ABSTRACT
PURPOSE: Persistent/recurrent disease in the neck is frequent in patients with papillary thyroid cancer (PTC). The goal of this study was to evaluate the efficacy of the reoperation and radioiodine (RAI) treatment for persistent/recurrent disease after the initial treatment. METHODS: A total of 30 patients (13 M/17 F) with PTC were enrolled in this study. All had been submitted to total thyroidectomy for PTC and subsequently to reoperation for local persistent/recurrent disease. All had received RAI, before and/or after reoperation. The mean age at initial thyroidectomy and cancer diagnosis was 41.4±15.2 years. Initial T status was T1 in 22 cases (73.3%), T2 in 4 cases (13.3%) and T3 in 4 cases (13.3%). Initial N status was N0 in 2 cases (6.6%), N1 in 15 cases (50%) and Nx in 13 cases (43.3%). RESULTS: Reoperation reduced the mean stimulated thyroglobulin (stimTg) serum concentration from 76.1±165.5 ng/mL to 20.1±28.8 ng/mL, p=0.002. The RAI treatment provided to 19 patients after reoperation reduced further the stimTg values from 28.6±32.4 ng/mL after reoperation, to 11.3±20.4 ng/mL, p=0.003. According to the dynamic risk stratification after the reoperation 7 patients (23.3%) had excellent response, 4 (13.3%) had biochemically incomplete response, 9 (30.0%) had indeterminate response and 10 (33.3%) had still structural incomplete response. CONCLUSION: Surgery for local persistent/recurrent disease in papillary thyroid carcinoma reduces tumor burden, improves the biochemical and structural disease. Administration of therapeutic RAI after lymph node resections appears to further improve biochemical disease.
Subject(s)
Neoplasm Recurrence, Local/radiotherapy , Neoplasm Recurrence, Local/surgery , Thyroid Cancer, Papillary/radiotherapy , Thyroid Cancer, Papillary/surgery , Adolescent , Adult , Aged , Female , Humans , Iodine Radioisotopes/therapeutic use , Male , Middle Aged , Treatment Outcome , Young AdultABSTRACT
PURPOSE: Thyroid nodular disease (TND) is a frequent clinical problem and the major concern is the probability of malignancy in a solitary nodule or in one or more nodules of a multinodular goiter. For this purpose, neck ultrasound and fine needle aspiration biopsy (FNAB) under ultrasound guidance have been established as the initial investigation of choice. METHODS: A total of 1113 patients (210 male/903 female) underwent FNABs for the same number of thyroid nodules. Correlated were the demographic profile (age and gender) and sonographic features of these nodules with the FNAB outcome. The Bethesda system (B) for reporting thyroid cytopathology was used. RESULTS: Out of total 1113 cases, 255 (22.9%) were characterised as nondiagnostic (B1), 780 (70.1%) were diagnosed as benign (B2), 35 (3.1%) were diagnosed as B3 (atypia/ follicular lesion of undetermined significance), 10 (0.9%) were diagnosed as B4 (follicular neoplasm or suspicious for follicular neoplasm), while 13 (1.2%) cases were categorized as B5 (suspicious for malignancy) and 20 (1.8%) as B6 (malignant). When comparing the sonographic features of nodules with benign cytology (category B2) vs those of nodules with cytology category B3-6, irregular shape and ill-defined margins of the nodule, and microcalcifications and the hypoechogenicity increased significantly the possibility for a B3-B6 cytology result (p<0.05). Finally, there was no association of gender and age with the (B) category results. CONCLUSION: The aforementioned sonographic findings decrease the possibility for a benign cytology result according to the Bethesda classification system. Key words: Bethesda classification system, fine needle aspiration biopsy, thyroid nodules, thyroid ultrasound.