Diagnostic Accuracy of CT and Ultrasonography for Evaluating Metastatic Cervical Lymph Nodes in Patients with Thyroid Cancer

Ahn, Ji Eun; Lee, Jeong Hyun; Yi, Jong Sook; Shong, Young Kee; Hong, Sungwook; Lee, Deok Hee; Choi, Choong Gon; Kim, Sang Joon

doi:10.1007/s00268-008-9588-7

Cited by 223 publications

(184 citation statements)

References 49 publications

(50 reference statements)

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“…In contradistinction to other studies, we deliberately neglected all ultrasound imaging criteria for identifying nodal metastases aiming to increase the sensitivity, and any lymph node detected in the central compartment was considered positive. The specificity of US in our study was 75%, which is still higher than that reported in some previous studies [20].…”

Section: Discussioncontrasting

confidence: 54%

“…Firstly, the technical difficulty; where metastatic nodes may be masked by the enlarged thyroid gland and the multifocal nodules and the presence of many surrounding structures with poor acoustic transmission [19,20,22], figure 3. Secondly, it should be noted that the experience of radiologists in US imaging of the central neck compartment is lower than that in the lateral neck.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound Imaging of Nodal Metastases in the Central Compartment in Thyroid Cancer: is it Possible to Increase Sensitivity

Hafez¹

2015

Thyroid Disorders Ther

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Background and Purpose: Ultrasound imaging criteria for cervical lymph nodes were set mainly to increase sensitivity. However, unlike the lateral neck compartment, the challenge in the central compartment is the low sensitivity of Ultrasonography. We performed this study to evaluate whether the sensitivity of Ultrasonography could be increased by considering any detected lymph node in the central compartment as malignant.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Ultrasound Imaging of Nodal Metastases in the Central Compartment in Thyroid Cancer: is it Possible to Increase Sensitivity

Hafez¹

2015

Thyroid Disorders Ther

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“…To our knowledge, there are no published reports that address the diagnostic value of US and CT for the evaluation of lymph node metastasis in PTMC. Previous studies (27,28) reported that for US, the sensitivity, specificity, accuracy, PPV and NPV at the lateral neck level of patients with PTC were 64 ∼65%, 82∼92%, 71∼82%, 83∼86%, and 59∼82%, respectively, while these diagnostic values for CT were 74 ∼78%, 78∼95%, 78∼87%, 86∼89%, and 68∼86%. Kim et al (27) reported a slight difference between the diagnostic accuracies of US and CT and that combined US and CT is superior to US alone in the detection of lymph node metastasis from PTC.…”

Section: Methodsmentioning

confidence: 99%

“…Kim et al (27) reported a slight difference between the diagnostic accuracies of US and CT and that combined US and CT is superior to US alone in the detection of lymph node metastasis from PTC. Ahn et al (28) reported that the sensitivity of CT was significantly higher than that of US for whole neck levels. We found that the sensitivity, specificity and accuracy for US and CT at the lateral neck level of patients with PTMC were comparable to that of the …”

Section: Methodsmentioning

confidence: 99%

Predictors of Lateral Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Review

Jeong

Mun

Bong

et al. 2013

Korean J Endocr Surg

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Purpose: Cervical lymph node metastasis in patients with papillary thyroid microcarcinoma (PTMC) is associated with an increased recurrence rate and distant metastases. In this study, we analyzed the predictive factors of lateral metastasis in patients with PTMC. Methods: We retrospectively reviewed the medical records of 1,030 patients with PTMC who underwent thyroidectomy. The clinicopathological characteristics and radiological findings upon ultrasonography (US) and computed tomography (CT) were then analyzed to evaluate the predictability of lateral metastasis of PTMC. Results: The overall rate of lateral metastasis was 3.3% for the 1,030 patients with PTMC. All patients underwent central lymph node dissection (CLND), and 119 of these patients (11.6%) underwent either prophylactic or therapeutic selective neck dissection (SND). Among patients who underwent lateral node evaluation, 28.6% had lateral metastasis. We found that lateral metastasis was associated with larger tumor size, extrathyroidal extension, multiple tumors, bilateral tumors, CLN metastasis, and positive expression of thyroid peroxidase. Positive findings of CLN and lateral metastases on ultrasonography (US) and computed tomography (CT) were significantly associated with lateral metastasis. Conclusion: This study demonstrated that, for patients with PTMC, larger tumor size, extrathyroidal extension, multiple tumors, bilateral tumors, CLN metastasis, positive expression of thyroid peroxidase, and positive CLN and lateral metastases identified on US and CT were significantly associated with lateral metastasis. Further studies with a large prospective study and longer follow-up are needed to clarify the predictive value of these factors.

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“…The sensitivity (27.3-55%) and specificity (69-90.0%) of preoperative US within the central compartment are lower than those (sensitivity 65-90.3%, specificity 82-94.8%) of the lateral compartment. [31][32][33][34] Recently several investigators have reported that preoperative US with CT had superior diagnostic performances to US alone, although the routine preoperative usage of CT is not recommended by the American Thyroid Association (ATA) guidelines under revision. 33,35,36) However, US and CT together were still not sufficiently sensitive to detect small lymph node metastases in the central neck.…”

Section: Presentation Of Nodal Metastasesmentioning

confidence: 99%

Regional Lymph Node Metastasis in Papillary Thyroid Cancer

Park

Lee

Bae

et al. 2014

J Korean Thyroid Assoc

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Papillary thyroid cancer is a common endocrine cancer and commonly presents with lymph node metastases. It has been generally accepted that lymphatic drainage occurs from the thyroid primarily to the central lymphatic compartment and secondarily to the lateral compartment nodes. Recently, improvements in the resolution of imaging studies and the availability of highly sensitive thyroglobulin assays have highlighted the importance of identifying disease in the pre-operative assessment and dealing effectively with metastatic regional disease in order to prevent recurrence. However, there are limitations to diagnosing central lymph node metastases. With unreliable imaging modalities, prophylactic central lymph node dissection should be performed on all patients with papillary thyroid cancer. In comparison with the central compartment, prophylactic lateral node dissection has little or no effect on improving the prognosis of patients with papillary thyroid cancer. Therefore, lateral node dissection is recommended only as a part of the therapeutic procedure. The extension of lateral neck dissection is recommended a comprehensive selective neck dissection of levels IIa, III, IV, and Vb. The rich lymphatic supply of the thyroid gland coupled with the propensity for nodal metastases in papillary thyroid cancer require the modern thyroid surgeon to be familiar with the indications for and techniques of regional lymph node dissection.

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Diagnostic Accuracy of CT and Ultrasonography for Evaluating Metastatic Cervical Lymph Nodes in Patients with Thyroid Cancer

Abstract: Despite of very high accuracy of USG by per patient analysis, the superior sensitivity of CT on the per level analysis may enable CT to play a complementary role for determining the surgical extent in selected patients with thyroid cancer.

Cited by 223 publications

References 49 publications

Ultrasound Imaging of Nodal Metastases in the Central Compartment in Thyroid Cancer: is it Possible to Increase Sensitivity

Ultrasound Imaging of Nodal Metastases in the Central Compartment in Thyroid Cancer: is it Possible to Increase Sensitivity

Predictors of Lateral Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Review

Regional Lymph Node Metastasis in Papillary Thyroid Cancer

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