Venous obstruction of thyroid malignancy origin: the Antoine Lacassagne Institute experience

Background and aims: To show the benefits of Ultrasonography in the diagnosis of great vein involvement in the neck and mediastinum in thyroid malignancies (primary or secondary) in our experience and to report patient outcomes. Methods: Clinical data were collected from the thyroid unit database of the Antoine Lacassagne Institute. Results: Of 1171 patients with thyroid cancer treated at our institution over the last 18 years, we retrospectively identified nine patients (0.8%), three women and six men, aged 34-81 years (median age: 70 years) presenting with malignant thyroid tumor of median diameter 45 mm (range: 23-87) having venous obstruction of thyroid malignancy origin. Two patients underwent multimodal therapy. All other patients underwent external beam radiation therapy alone +/- chemotherapy or palliative care. Ultrasound (US) provided particularly useful information on venous involvement characteristics. Median survival was 7 months and median progression-free survival was 6 months. Survival in our series was worse than that of previously reported series despite diagnosis of vein involvement at an early stage in 2/3 cases using US. Conclusion: Despite small numbers of patients, it seems that aggressive treatment modalities including surgery are required to improve survival. In our experience, US was a useful non-invasive method to describe tumor extensions to great veins of the neck (invasion versus compression, tumor thrombus versus blood clot) and should be recommended to depict early venous invasion in cases of suspected thyroid malignancy.