Peiling Yang Samantha, Bach Ariadne M, Tuttle R Michael, Fish Stephanie A
Endocrinology Service (S.P.Y., R.M.T., S.A.F.), Department of Medicine, and Department of Radiology (A.M.B.), Memorial Sloan Kettering Cancer Center, New York, New York 10021; and Endocrinology Division (S.P.Y.), Department of Medicine, National University Hospital, Singapore 119228.
J Clin Endocrinol Metab. 2015 Apr;100(4):1561-7. doi: 10.1210/jc.2014-3651. Epub 2015 Jan 29.
American Thyroid Association (ATA) intermediate-risk thyroid cancer patients who achieve an excellent treatment response demonstrate a low risk of structural disease recurrence. Despite this fact, most patients undergo frequent surveillance neck ultrasound (US) during follow-up.
The objective of the study was to evaluate the clinical utility of routine screening neck US in ATA intermediate-risk patients documented to have a nonstimulated thyroglobulin less than 1.0 ng/mL and a neck US without suspicious findings after therapy.
Retrospective review of 90 ATA intermediate-risk papillary thyroid carcinoma patients treated with total thyroidectomy and radioactive iodine ablation in a tertiary referral center.
A comparison between the frequency of finding false-positive US abnormalities and the frequency of identifying structural disease recurrence in the study cohort was measured.
Over a median of 10 years, 90 patients had a median of six US (range 2-16). Structural disease recurrence was identified in 10% (9 of 90) at a median of 6.3 years. Recurrence was associated with other clinical indicators of disease in 5 of the 90 patients (5.6%, 5 of 90) and was detected without other signs of recurrence in four patients (4.8%, 4 of 84). False-positive US abnormalities were identified in 57% (51 of 90), leading to additional testing, which failed to identify clinically significant disease.
In ATA intermediate-risk patients who have a nonstimulated thyroglobulin less than 1.0 ng/mL and a neck US without suspicious findings after therapy, frequent US screening during follow-up is more likely to identify false-positive abnormalities than clinically significant structural disease recurrence.
美国甲状腺协会（ATA）中危甲状腺癌患者若获得良好的治疗反应，其结构疾病复发风险较低。尽管如此，大多数患者在随访期间仍需频繁接受颈部超声（US）检查。
本研究的目的是评估常规筛查颈部超声在ATA中危患者中的临床应用价值，这些患者的非刺激甲状腺球蛋白低于1.0 ng/mL，且治疗后颈部超声无可疑发现。
对在一家三级转诊中心接受全甲状腺切除术和放射性碘消融治疗的90例ATA中危乳头状甲状腺癌患者进行回顾性研究。
测量研究队列中发现超声假阳性异常的频率与识别结构疾病复发的频率之间的比较。
在中位10年的时间里，90例患者接受超声检查的中位次数为6次（范围为2 - 16次）。10%（90例中的9例）在中位6.3年时发现结构疾病复发。90例患者中有5例（5.6%，90例中的5例）的复发与其他疾病临床指标相关，84例患者中有4例（4.8%，84例中的4例）在无其他复发迹象的情况下检测到复发。57%（90例中的51例）发现超声假阳性异常，导致进行额外检查，但未发现具有临床意义的疾病。
在非刺激甲状腺球蛋白低于1.0 ng/mL且治疗后颈部超声无可疑发现的ATA中危患者中，随访期间频繁进行超声筛查更有可能发现假阳性异常，而非具有临床意义的结构疾病复发。
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