Reoperations for structurally persistent or recurrent disease after thyroidectomy: analysis via preoperative CT

Hyeung Kyoo Kim,Miran Han,Euy Young Soh,Eun Ju Ha,Jeonghun Lee

doi:10.1038/s41598-020-69398-w

Abstract

The incidence rates of structural persistent disease (PD) and recurrent disease (RD) after thyroidectomy, and their clinicoradiological (CT) characteristics, remain poorly understood. Therefore, we characterized differentiated thyroid cancer (DTC) patients who underwent re-operations, with a focus on preoperative CT scans. We examined neck CT scans obtained prior to initial surgery and reoperation, and classified the disease into four categories according to the persistence/recurrence and neck dissection/non-dissection status. In total, 121 of 9,173 DTC patients underwent reoperations to treat PD or RD; the mean time to reoperation was 25.5 and 54.1 months, respectively. Of all reoperations, 19% (23/121) were performed to treat RD; 81% (98/121) were performed to treat PD. Compared to RD, PD was commonly detected in the non-dissected neck. Tumor multiplicity and the number of pathologically positive lymph nodes were greater in the non-dissected than dissected neck. A review of the CT data revealed more false-negative findings on the 60-s- versus 30–40-s-delay scans of PD patients with non-dissected necks. In conclusion, most of the reoperations performed on DTC patients were for management of PD. Improved preoperative CT assessments and initial surgery, based on the information of clinico-radiological characteristics, are required in the care of DTC patients.

Highlights

The incidence rates of structural persistent disease (PD) and recurrent disease (RD) after thyroidectomy, and their clinicoradiological (CT) characteristics, remain poorly understood
We retrospectively reviewed 17 years of medical records held in a single tertiary hospital
We found no significant difference in age, tumor size or histology, the extent of gross extrathyroidal extension or lymphovascular invasion, TNM stage, or the extent of initial surgery between patients with PD and RD

Summary

Introduction

The incidence rates of structural persistent disease (PD) and recurrent disease (RD) after thyroidectomy, and their clinicoradiological (CT) characteristics, remain poorly understood. We characterized differentiated thyroid cancer (DTC) patients who underwent re-operations, with a focus on preoperative CT scans. We characterized DTC patients who underwent re-operations in terms of the incidence rates and clinicoradiological characteristics of PD and RD, with a focus on preoperative CT scans. Characteristic Mean age at diagnosis (years) < 55 ≥ 55 Gender (male: female) Initial tumor size (cm) < 1.0 ≥ 1.0 Histological findings Conventional PTC Follicular variant Tall cell variant Diffuse sclerosing variant Bilaterality Gross extrathyroidal extension Lymphovascular invasion Initial TNM stage (8th edition) I II III IV Extent of initial operation Lobectomy with CND Total thyroidectomy with CND Total thyroidectomy with ipsilateral MRND Total thyroidectomy with bilateral MRND

Methods

Results

Conclusion