography • thyroid cancer

Abbreviations: FNA, fine-needle aspiration • T4, thyroxine • Tg, thyroglobulin • TgAb, anti-Tg antibody • TSH, thyroid-stimulating hormone • WBS, whole-body scanning




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Copyright © 2004 by the American Institute of Ultrasound in Medicine.