Download PDF
CC BY-NC-ND 4.0 · Ultrasound Int Open 2018; 4(04): E124-E130
DOI: 10.1055/a-0749-8688
Original Article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

Sonographic Evaluation of Nodules Newly Detected in the Neck After Thyroidectomy: Suture Granuloma Versus Recurrent Carcinoma

Hitomi Aga
1   Kuma Hospital, Department of Clinical Laboratory, Kobe, Japan
,
Mitsuyoshi Hirokawa
2   Kuma Hospital, Department of Diagnostic Pathology and Cytology, Kobe, Japan
,
Ayana Suzuki
1   Kuma Hospital, Department of Clinical Laboratory, Kobe, Japan
,
Hisashi Ota
1   Kuma Hospital, Department of Clinical Laboratory, Kobe, Japan
,
Maki Oshita
1   Kuma Hospital, Department of Clinical Laboratory, Kobe, Japan
,
Takumi Kudo
3   Kuma Hospital, Department of Internal Medicine, Kobe, Japan
,
Mitsuhiro Fukushima
4   Kuma Hospital, Department of Surgery, Kobe, Japan
,
Kaoru Kobayashi
4   Kuma Hospital, Department of Surgery, Kobe, Japan
,
Akira Miyauchi
4   Kuma Hospital, Department of Surgery, Kobe, Japan
› Author Affiliations
Further Information

Publication History

received 30 May 2018
revised 05 September 2018

accepted 10 September 2018

Publication Date:
23 October 2018 (online)

Also available at
   Permissions and Reprints

Abstract

Purpose

This study aimed to clarify the sonographic features of suture granuloma and recurrent carcinoma newly detected after thyroidectomy.

Materials and Methods

We retrospectively analyzed ultrasound reports with images of 25 cases of suture granuloma and 18 cases of recurrent carcinoma that newly appeared in the resected area after thyroidectomy in our institution.

Results

Both suture granulomas and recurrent carcinomas more frequently exhibited multiple lesions rather than solitary lesions. Suture granulomas tended to appear in the more superficial areas than the carotid artery, while recurrent carcinomas were more common between the trachea and carotid artery. A total of 10 of the 11 suture granulomas that we followed up decreased in size. Recurrent carcinomas showed irregular shape (55.6%), taller-than-wide shape (38.9%), low internal echogenicity (83.3%), and no punctate microcalcifications. By contrast, suture granulomas were fusiform in shape (56.0%) and showed linear internal echo parallel to the tissue plane on the longitudinal scan (64.0%). The vascular flow sign was mild to none in the majority of both lesions.

Conclusion

Fusiform shape and linear internal echoes indicate suture granuloma, while irregular shape, taller-than-wide shape, and low echogenicity indicate recurrent carcinoma. Given that the clinical management of suture granuloma differs from that of recurrent carcinoma, it is important to distinguish between these two lesions.

