Using 2-dimensional color superb microvascular imaging vascularization index technique in the assessment of thyroid surgical bed

Mehmet Sedat Durmaz, Gonca Kara Gedik, Abdussamet Batur, Farise Yılmaz

Abstract


Aim: The purpose of this study was to investigate the effectiveness of the vascularization index (VI) obtained using color superb microvascular imaging (cSMI) technique in the assessment of thyroid surgical bed for remnant thyroid tissue (RTT).

Material and methods: We evaluated the thyroid surgical bed of 65 patients who had underwent total thyroidectomy (TT) due to papillary carcinoma (PC) using thyroid scintigraphy and cSMI. Color SMI was also performed for the examination of the thyroid parenchyma of 39 healthy asymptomatic participants. VI measurements were performed by manually drawing the contours of the RTT in those with remnant thyroid, the thyroid surgical bed in the patients’ group without remnant thyroid, and normal thyroid parenchyma in the control group, using the free region of interest (ROI) with 2-dimensional color SMI VI (2DcSMIVI) mode. The volume of ROI was measured and echogenicity was evaluated. The quantitative 2DcSMIVI values of the surgical bed with RTT (Group A), the surgical bed without RTT (Group B) and normal thyroid of healthy asymptomatic participants (Group C) were compared.

Results: The mean 2DcSMIVI values of Group A was significantly higher than Group B and C (p=0.001). The presence of RTT can be diagnosed with 89.1% sensitivity and 87.5% specificity when 1.75 2DcSMIVI is designated as the cut-off value.

Conclusion: The 2DcSMIVI is an effective imaging technique that can be used for the diagnosis of RTT.


Keywords


papillary thyroid carcinoma; remnant thyroid tissue; total thyroidectomy; ultrasonography

Full Text:

PDF

References


Zaheer S, Tan A, Ang ES, et al. Post-thyroidectomy neck ultrasonography in patients with thyroid cancer and a review of the literature. Singapore Med J 2014;55:177-183.

Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-1214.

Sheth S, Hamper UM. Role of sonography after total thyroidectomy for thyroid cancer. Ultrasound Q 2008;24:147-154.

Salvatori M, Raffaelli M, Castaldi P, et al. Evaluation of the surgical completeness after total thyroidectomy for differentiated thyroid carcinoma. Eur J Surg Oncol 2007;33:648-54.

Kim JW, RohJL, GongG: Treatment outcomes and risk factors for recurrence after definitive surgery for well-differentiated papillary thyroid carcinoma. Thyroid 2016;26:262-270.

Dhillon VK, Tufano RP, Removal of thyroid remnant for cancer in the previously operated central neck. Operative Techniques in Otolaryngology-Head and Neck Surgery 2018;29:19-23.

Shin JH, Han BK, Ko EY, Kang SS. Sonographic findings in the surgical bed after thyroidectomy: comparison of recurrent tumors and nonrecurrent lesions. J Ultrasound Med 2007;26:1359-1366.

Tufano RP, Clayman G, Heller KS, et al. Management of recurrent/persistent nodal disease in patients with differentiated thyroid cancer: a critical review of the risks and benefits of surgical intervention versus active surveillance. Thyroid 2015;25:15–27.

Hay ID, Thompson GB, Grant CS, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940-1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg. 2002;26:879-885.

N. Arslan, S. Ilgan, M. Serdengecti et al. Post-surgical ablation of thyroid remnants with high-dose 131I in patients with differentiated thyroid carcinoma. Nucl Med Commun 2001;22:1021-1027.

Lee JH, Lee HK, Lee DH, et al. Ultrasonographic findings of a newly detected nodule on the thyroid bed in postoperative patients for thyroid carcinoma: correlation with the results of ultrasonography-guided fine-needle aspiration biopsy. Clin Imaging 2007;31:109-13.

O’Malley J, Zeissman A, Fahey HF. Endocrine System. In: O’Malley J, Zeissman A, (eds). Nuclear medicine and Molecular Imaging: The requisites. 5th ed. Philedelphia, PA: Elsevier Inc; 2020;152-179.

Black EG, Sheppard MC. Serum thyroglobulin measurements in thyroid cancer: evaluation of 'false' positive results. Clin Endocrinol (Oxf). 1991;35:519-520.

Ko MS, Lee JH, Shong YK, Gong GY, Baek JH. Normal and abnormal sonographic findings at the thyroidectomy sites in postoperative patients with thyroid malignancy. Am J Roentgenol 2010;194:1596–1609.

Leenhardt L, Erdogan MF, Hegedus L, et al. 2013 European Thyroid Association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer. Eur Thyroid J 2013;2:147–159.

Haugen BR, Alexander EK, Bible KC, et al. American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1–133.

Kamaya A, Gross M, Akatsu H, Jeffrey RB. Recurrence in the thyroidectomy bed: sonographic findings. Am J Roentgenol 2011;196:66-70.

DurmazMS, SivriM. Comparison of superb micro-vascular imaging (SMI) and conventional Doppler imaging techniques for evaluating testicular blood flow. J Med Ultrason (2001) 2018;45:443–452.

Durmaz MS, Akyürek N, Kara T, et al. Quantitative Assessment of Thyroid Gland Vascularization With Vascularization Index Using Color Superb Microvascular Imaging in Pediatric Patients With Hashimoto Thyroiditis. Ultrasound Q 2019;35:281-289.

Frasoldati A, Pesenti M, Gallo M, Caroggio A, Salvo D, Valcavi, R. Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma. Cancer: Interdisciplinary International Journal of the American Cancer Society 2003;97:90-96.

D'Andrea V, Cantisani V, Catania A, et al. Thyroid tissue remnants after "total thyroidectomy". G Chir 2009;30:339-344.

Meier DA, Brill DR, Becker DV, et al. Procedure guideline for therapy of thyroid disease with (131)iodine. J Nucl Med 2002;43:856-861.

Liu G, Li N, Li X, Chen S, Du B, Li Y. Thyroid Remnant Estimation by Diagnostic Dose (131)I Scintigraphy or (99m)TcO4(-) Scintigraphy after Thyroidectomy: A Comparison with Therapeutic Dose (131)I Imaging. Biomed Res Int 2016;2016:4763824.

Giovanella L, Suriano S, Ricci R, Ceriani L, Anton Verburg F. Postsurgical thyroid remnant estimation by (⁹⁹m) Tc-pertechnetate scintigraphy predicts radioiodine ablation effectiveness in patients with differentiated thyroid carcinoma. Head Neck 2011;33:552-556.

Durante C, Montesano T, Torlontano M, et al. Papillary thyroid cancer: time course of recurrences during postsurgery surveillance. J Clin Endocrinol Metab 2013;98:636-642.




DOI: http://dx.doi.org/10.11152/mu-2875

Refbacks

  • There are currently no refbacks.