Reading, Carl C.

AbstractBackgroundIntense disease surveillance and frequent lymph node metastases (LNMs) in papillary thyroid cancer (PTC) have resulted in increased locoregional recurrences. We examined the safety and efficacy of an optimized surgical approach including preoperative ultrasonograpy (US), bilateral thyroidectomy, routine compartment VI dissection, and lateral neck dissection for LNM.MethodsDuring 1999–2006, a total of 420 patients underwent optimized primary surgery; 291(69%) females, median age 46 years; follow‐up 98%, median 4.4 years. Patients were reviewed for tumor characteristics, pattern of LNM, staging, and outcomes.ResultsTotal or near‐total thyroidectomy was performed in 212 (51%) and 208 (49%) patients, respectively. Tumors were multicentric, 40% (average 1.7 cm); were bilateral, 30%; and showed extrathyroidal extension, 17%. Overall, 223 (53%) patients had LNMs: 213 (51%) were central and 85 (20%) were lateral jugular. pTNM staging: I, 258 (61%); II, 35 (8%); III, 88 (21%); IV, 39 (9%). AGES (age, grade, extension, and size—thyroid tumor; and MACIS (metastasis, age, completeness of resection, invasion, and size) prognostic scores were low risk in 362 (86%) and 352 (84%), respectively. Relapse developed in 57 (14%) patients: LNM in 44, soft tissue local recurrence (LR) in 5, distant metastases (DM) in 8. Hypoparathyroidism occurred in 5 (1.2%) patients and 1 had unintentional laryngeal nerve damage. Relapse with LNM occurred in previously operated fields in 19 (5%) patients, 11(3%) from disease virulence (LR or DM), preoperative false‐negative (FN) US in 12 (3%), and combination of FN‐US and recurrence in the operated field in 5 (1%) patients.ConclusionsRecurrence was limited to 5% of patients when the extent of disease was accurately defined and potentially curable. This optimized surgical strategy is relatively safe.

The authors' purpose was to evaluate the current practice of registered diagnostic medical sonographers, with specialty in abdomen, of the American Registry of Diagnostic Medical Sonographers (ARDMS).A randomized sample of 2350 registered diagnostic medical sonographers with specialty in abdomen were chosen from the ARDMS database to complete a task survey on the Internet.The survey consisted of a 235-item ques tionnaire with regard to demographics, education, and frequency of specific sonograms performed in daily practice.Compared with the 1994 survey, registrants have received more formal education and less on-the-job training. Traditional tasks remain the predominant responsibilities of registered diagnostic medical sonographers with specialty in abdomen, including liver, biliary system, gallbladder, kidney, and pancreas, but a small minority of sonographers also perform liver transplant, kidney transplant, trauma, and musculoskeletal sonograms, and use newer technologies, such as power Doppler and tissue harmonic sonography, as well as transrectal sonography.The authors conclude that the ARDMS abdomen examination reflects current practice, but future revisions should include a small percentage of items in these newer areas.