Key words

Thyroid - Suture granuloma - Recurrent carcinoma - Ultrasound - Thyroidectomy
 

  • References

  • 1 Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 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
    CrossrefPubMedSearch in Google Scholar
  • 2 Moslehi M, Assadi M. Contribution of ultrasound examination in the detection of neck recurrence in low-risk differentiated thyroid carcinoma patients at first follow-up visits. Nuclear Med Rev 2014; 17: 3-6
    PubMedSearch in Google Scholar
  • 3 Kamaya A, Gross M, Akatsu H, Jeffrey RB. Recurrence in the thyroidectomy bed: Sonographic findings. Am J Roentgenol 2011; 196: 66-70
    CrossrefPubMedSearch in Google Scholar
  • 4 Lee JH, Lee HK, Lee DH, Choi CG, Gong G, Shong YK, Kim SJ. 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: 109-113
    CrossrefPubMedSearch in Google Scholar
  • 5 Zaheer S, Tan A, Ang ES, Loke KS, Kao YH, Goh A, Wong WY. Post-thyroidectomy neck ultrasonography in patients with thyroid cancer and a review of the literature. Singapore Med J 2014; 55: 343-350
    PubMedSearch in Google Scholar
  • 6 Kim HR, Hong HS, Lee EH, Lee MH, Park JM, Kwak JJ, Lee SW. Ultrasonographic findings of foreign-body granulomas after endoscopic thyroidectomy via an axillo-breast approach. J Korean Soc Radiol 2012; 66: 507-517
    CrossrefPubMedSearch in Google Scholar
  • 7 Chung YE, Kim EK, Kim MJ, Yun M, Hong SW. Suture granuloma mimicking recurrent thyroid carcinoma on ultrasonography. Yonsei Med J 2006; 31: 748-751
    PubMedSearch in Google Scholar
  • 8 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
    CrossrefPubMedSearch in Google Scholar
  • 9 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
    CrossrefPubMedSearch in Google Scholar
  • 10 Rettenbacher T, Macheiner P, Hollerweger A, Gritzmann N, Weismann C, Todoroff B. Suture granulomas: sonography enables a correct preoperative diagnosis. Ultrasound Med Biol 2001; 27: 343-350
    CrossrefPubMedSearch in Google Scholar
  • 11 Kim JH, Lee JH, Shong YK, Hong SJ, Ko MS, Lee DH, Choi CG, Kim SJ. Ultrasound features of suture granulomas in the thyroid bed after thyroidectomy for papillary thyroid carcinoma with an emphasis on their differentiation from locally recurrent thyroid carcinomas. Ultrasound Med Biol 2009; 35: 1452-1457
    CrossrefPubMedSearch in Google Scholar
  • 12 Rosenberg N, Moolten SE, Vroman L. Tissue reactions to waxes derived from spool cotton; Possible etiologic relation to suture granulomas and suture extrusion. Arch Surg 1950; 60: 363-371
    PubMedSearch in Google Scholar
  • 13 Rosenberg D, Schechtmann M. Granuloma of the stomach caused by a foreign body (cotton thread suture). Rev Paul Med 1963; 62: 325-332
    PubMedSearch in Google Scholar
  • 14 Augustin G, Korolija D, Skegro M, Jakic-Razumovic J. Suture granuloma of the abdominal wall with intra-abdominal extension 12 years after open appendectomy. World J Gastroenterol 2009; 28: 4083-4086
    PubMedSearch in Google Scholar
  • 15 Shulumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med 1998; 338: 297-306
    CrossrefPubMedSearch in Google Scholar
  • 16 Mazzaferri EL. An overview of the management of papillary and follicular thyroid carcinoma. Thyroid 1999; 9: 421-427
    CrossrefPubMedSearch in Google Scholar
  • 17 Titton RL, Gervais DA, Boland GW, Maher MM, Mueller PR. Sonography and sonographically guided fine-needle aspiration biopsy of the thyroid gland: indications and techniques, pearls and pitfalls. Am J Roentgenol 2003; 181: 267-271
    CrossrefPubMedSearch in Google Scholar
  • 18 Oh EM, Chung YS, Song WJ, Lee YD. The pattern and significance of the calcifications of papillary thyroid microcarcinoma presented in preoperative neck ultrasonography. Ann Surg Treat Res 2014; 86: 115-121
    CrossrefPubMedSearch in Google Scholar
  • 19 Baskin HJ. Detection of recurrent papillary thyroid carcinoma by thyroglobulin assessment in the needle washout after fine-needle aspiration of suspicious lymph nodes. Thyroid 2004; 14: 959-963
    CrossrefPubMedSearch in Google Scholar
  • 20 Achille G, Garrisi VM, Russo S, Guastamacchia E, Giagulli VA, Schirosi L, Daniele A, Tufaro A, Cafagna V, Centrone M, Simone G, Abbate I, Triggiani V. Thyroglobulin determination in fine needle aspiration biopsy washout of suspicious lymph nodes in thyroid carcinoma follow up. Endocr Metab Immune Disord Drug Targets 2017; 17: 213-218
    PubMedSearch in Google Scholar
  • 21 Baloch ZW, Barroeta JE, Walsh J, Gupta PK, Livolsi VA, Langer JE, Mandel SJ. Utility of thyroglobulin measurement in fine-needle aspiration biopsy specimens of lymph nodes in the diagnosis of recurrent thyroid carcinoma. CytoJournal 2008; 31: 1
    PubMedSearch in Google Scholar
  • 22 Cantisani V, Consorti F, Guerrisi A, Guerrisi I, Ricci P, Di Segni M, Mancuso E, Scardella L, Milazzo F, D'Ambrosio F, Antonaci A. Prospective comparative evaluation of quantitative-elastosonography (Q-elastography) and contrast-enhanced ultrasound for the evaluation of thyroid nodules: Preliminary experience. Eur J Radiol 2013; 82: 1892-1898. doi: 10.1016/j.ejrad.2013.07.005
    CrossrefPubMedSearch in Google Scholar
  • 23 Cantisani V, Maceroni P, D'Andrea V, Patrizi G, Di Segni M, De Vito C, Grazhdani H, Isidori AM, Giannetta E, Redler A, Frattaroli F, Giacomelli L, Di Rocco G, Catalano C, D'Ambrosio F. Strain ratio ultrasound elastography increases the accuracy of colour-Doppler ultrasound in the evaluation of Thy-3 nodules. A bi-centre university experience. Eur Radiol 2016; 26: 1441-1449. doi: 10.1007/s00330-015-3956-0
    CrossrefPubMedSearch in Google Scholar
  • 24 Sidhu PS, Brabrand K, Cantisani V, Correas JM, Cui XW, D'Onofrio M, Essig M, Freeman S, Gilja OH, Gritzmann N, Havre RF, Ignee A, Jenssen C, Kabaalioğlu A, Lorentzen T, Mohaupt M, Nicolau C, Nolsøe CP, Nürnberg D, Radzina M, Saftoiu A, Serra C, Spârchez Z, Sporea I, Dietrich CF. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II. Diagnostic Ultrasound-Guided Interventional Procedures (Long Version). Ultraschall Med 2015; 36: E15-E35. doi: 10.1055/s-0035-1554036
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Sidhu PS, Brabrand K, Cantisani V, Correas JM, Cui XW, D'Onofrio M, Essig M, Freeman S, Gilja OH, Gritzmann N, Havre RF, Ignee A, Jenssen C, Kabaalioğlu A, Lorentzen T, Mohaupt M, Nicolau C, Nolsøe CP, Nürnberg D, Radzina M, Saftoiu A, Serra C, Spârchez Z, Sporea I, Dietrich CF. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II. Diagnostic Ultrasound-Guided Interventional Procedures (Short Version). Ultraschall Med 2015; 36: 566-580. doi: 10.1055/s-0035-1566760
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Sidhu PS, Cantisani V, Dietrich CF, Gilja OH, Saftoiu A, Bartels E, Bertolotto M, Calliada F, Clevert DA, Cosgrove D, Deganello A, D'Onofrio M, Drudi FM, Freeman S, Harvey C, Jenssen C, Jung EM, Klauser AS, Lassau N, Meloni MF, Leen E, Nicolau C, Nolsoe C, Piscaglia F, Prada F, Prosch H, Radzina M, Savelli L, Weskott HP, Wijkstra H. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Short Version). Ultraschall Med 2018; 39: 154-180. doi: 10.1055/s-0044-101254
    Thieme ConnectPubMedSearch in Google Scholar