Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Wisconsin, Madison, Wisconsin 53792, USA.
Endocr Pract. 2012 May-Jun;18(3):403-9. doi: 10.4158/EP11221.OR.
To determine the impact of neck ultrasonography in predicting papillary thyroid cancer persistence or recurrence.
Between March 2005 and March 2009, we identified patients with a preoperative diagnosis of papillary thyroid cancer. Exclusion criteria included no documented preoperative ultrasonography and initial surgery at an outside institution. Patients with positive preoperative ultrasonography were compared with patients who had negative preoperative ultrasonography by assessing rates of neck dissection, complications, disease persistence or recurrence, and the need for repeated surgery.
Of 127 patients initially identified, 16 did not have preoperative ultrasonography and 4 did not have their initial surgery at our institution, leaving 107 patients in our cohort. Twenty-two patients had positive preoperative ultrasonography and 85 patients had negative preoperative ultrasonography. Patients with positive preoperative ultrasonography had a higher rate of repeated surgery than those with negative preoperative ultrasonography (27% vs 4.7%, P = .003). There was no difference in postoperative complication rates. No patients with negative preoperative ultrasonography and an ultrasound report stating specifically "no suspicious lymph nodes" required repeated surgery.
Negative preoperative ultrasonography with specific lymph node evaluation predicts a low risk of needing early reoperation. Positive preoperative ultrasonography may be a marker for more aggressive disease and the best predictor of the need for additional surgery in the future.
确定颈部超声在预测甲状腺乳头状癌持续存在或复发中的作用。
我们在 2005 年 3 月至 2009 年 3 月间确定了术前诊断为甲状腺乳头状癌的患者。排除标准包括术前未记录超声检查和初始手术在院外进行。通过评估颈部清扫术、并发症、疾病持续存在或复发的发生率以及重复手术的必要性，比较术前超声阳性患者与术前超声阴性患者的情况。
最初确定的 127 例患者中，有 16 例无术前超声检查，4 例初始手术不在本院进行，因此，我们的队列中有 107 例患者。22 例患者术前超声阳性，85 例患者术前超声阴性。术前超声阳性患者重复手术的发生率高于术前超声阴性患者（27%对 4.7%，P =.003）。术后并发症发生率无差异。术前超声阴性且超声报告明确指出“无可疑淋巴结”的患者无需重复手术。
术前超声阴性且特定淋巴结评估提示早期再次手术的风险较低。术前超声阳性可能是疾病侵袭性更强的标志，也是未来需要额外手术的最佳预测指标。
