Frequent Neck US in Papillary Thyroid Cancer Likely Detects Non-Actionable Findings.

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American Thyroid Association (ATA) low-intermediate risk papillary thyroid cancer (PTC) patients without structural and biochemical evidence of disease on initial post treatment evaluation have a low risk of recurrence. Studies have shown that with current ultrasound scans (US) and thyroglobulin assays, recurrences mostly occurred 2-8 years after initial therapy. The ATA recommends that neck US be done 6-12 months after surgery to establish patient's response to therapy, then periodically depending on risk of recurrence. The lack of clarity in recommendations on timing of follow-up US and fear of recurrence lead to frequent tests.To evaluate the utility of routine neck US in ATA low-intermediate risk PTC patients with no structural disease on neck US and non-stimulated thyroglobulin<1.0ng/mL after initial therapy.A retrospective study of 93 patients from Singapore, Saudi Arabia, and Argentina with ATA low (n=49) to intermediate (n=44) risk PTC was conducted between 1998-2017. The outcome was to measure the frequency of identifying structural disease recurrence and non-actionable US abnormalities.Over a median follow-up of 5 years, five of the 93 patients (5.4%) developed structural neck recurrence on US at a median of 2.5 years after initial treatment. Indeterminate US abnormalities were detected in 19 of the 93 patients (20.4%) leading to additional tests, which did not detect significant disease.In ATA low-intermediate risk PTC with no suspicious findings on neck US and a non-stimulated thyroglobulin of <1.0ng/mL after initial therapy, frequent US is more likely to identify non-actionable abnormalities than clinically significant disease.


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