TGDR carcinoma is a rare malignant tumor that is usually diagnosed after surgery; papillary carcinoma is the most common type. The currently recommended treatment is a Sistrunk procedure, with a tendency to deferred total thyroidectomy in selected cases (similar criteria exist for papillary carcinoma of the thyroid gland). The prognosis is excellent, with a good long-term survival.

Objective:To determine the frequency of occult macroscopic metastasis detected by preoperative US evaluation of the neck in patients with PTC. Papillary thyroid carcinoma (PTC) is a malignancy with a high rate of lymph node metastasis. The findings of routine thyroid ultrasonography(US)andphysicalexaminationmayunderestimatemetastatic disease. Thus, we propose that patients diagnosed as having PTC undergo preoperative US staging of the neck.Design: This prospective study included 60 patients diagnosed as having PTC from January 1 through June 30, 2006. Patients had undergone previous thyroid US evaluation with no palpable adenopathy. Lymph nodes were deemed suspicious by US findings with a minor axis greater than 10 mm, a minor axis greater than 50% of the major axis, or hyperechogenicity with or without microcalcifications. Metastasis was confirmed by fineneedle aspiration biopsy or frozen section analysis. Patients with confirmed metastasis underwent a neck dissection. The location of adenopathy reported by US was correlated with the pathological report. Results:The US evaluation identified 12 of 60 patients (20%) with adenopathy suggestive of metastasis. Metastasis was confirmed in 11 of 12 patients (92%). Metastasis was found in 1 of 48 patients who had a negative US finding. Overall, sensitivity, specificity, and positive and negative predictive values were 92%, 98%, 92%, and 98%, respectively. All neck levels with suspicious adenopathy detected by US evaluation, with 1 exception, were confirmed by pathological findings. Nine patients had additional neck levels involved with microscopic disease undetected by the US evaluation. Conclusions:In patients with PTC, preoperative US evaluation of the neck is effective in detecting nonpalpable metastasis. Therefore, routine preoperative neck US evaluation is recommended to optimize primary surgical planning.

Our study suggests that the presence of thyroid microcalcifications without a nodule is suspicious for PTC. We found that both patterns were suspicious for PTC, particularly in young patients. Special concern arises for those clustered microcalcifications on a background of Hashimoto thyroiditis.

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