Yoon Jung Hyun, Lee Hye Sun, Kim Eun-Kyung, Youk Ji Hyun, Kim Hyun Gi, Moon Hee Jung, Kwak Jin Young
From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (JHY, E-KK, HJM, JYK); Department of Research Affairs, Biostatistics Collaboration Unit (HSL); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (JHY); and Department of Radiology, Ajou University School of Medicine, Suwon, Korea (HGK).
Medicine (Baltimore). 2016 Jan;95(1):e2435. doi: 10.1097/MD.0000000000002435.
To investigate the value of the annual follow-up neck ultrasonography (US) for postoperative surveillance in patients with papillary thyroid microcarcinoma (PTMC). This retrospective study has been approved by our institutional review board (IRB) with waiver for informed consent. A total of 375 patients diagnosed as PTMCs, who underwent total thyroidectomy with radioiodine remnant ablation were included, to identify the recurrence rate and the false-positive rate of annual ultrasound. The number, interval, and the results of follow-up US or fine needle aspiration were obtained from electronic medical records. Four (1.1%, 4/375) recurrences were found 3 years after the initial treatment, and only 1 patient (0.3%, 1/375) had a metastatic lymph node larger than 8 mm in the shortest diameter on US found 7.6 years after initial treatment with biochemical abnormalities. Cumulative risk of having at least 1 false-positive exam was 8.3% by the 8th US, and 8.1% by the 8-9 year follow-up. Cox multivariate regression showed shorter interval of follow-up US and presence of lymph node metastasis at initial surgery are independent predictors affecting the cumulative false-positive results (hazard ratio [HR], 0.60; 95% confidence interval [CI]: 0.49-0.73; P < 0.001 and HR, 2.19; 95% CI: 1.01-4.75; P = 0.048, respectively). Short-term follow-up US can result in higher cumulative false-positive results without detection of meaningful recurrences in patients with PTMCs who do not have biochemical abnormalities.
探讨年度颈部超声检查（US）对甲状腺微小乳头状癌（PTMC）患者术后监测的价值。本回顾性研究已获本机构审查委员会（IRB）批准，豁免知情同意。纳入375例诊断为PTMC且接受全甲状腺切除及放射性碘残余消融的患者，以确定年度超声检查的复发率和假阳性率。从电子病历中获取随访超声检查或细针穿刺的次数、间隔时间及结果。初始治疗3年后发现4例（1.1%，4/375）复发，仅1例患者（0.3%，1/375）在初始治疗7.6年后出现生化异常，超声检查发现最短直径大于8 mm的转移淋巴结。至第8次超声检查时至少出现1次假阳性检查的累积风险为8.3%，随访8 - 9年时为8.1%。Cox多因素回归分析显示，随访超声检查间隔时间较短及初始手术时存在淋巴结转移是影响累积假阳性结果的独立预测因素（风险比[HR]分别为0.60；95%置信区间[CI]：0.49 - 0.73；P < 0.001和HR 2.19；95% CI：1.01 - 4.75；P = 0.048）。对于无生化异常的PTMC患者，短期随访超声检查会导致较高的累积假阳性结果，且未检测到有意义的复发。
