The role of neck ultrasound in the follow-up of low- and intermediate- risk papillary thyroid cancer

ABSTRACT

ABSTRACT Objective: The optimal time for a neck ultrasound (US) in the follow-up of papillary thyroid cancer (PTC) after the first year is undetermined. We aimed to verify the utility of routine neck US in the surveillance of patients diagnosed with low- and intermediate-risk PTC with no evidence of disease at the one-year assessment. Materials and methods: We conducted a retrospective longitudinal study of patients with low- and intermediate-risk PTC with normal neck US, unstimulated serum thyroglobulin (Tg) < 1 ng/mL and negative anti-Tg antibodies at the one-year follow-up. Patients were divided into group 1 [undetectable Tg (<0.20 ng/mL)] and group 2 [detectable Tg but < 1 ng/mL]. The negative predictive value (NPV) of the one-year unstimulated Tg at the five-year and last follow-up visits was calculated. Results: We included n = 88 patients in group 1 and n = 8 patients in group 2. No patient from group 1 presented suspicious US findings at the five-year evaluation [NPV 100.0% (95% confidence interval (CI) 95.5%-100.0%)], and at the last visit, only one patient had developed a lymph node classified as suspicious [NPV 98.8% (95% CI 93.2%-100.0%); mean follow-up 6.7 years]. In group 2, two patients' USs presented suspicious findings at the five-year evaluation [NPV 75.0% (95% CI 34.9%-96.8%)]. At the last visit, only one patient persisted with suspicious findings in the US [NPV 87.5% (95% CI 47.4%-99.7%); mean follow-up 6.5 years]. Conclusion: Low- and intermediate-risk PTC with an excellent response to treatment at the one-year assessment can be safely monitored with regular unstimulated Tg assessments. Conclusions should not be drawn for Tg levels between 0.20-0.99 ng/mL.