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SURGEON PERFORMED ULTRASOUND IS HIGHLY BENEFICIAL IN THE POST-OPERATIVE SURVEILLANCE OF THYROID CANCER PATIENTS
*Liudmila Muraveika¹, *Vanessa Baratta², *Travis Cotton¹, Peter Mazzaglia^1
1Brown University, Department of Surgery, Providence, RI;²Brown University, Warren Alpert School of Medicine, Providence, RI

Objective: This study examines the relative value of surgeon-performed ultrasound (SPUS). Design: retrospective review. Setting: All patients operated on by a single endocrine surgeon 2006-2010 were followed annually with SPUS for 5 years. Patients: 105 patients, 79 women, 26 men. Main Outcome Measures: Sensitivity of SPUS was 56% for central compartment metastases, and 100 % for lateral compartment disease. The negative predictive value of a normal surveillance SPUS was 98.7 %. Results: Mean primary tumor size was 2.7 cm. 22 patients had suspicion of lateral cervical lymph node metastases by SPUS prior to thyroidectomy, and ultrasound-guided fine needle aspiration biopsy performed in all of them. 10 biopsies were benign, 11 biopsies were positive for papillary cancer and 1 was non-diagnostic. At the initial operation, 23 patients had a central compartment lymph node dissection and 12 patients had a lateral compartment dissection. Pathology was papillary in 84, follicular in 20 and medullary in 2. 73 had Stage I, 8 Stage II, 22 Stage III, and 2 Stage IV disease. Recurrent disease was detected in 11 patients, 1 in the central compartment and 10 in the lateral compartment. Mean time to recurrence was 20.7 months. The initial test suggesting disease recurrence was physical exam in 2, rising thyroglobulin in 1, SPUS in 6, outside US in 1, and RIU in 1. After confirmatory biopsy, recurrent disease was treated operatively in 10 and with radio-iodine ablation in 1. Conclusions: SPUS is highly sensitive for the pre-operative detection of thyroid cancer metastatic to the lateral neck, and was the most sensitive method for detecting recurrent disease. In the post-operative surveillance annual ultrasound by an endocrine surgeon improves care.

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