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© 2007 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 26:1359-1366 • 0278-4297

Sonographic Findings in the Surgical Bed After Thyroidectomy

Comparison of Recurrent Tumors and Nonrecurrent Lesions

Jung Hee Shin, MD, Boo-Kyung Han, MD, Eun Young Ko, MD and Seok Seon Kang, MD

Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address correspondence to Boo-Kyung Han, MD, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea. E-mail: bkhan{at}smc.samsung.co.kr

Objective. The purpose of this study was to assess the sonographic findings of recurrent tumors and nonrecurrent lesions mimicking recurrent tumors in the surgical bed after thyroidectomy for thyroid cancer. Methods. Fifty-eight patients who underwent sonography and sonographically guided fine-needle aspiration for evaluation of abnormal lesions in the surgical bed after thyroidectomy were included in this retrospective study. We compared the sonographic findings of recurrent tumors and nonrecurrent lesions, including lesion size, shape, margins, and echogenicity, presence or absence of microcalcification, and vascular flow signals. The reference standard was repeated sonographically guided fine-needle aspiration, surgery, or follow-up for at least 1 year. Results. Of 59 lesions in 58 patients, 20 were confirmed as recurrent tumors, and 36 were confirmed as nonrecurrent lesions in the surgical bed; 3 patients were lost to follow-up. On sonographic examination, the recurrent tumors diagnosed in 20 patients were oval in 70%, had well-defined margins in 100%, were hypoechoic in 70%, and had microcalcification in 10%. The average size was 0.7 cm (range, 0.4–2.1 cm). There was no statistical difference in sonographic findings between recurrent tumors and nonrecurrent lesions (P > .05). The 36 nonrecurrent lesions included remnant thyroidal tissue (n = 8), postoperative fibrosis (n = 7), suture granuloma (n = 7), strap muscle with a nodular contour (n = 4), reactive lymph nodes (n = 4), cysts (n = 3), tracheal cartilage (n = 2), and fat necrosis (n = 1). Conclusions. For lesions located in the surgical bed in patients after thyroidectomy, the distinction between recurrent thyroid cancer and nonrecurrent benign lesions cannot be made on the basis of the sonographic features. Fine-needle aspiration is helpful in determining the histologic nature of such lesions.

Key Words: recurrence • sonography • thyroid bed

Abbreviations: DTC, differentiated thyroid cancer • FNA, fine-needle aspiration • Tg, thyroglobulin • TSH, thyrotropin • WBS, whole-body scanning

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Copyright © 2007 by the American Institute of Ultrasound in Medicine.