Hekimsoy İlhan, Güven Mertcan, Tokaç Recep Halit, Kavukçu Gülgün, Akgün Ayşegül
Department of Radiology, İzmir Torbalı State Hospital, İzmir, Turkey.
Department of Nuclear Medicine, Ege University Faculty of Medicine, İzmir, Turkey.
Endocrine. 2025 Apr;88(1):135-142. doi: 10.1007/s12020-024-04147-x. Epub 2024 Dec 30.
To assess the contribution of intense neck ultrasonography (US) follow-up in the clinical management of differentiated thyroid carcinoma (DTC) patients with the American Thyroid Association (ATA) low-intermediate-risk of recurrence and an excellent response after total thyroidectomy and radioiodine therapy.
Medical records of patients who underwent serial follow-up neck US examinations between 1996 and 2022 were analyzed retrospectively. The utility of serial US examinations in detecting structural recurrence was assessed in all patients and different subgroups-categorized per the initial risk of recurrence and stimulated thyroglobulin (sTg) level at 1-year response assessment.
Among 2823 US examinations in 296 patients, 2 (0.1%) were categorized as true-positive, 2670 (94.6%) as true-negative, and 151 (5.3%) as false-positive, whereas no false-negative results were observed. Thus, sensitivity, specificity, positive predictive value (PPV), negative predictive value, and accuracy [confidence interval] in all patients were 100% [34.2-100%], 94.7% [93.8-95.4%], 1.3% [0.36-4.6%], 100% [99.9-100%], and 94.7% [93.8-95.4%], respectively. Non-significant higher PPVs were calculated in intermediate-risk patients and patients having sTg ≥0.1 ng/mL, while slightly lower specificity and accuracy were demonstrated in the former group. No recurrence was identified in patients with a low risk of recurrence and those having sTg <0.1 ng/mL.
Frequent US examination yields remarkably low PPVs in identifying recurrences in ATA low-intermediate-risk patients with DTC and attaining excellent response after total thyroidectomy and radioiodine ablation. Therefore, US surveillance protocol should be individualized per the initial risk of recurrence and Tg levels at response assessment.
评估强化颈部超声（US）随访在分化型甲状腺癌（DTC）患者临床管理中的作用，这些患者具有美国甲状腺协会（ATA）低-中复发风险，且在全甲状腺切除和放射性碘治疗后反应良好。
回顾性分析1996年至2022年间接受系列颈部超声检查患者的病历。在所有患者以及根据复发初始风险和1年反应评估时的刺激甲状腺球蛋白（sTg）水平分类的不同亚组中，评估系列超声检查在检测结构复发方面的效用。
在296例患者的2823次超声检查中，2例（0.1%）为真阳性，2670例（94.6%）为真阴性，151例（5.3%）为假阳性，未观察到假阴性结果。因此，所有患者的敏感性、特异性、阳性预测值（PPV）、阴性预测值和准确性[置信区间]分别为100%[34.2 - 100%]、94.7%[93.8 - 95.4%]、1.3%[0.36 - 4.6%]、100%[99.9 - 100%]和94.7%[93.8 - 95.4%]。中风险患者和sTg≥0.1 ng/mL的患者计算出的PPV略高，而前一组的特异性和准确性略低。复发风险低和sTg<0.1 ng/mL的患者未发现复发。
对于ATA低-中风险的DTC患者，在全甲状腺切除和放射性碘消融后反应良好的情况下，频繁的超声检查在识别复发方面的PPV极低。因此，应根据复发初始风险和反应评估时的Tg水平对超声监测方案进行个体化。
