Combined Ultrasound and MRI Assessment in Patients Undergoing Reoperation for Recurrent Papillary Thyroid Carcinoma: Oncological Outcomes and Surgical Safety

Reoperation for papillary thyroid carcinoma (PTC) requires precise lymph node metastasis assessment, yet ultrasound (US) alone may be insufficient in complex or high-risk cases. This study evaluated whether supplementing US with magnetic resonance imaging (MRI) improves surgical guidance and outcomes in reoperation. We retrospectively analyzed 375 patients who underwent reoperation between 2014 and 2022. Propensity score matching yielded 101 patients in the USUS-only group and 62 in the US+MRI group. Pathological and imaging data were compared to assess diagnostic performance, surgical outcomes, biochemical responses, and recurrence-free survival. The combined approach significantly increased sensitivity for detecting central lymph node metastasis from 52.5% to 90.9% and resulted in higher rates of central neck dissections (65.1% versus 45.5%) with greater lymph node yield (median: 29 versus 20) but lower lymph node ratios. More patients in the combined group achieved excellent biochemical responses (50.0% versus 27.7%). While overall recurrence-free survival (RFS) was not significantly different, the US+MRI group showed improved RFS among patients with ≥2 positive central nodes (HR = 0.24, <i>p</i> = 0.032). Importantly, complication rates were comparable, suggesting that improved outcomes were achieved without added surgical risk. Combined US and MRI assessment enhances diagnostic performance and may improve surgical and oncological outcomes in select high-risk patients undergoing PTC reoperation.