Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer
Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer
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DOI：
10.1016/s0039-6060(03)00424-0
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发表时间：
2003-12-01
期刊：
影响因子：
3.8
通讯作者：
Evans, DB
中科院分区：
文献类型：
--
作者：
Kouvaraki, MA;Shapiro, SE;Evans, DB
背景高达30%的分化型甲状腺癌患者发生宫颈复发。我们回顾性比较了术前经皮超声检查和体格检查（PE）对甲状腺癌患者局部区域转移（淋巴结和软组织）的检测结果。数据收集回顾性的病历甲状腺癌患者谁接受术前超声检查。患者分为3组：第1组，接受初次甲状腺/颈部手术的患者;第2组，因持续性疾病接受再次手术的患者;第3组，因复发性甲状腺癌接受再次手术的患者。对于每一组，我们记录超声检查在PE上正常的颈部室（中央或外侧）中发现疾病的频率。212例患者因原发性、持续性或复发性乳头状癌（n = 130）、髓样癌（n = 61）或滤泡/Hurthle细胞癌（n = 21）接受手术。超声检查在107例I组患者中的21例（20%）、28例2组患者中的9例（32%）和77例3组患者中的52例（68%）中发现了PE未发现的其他转移性疾病部位。在212例患者中，82例（39%）的术前超声检查信息改变了手术操作。在107例I组患者中，尽管有67例（63%）肿瘤大于2 cm或淋巴结肿大，但在中位随访36个月时仅6例（6%）宫颈复发。术前高质量超声检查发现颈部淋巴结或软组织转移，认为39%的患者未被PE累及。超声检查结果改变了这些患者的手术程序，有利于完全切除疾病，并可能最大限度地减少局部复发。
Background. Cervical recurrence occurs in up to 30% of patients with differentiated thyroid carcinoma. We retrospectively compared preoperative transcutaneous ultrasonography and physical examination (PE) results in the detection of local-regional metastases (lymph node and soft tissue) in patients with thyroid cancer.Methods. Data were collected retrospectively from the medical records of patients with thyroid carcinoma who underwent preoperative ultrasonography. Patients were divided into 3 groups: group 1, those undergoing primary thyroid/neck surgery; group 2, those undergoing reoperation for Persistent disease; and group 3, those undergoing reoperation for recurrent thyroid carcinoma. For each group, we recorded the frequencies with which ultrasonography detected disease in a neck compartment (central or lateral) that was normal on PE.Results. Two hundred twelve patients underwent operation for Primary, persistent, or recurrent papillary (n = 130), medullary (n = 61), or follicular/Hurthle cell (n = 21) carcinoma. Ultrasonography detected additional sites of metastatic disease not appreciated on PE in 21 (20%) of 10 7 group I patients, 9 (32%) of 28 group 2 patients, and 52 (68%) of 77 group 3 patients. The surgical procedure performed was altered by the information obtained from preoperative ultrasonography in 82 (39%) of the 212 patients. Of the 107 group I patients, cervical recurrence has been detected in only 6 (6%) at a median follow-up of 36 months, in spite of 6 7 (63%) having tumors larger than 2 cm or lymph node metastases.Conclusions. Preoperative high-quality ultrasonography detected lymph node or soft-tissue metastases in neck compartments believed, to be uninvolved by PE in 39% of patients. Ultrasound findings altered the operative procedure in these patients, facilitating complete resection of disease and potentially minimizing local-regional recurrence.