Mirallie E, Visset J, Sagan C, et al (centre Hospitalo-Universitaire, Nantes, France)
Localization of Cervical Node Metastasis of Papillary Thyroid Carcinoma.
World J Surg 23 : 970-974, 1999
Node sites in 119 patients of papillary thyroid carcinoma were retrospectively examined to determine a possible dissection procedure and to define the extent of neck dissection.
60.5% was incidence of cervical node metastasis and bilateral in 40.8% patients. The most commonly involved sites were ipsilateral paratracheal and jugular sites. Occasional involvement of lateral compartment was present and was independent of central involvement.
Alam MDS, Kasagi K, et al (Kyoto Univ, Japan)
Diagnostic Value of Technetium-99m Methoxyisobutyl Isonitrile (99mTc-MIBI) Scintigraphy in Detecting Thyroid Cancer Metastases: A Critical Evaluation.
Thyroid 8: 1091 – 110, 1998
68 patients who underwent total thyroidectomy and radio-iodine ablation were included for study.
The above procedure is recommended as first line choice to detect metastases. Advantages over I131 scintigraphy is better sensitivity, no need to restrict dietary iodide intake and no need to discontinue administration of thyroid hormones. Its limitations are detection of small lung metastasis. In this situation I131 scintigraphy and serum Tg level measurements are recommended.
Editor, R.A. Otto, agrees with the findings.
Grigsby PW, Baglan K, Siegel BA (Washington Univ, St. Louis)
Surveillance of Patients to Detect Recurrent Thyroid Carcinoma
Cancer 85: 945-951, 1999
Seventy Six patients undergoing total thyroidectomy and I131 ablation had at least one negative whole body I131 scintigraphy at 1yr follow up. I131 imaging should be performed for surveillance until 2 negative annual studies are observed, after which repeat imaging at 3 to 5 yrs seen satisfactory.
Wang W, Macapinlac H, Larson SM, et al (Mem Sloan-Kettering Cancer Ctr, New York)
[18F]-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography Localizes Residual Thyroid Cancer in Patients with Negative Diagnostic 131I Whole Body Scans and Elevated Serum Thyroglobulin Levels.
J Clin Endocrinol Metab 84: 2291-2302, 1999
37 patients treated with surgery and radioiodine ablation and whose follow-up DxWBS (131I Whole Body Scans) results were negative, and patients were studied by FDG-PET, measurements of serum Tg levels. This has high predictive value in localizing residual thyroid cancer. Shortcomings are detection of minimum residual disease present in cervical nodes.
For clinicians faced with dilemma of residual disease inspite of Whole Body Scan and elevated Tg levels setting FDG-PET may prove useful – R.A. Otto.
Pitas AG, Adler M, et al (Mem Sloan Kettering Cancer Ctr, New York)
Bone Metastases from Thyroid Carcinoma: Clinical Characteristics and Prognostic Variables in One Hundred Forty-Six Patients
Thyroid 10: 261-268, 2000
Bone metastases from thyroid carcinoma carry a poor prognosis.
In this retrospective review of 146 patients, data was collected from medical records of patients with documented bone metastases from 1960 to 1998.
Significant prognostic factors were:
1) Radio-iodine uptake by skeletal metastases
2) Absence of non-osseous metastases
3) Treatment with radioiodine.
The authors conclude that when bone metastases were associated with thyroid cancer, survival is reduced.
If nonosseous metastases develop and the lesions do NOT take up radio-iodine, the prognosis declines further.
Hürthle cell carcinoma is associated with the best prognosis. The undifferentiated histologic type carries the worst outlook.