Contribution of routine chest x-ray in the long-term follow-up of patients with differentiated thyroid carcinoma

Context: Chest x-ray (CXR) is performed routinely in patients with differentiated thyroid cancer (DTC) but its importance is not well defined. Objective: Determine the contribution of routine CXR in the detection of intrathoracic metastases in patients with DTC on follow-up. Design: Retrospective chart review. Setting: Comprehensive cancer center. Patients: Patients with localized DTC, seen at the University of Texas M. D. Anderson Cancer Center over a 20-year period. Main outcomes: CXR abnormality developed in 6.6% of patients. Results: Of 333 patients, (298 papillary and 35 follicular thyroid carcinoma), 22 patients (6.6%) (18 papillary and 4 follicular) developed abnormal CXR. Median interval to CXR conversion was 66 months (range, 8-228 months). Most had additional evidence of disease at the time of CXR conversion. At last follow-up, 9 were alive with disease, 7 had died of other etiology, and 6 had died of DTC. Of 311 patients with normal CXRs throughout, (280 papillary and 31 follicular) 226 had no evidence of disease, 71 were alive with disease, and 14 had died of other etiology at last follow-up. Conclusions: In the absence of other evidence of disease, the contribution of CXR is limited in the long-term follow-up of patients with DTC.