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Thyroid. 2018 Nov;28(11):1490-1499. doi: 10.1089/thy.2018.0151. Epub 2018 Oct 16.

Persistent/Recurrent Differentiated Thyroid Cancer: Clinical and Radiological Characteristics of Persistent Disease and Clinical Recurrence Based on Computed Tomography Analysis.

Kim TM1,2, Kim JH1,2,3, Yoo RE1,2, Kim SC4, Chung EJ5, Hong EK1,2, Jo S1, Kang KM1,2, Choi SH1,2,3, Sohn CH1,2,3, Rhim JH6, Park SW2,6, Park YJ7.

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1 Department of Radiology, Seoul National University Hospital , Seoul, Republic of Korea.
2 Department of Radiology, Seoul National University College of Medicine , Seoul, Republic of Korea.
3 Institute of Radiation Medicine, Seoul National University Medical Research Center , Seoul, Republic of Korea.
4 Department of Radiology, Gangnam Center, Seoul National University Hospital Healthcare System , Seoul, Republic of Korea.
5 Department of Otorhinolaryngology, Seoul National University College of Medicine , Seoul, Republic of Korea.
6 Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
7 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea.



The natural course of persistent/recurrent differentiated thyroid cancer (DTC) has not been fully elucidated. The purpose of this study was to assess the relative incidence and clinico-radiological characteristics of persistent disease and clinical recurrence based on computed tomography (CT) analysis in patients with persistent/recurrent DTC.


From January 2005 to December 2016, this retrospective study included 107 patients (M:F = 28:79; Mage = 53.5 years) with surgically proven cervical locoregional recurrence of DTC. Two neck CT examinations (median interval 1.92 years; range 0.17-7.58 years) before the last thyroid cancer surgery within the study period were reevaluated. Based on the presence of the lesion on the first CT and its progression on the second CT, the locoregional recurrence was classified into the following categories: stable persistence (decrease, no change, or increase by <2 mm in short dimension on the second CT), progressive persistence (increase by ≥2 mm), and clinical recurrence (newly appeared on the second CT). Clinical and radiological characteristics of the three groups were compared using univariate and multivariate logistic regression analyses.


The relative incidences of stable persistence, progressive persistence, and clinical recurrence were 56.1% (60/107), 15.0% (16/107), and 29.0% (31/107), respectively. Multivariate analysis between the clinical recurrence (29.0%) and persistence (71.0%) groups revealed various independent factors for prediction of clinical recurrence. These included longer interval between the two CT examinations (median 2.67 vs. 1.79 years; p = 0.021), a smaller number of thyroid surgeries (1.16 ± 0.45 vs. 1.55 ± 0.81; p = 0.002), and a history of neck dissection at the location of the largest locoregional recurrence (70.0% vs. 31.4%; p < 0.001). There was no significant independent factor for differentiation between the stable persistence (78.9%; 60/76) and progressive persistence (21.1%; 16/76) groups. The results may have been influenced by selection bias because this study included only surgically proven cases.


With regard to cervical locoregional recurrence of DTC, active surveillance may be favored because more than a half of the cases are structurally persistent and stable. However, meticulous evaluation is necessary to detect progressive persistence and clinical recurrence, considering various clinical factors.


computed tomography; persistent; recurrence; thyroid cancer; ultrasonography


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