Limited Utility of Routine Surveillance Ultrasound in Differentiated Thyroid Cancer Patients With Undetectable Postoperative Thyroglobulin Levels
An erratum to this article was published (Clin Endocrinol (Oxf), Aug 2025 ↗)
Authors' 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.
Study context
- Population
- Differentiated thyroid cancer (DTC) patients after total thyroidectomy at one institution (2010–2023) who had ultrasound (US)-guided fine needle aspiration (FNA) during surveillanceFNA biopsies in 118 patients
- Participants
- 146 patients
- Exposure
- PPV of neck US by pre-biopsy serum thyroglobulin (Tg) and Tg Ab status
- Negative Tgn = 33
- Positive Tgn = 84
- Positive Tg Abn = 29
- Outcome
- PPV of neck US (true positive: US finding prompting FNA with DTC; false positive: FNA not DTC)
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
PPV of neck US
| Group | PPV | True positives | False positives |
|---|---|---|---|
| Negative Tg | 3% | 1 | 32 |
| Positive Tg | 50% | 42 | 42 |
| Positive Tg Ab | 52% | 15 | 14 |
PPV
Negative Tg3%
Positive Tg50%
Positive Tg Ab52%
True positives
Negative Tg1
Positive Tg42
Positive Tg Ab15
False positives
Negative Tg32
Positive Tg42
Positive Tg Ab14
Observational data: associations, not effects.
Further findings
PPV of neck US in Positive Tg by serum Tg cutoff
- PPV at just detectable Tg of 0.2 ng/dL
- 29%
- PPV for Tg < 1.0 ng/dL
- 38%
- PPV for Tg ≥ 1 ng/dL
- 58%
Original publication
Limited Utility of Routine Surveillance Ultrasound in Differentiated Thyroid Cancer Patients With Undetectable Postoperative Thyroglobulin Levels. Clin Endocrinol (Oxf). Published 23 January 2025. doi:10.
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