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Preoperative Lateral Neck Ultrasonography as a Long-term Outcome Predictor in Papillary Thyroid Cancer

2011; American Medical Association; Volume: 137; Issue: 2 Linguagem: Inglês

10.1001/archoto.2010.254

1538-361X

Mauricio A. Moreno, Garima Agarwal, Rolando de Luna, Eric R. Siegel, Steven I. Sherman, Beth S. Edeiken‐Monroe, Gary L. Clayman,

Head and Neck Anomalies

Objective To evaluate the long-term outcomes and prognostic value of our sonographically based surgical approach to the lateral neck for recurrences in papillary thyroid cancer (PTC). Design Retrospective medical chart review. Setting Tertiary cancer institution. Patients The study population comprised 331 consecutive patients primarily treated for papillary thyroid carcinoma (PTC) at a tertiary cancer institution between 1996 and 2003. The lateral neck compartments were surgically addressed only in the presence of abnormalities on ultrasonography (US). Main Outcome Measures Recurrence-free interval and overall, disease-specific, and recurrence-free survival. Results There were 112 male and 219 female patients, with a median age of 44.7 years (range, 11-87 years). The median follow-up time for the series was 77.9 months (range, 12.7-148.7 months). Preoperative US abnormalities were found in the right neck in 13.3%, in the left neck in 12.3%, and bilaterally in 11.2%; all of these patients underwent a lateral neck dissection at the time of the thyroidectomy. There were 11 recurrences in the series (0.3%), with a median time to presentation of 22.8 months (range, 6.0-55.3 months). Predictors of lateral neck disease-free interval were T stage and distant disease at presentation ( P = .01 and P < .001, respectively) and the sonographic status of the ipsilateral and central neck ( P = .001 and P < .001). The number of abnormal neck compartments in US correlated with the risk of regional failure ( P = .01). The presence of US abnormalities in the lateral neck decreased the 10-year disease-specific survival from 98.3% to 66.9% ( P < .001). Conclusions Preoperative US is an excellent outcome predictor for lateral neck disease-free interval and for disease-specific survival in PTC. Sonographically based surgical approach provides excellent long-term regional control and validates current treatment guidelines.