Vicki Munro, Syed Mustafa, Ferhan S Siddiqi, Murali Rajaraman, Andreu F Costa, Syed Ali Imran
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引用次数: 0
Abstract
Background: Differentiated thyroid cancer (DTC) requires long-term follow-up due to the risk of delayed recurrence. Follow-up surveillance involves serial neck ultrasound (US) and thyroglobulin (Tg); however, the optimal frequency and diagnostic performance of neck US outside of specialized thyroid cancer centres in higher risk patients is not well defined. We sought to evaluate the diagnostic performance of US and serial Tg in advanced stage DTC.
Methods: We retrospectively reviewed our thyroid cancer database for patients with stage III and IV DTC from 2006 to 2018, total thyroidectomy, and at least 2 years follow-up to assess recurrence rates. Those with hemi-thyroidectomy or anti-Tg antibodies were excluded. Diagnostic performance of US and Tg were assessed using a composite reference standard of follow-up imaging and pathology. All relevant US were reviewed by a blinded expert radiologist for uniformity.
Results: Of 136 included patients (91 females, mean age 58.9), 26 (19%) had recurrence of DTC over median follow-up of 6.6 years (IQR 5.3-9.3). The sensitivity and specificity of US in diagnosing cervical recurrence were 73.3% (95% CI 0.51-0.96) and 68.3% (95% CI 0.60-0.77) based on historical reports, respectively, and 80% (95% CI 0.60-1.00) and 87.8% (95% CI 0.82-0.93) based on blinded expert review, respectively. Tg had a sensitivity of 95.5% (95% CI 0.89-1.0) and specificity of 96.2% (95% CI 0.92-0.99) in detecting cervical recurrence or distant metastases. False positive US findings on historical US and subsequent review occurred in 38 (28%) and 15 (11%) patients, respectively, while 5 (3.6%) had false positive Tg results.
Conclusion: Serial Tg has better sensitivity and specificity than US for detecting recurrence of advanced stage DTC. Furthermore, re-interpretation of abnormal findings using structured US reporting with a subspecialized reader may improve diagnostic performance of US and improve its utility in clinical care.
背景：分化型甲状腺癌（DTC）有延迟复发的风险，因此需要长期随访。随访监测包括连续性颈部超声（US）和甲状腺球蛋白（Tg）检查；然而，在甲状腺癌专科中心以外，对高危患者进行颈部US检查的最佳频率和诊断效果尚无明确定义。我们试图评估颈部 US 和连续 Tg 对晚期 DTC 的诊断效果：我们回顾性地查看了甲状腺癌数据库中2006年至2018年期间III期和IV期DTC患者的资料，对其进行了甲状腺全切除术，并进行了至少2年的随访，以评估复发率。排除了半甲状腺切除术或抗Tg抗体患者。采用随访影像学和病理学的综合参考标准评估US和Tg的诊断性能。所有相关的 US 均由一名盲法放射学专家进行审查，以确保一致性：在纳入的136名患者（91名女性，平均年龄58.9岁）中，26人（19%）在中位随访6.6年（IQR 5.3-9.3）后DTC复发。根据历史报告，US 诊断宫颈复发的敏感性和特异性分别为 73.3% (95% CI 0.51-0.96) 和 68.3% (95% CI 0.60-0.77)；根据盲法专家审查，US 诊断宫颈复发的敏感性和特异性分别为 80% (95% CI 0.60-1.00) 和 87.8% (95% CI 0.82-0.93)。在检测宫颈复发或远处转移方面，Tg 的灵敏度为 95.5%（95% CI 0.89-1.0），特异性为 96.2%（95% CI 0.92-0.99）。38名患者（28%）和15名患者（11%）分别在历史US检查和后续复查中发现假阳性US结果，而5名患者（3.6%）的Tg结果为假阳性：结论：在检测晚期 DTC 复发方面，连续 Tg 比 US 具有更好的敏感性和特异性。此外，使用结构化的 US 报告和亚专业阅读器重新解释异常结果可提高 US 的诊断性能并改善其在临床护理中的实用性。
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