Limited Utility of Routine Surveillance Ultrasound in Differentiated Thyroid Cancer Patients With Undetectable Postoperative Thyroglobulin Levels

IF 2.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM Clinical Endocrinology Pub Date : 2025-01-23 DOI:10.1111/cen.15198

Young-Ji Seo, Ryan Tiu, Katharina Stahl, Elena Hughes, Chi-Hong Tseng, Michael Yeh, Masha Livhits, James X. Wu

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Abstract

Background

Neck ultrasound (US) and serum thyroglobulin (Tg) measurements are mainstays of long-term differentiated thyroid cancer (DTC) surveillance. Given the high sensitivity of serum Tg, we aimed to assess the utility of neck US in DTC patients who underwent total thyroidectomy and have undetectable serum Tg.

Methods

We performed a retrospective cohort analysis of DTC patients who underwent a total thyroidectomy at our institution (2010–2023) and received US-guided fine needle aspiration (FNA) during their surveillance. Patients were categorised into three lab categories based on serum Tg and Tg antibody (Tg Ab) status before the biopsy: (1) ‘Negative Tg' if undetectable Tg ( < 0.2 ng/dL) and Tg Ab, (2) 'Positive Tg' if detectable Tg and undetectable Tg Ab, and (3) 'Positive Tg Ab' if detectable Tg Ab. To calculate the positive predictive value (PPV) of neck US, we defined the 'true positive' of US as findings that prompted an FNA biopsy resulting with DTC, and 'false positive' findings prompting an FNA biopsy that did not result as DTC.

Results

A total of 118 patients were included, encompassing 146 FNA biopsies: 33 (23%) had Negative Tg, 84 (57%) had Positive Tg, and 29 (20%) had Positive Tg Ab lab results before their biopsies. The PPV of neck US in the setting of Negative Tg was 3% (one true positive, 32 false positives), while the PPV was 50% (42 true positives, 42 false positives) for Positive Tg, and 52% (15 true positives, 14 false positives) for Positive Tg Ab cohorts. Sub-analysis of the Positive Tg cohort using different serum Tg level cutoffs revealed a PPV of 29% at just detectable serum Tg of 0.2 ng/dL, and PPV of 38% for Tg < 1.0 ng/dL. The PPV stabilised at 58% for Tg levels ≥ 1 ng/dL.

Conclusion

With the low PPV of neck US, high cost of surveillance, and the advent of ultra-sensitive serum Tg measurements, future guidelines should consider reducing routine neck US surveillance in patients with undetectable serum Tg and only performing it when there is a rise in serum Tg levels.

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常规超声监测在无法检测到术后甲状腺球蛋白水平的分化型甲状腺癌患者中的有限应用。

背景：颈部超声（US）和血清甲状腺球蛋白（Tg）测量是长期分化型甲状腺癌（DTC）监测的主要手段。鉴于血清Tg的高敏感性，我们的目的是评估颈部US在接受甲状腺全切除术且血清Tg检测不到的DTC患者中的效用。方法：我们对2010-2023年在我院接受甲状腺全切除术并在监测期间接受美国引导细针穿刺（FNA）的DTC患者进行了回顾性队列分析。根据活检前血清Tg和Tg抗体（Tg Ab）状态将患者分为三种实验室类别：(1)结果：共纳入118例患者，包括146例FNA活检：33例（23%）Tg阴性，84例（57%）Tg阳性，29例（20%）在活检前Tg Ab实验室结果阳性。阴性Tg组颈部US的PPV为3%（1例真阳性，32例假阳性），阳性Tg组的PPV为50%（42例真阳性，42例假阳性），阳性Tg Ab组的PPV为52%（15例真阳性，14例假阳性）。Sub-analysis的积极Tg群体使用不同血清Tg水平达标显示只有29%的PPV检测血清Tg 0.2毫微克/分升,PPV和38%的Tg结论:低PPV的脖子,监测费用高,和敏感的血清Tg测量的出现,未来的指导方针应该考虑减少常规脖子我们监测患者察觉血清Tg和只执行时血清Tg水平上升。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Endocrinology 医学-内分泌学与代谢

CiteScore

6.40

自引率

3.10%

发文量

192

审稿时长

1 months

期刊介绍： Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.