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CT Detection of Metastatic Lymphadenopathy in Papillary Thyroid Cancer

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ClinicalTrials.gov Identifier: NCT03359668
Recruitment Status : Completed
First Posted : December 2, 2017
Last Update Posted : December 2, 2017
Sponsor:
Information provided by (Responsible Party):
University Health Network, Toronto

Brief Summary:
Localized thyroid cancer is potentially curable. Before thyroid surgery, an ultrasound test is done to see if cancer has spread to the lymph nodes in the neck. Excellent for evaluation of the thyroid gland, this test has limitations in evaluating larger anatomic areas, like all groups of lymph nodes in the neck. It has a limited area of coverage making it difficult to define an area of interest, depends on the skill level of the person performing it, and is difficult to exactly reproduce on follow-up. For these reasons, CT is often performed in these patients but without intravenous (IV) contrast since iodine-based contrast agents may saturate the thyroid, limiting the usefulness of other iodine-based diagnostic and treatment options. However, contrast-CT can give more detailed information about tumor spread including spread to lymph nodes. We aim to determine if use of IV contrast agent during CT leads to earlier and more accurate detection of lymph node disease from thyroid cancer.

Condition or disease Intervention/treatment Phase
Papillary Thyroid Cancer Diagnostic Test: Use of IV contrast during head and neck CT Not Applicable

Detailed Description:

Papillary thyroid cancer represents 75% of all epithelial thyroid malignancies. Imaging not only delineates the primary tumour within the thyroid gland, but also helps assess lymph nodal metastatic disease helping guide the extent of surgical neck dissection. Ultrasonography (US) is the current imaging standard (American Thyroid Association guidelines). However, US is limited by operator skills and lacks specific anatomic references essential to plan surgery. CT is performed to address these issues, often without intravenous (IV) contrast for fear of saturating thyroid tissue with iodine present in it, thus rendering iodine-labeled nuclear testing/treatment ineffective for a finite period of time. But post-contrast nodal enhancement is a predominant morphologic feature of suspicious lymphadenopathy in papillary thyroid cancer, and contrast-CT can facilitate an earlier detection. Iodine-saturation is not a concern in these patients as its concentration will normalize during recovery.

In pre-surgical thyroidectomy patients with proven papillary thyroid cancer, the use of intravenous (IV) CT contrast improves the reliability and accuracy of suspicious head and neck lymph node detection, in comparison to CT without IV contrast.

This study will help define the accuracy and reliability of intravenous (IV) contrast use in the detection of metastatic neck lymph nodes from papillary thyroid cancer. Improved detection of suspicious metastatic lymphadenopathy in papillary thyroid cancer will directly impact the patient's management since the surgical plan will be based upon the detection of these suspicious lymph nodes. CT imaging provides an anatomically relevant approach to surgery and is consistently reproducible, thus providing direct benefits to the pre-surgical assessment. Ultimately, this will result in decreased nodal recurrences within the neck.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 47 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Each patient had CT imaging with and without IV contrast
Masking: Single (Investigator)
Masking Description: The investigator will read the randomized non-contrast CTs separately from the contrast-enhanced CTs
Primary Purpose: Diagnostic
Official Title: CT Detection of Metastatic Lymphadenopathy in Papillary Thyroid Cancer
Actual Study Start Date : April 28, 2011
Actual Primary Completion Date : April 20, 2017
Actual Study Completion Date : April 20, 2017

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Non-contrast-enhanced CT
Comparison of non-contrast CT to the standard-of-care contrast-enhanced CT of the head and neck in detection of suspicious lymph nodes
Diagnostic Test: Use of IV contrast during head and neck CT
Use of IV contrast during head and neck CT
Other Name: Non-contrast-enhanced CT of the head and neck

Active Comparator: Contrast-enhanced CT
Comparison of non-contrast CT to the standard-of-care contrast-enhanced CT of the head and neck in detection of suspicious lymph nodes
Diagnostic Test: Use of IV contrast during head and neck CT
Use of IV contrast during head and neck CT
Other Name: Non-contrast-enhanced CT of the head and neck




Primary Outcome Measures :
  1. Increased detection of suspicious lymph nodes in PTC with IV-contrast enhanced CT [ Time Frame: up to 7 years ]


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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Pre-operative thyroidectomy patients with pathology-proven papillary thyroid cancer (PTC) needing lymph node staging for potential neck dissection.

Exclusion Criteria:

  • Patients with history of prior surgery within the head and neck.
  • Patients with history of prior radiation to the head and neck.
  • Patients with history of lymphoma, leukemia, or other lymphoproliferative disorders affecting the head and neck.
  • Pregnant/breast feeding patients (by question).

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Responsible Party: University Health Network, Toronto
ClinicalTrials.gov Identifier: NCT03359668     History of Changes
Other Study ID Numbers: 11-0192-C
First Posted: December 2, 2017    Key Record Dates
Last Update Posted: December 2, 2017
Last Verified: November 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:
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Thyroid Diseases
Thyroid Neoplasms
Lymphadenopathy
Thyroid Cancer, Papillary
Endocrine System Diseases
Endocrine Gland Neoplasms
Neoplasms by Site
Neoplasms
Head and Neck Neoplasms
Lymphatic Diseases
Adenocarcinoma, Papillary
Adenocarcinoma
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type