Utility of Surgeon-Performed Ultrasound Assessment of the Lateral Neck for Metastatic Papillary Thyroid Cancer

Abstract

Ultrasound is the recommended staging modality for papillary thyroid cancer. Surgeons proficient in US assessment of the neck and experienced in the management of papillary thyroid cancer (PTC) appear uniquely qualified to assess the lateral cervical lymph nodes for metastatic disease. Of 310 patients treated for PTC between 2000 and 2008, 109 underwent surgeon-performed ultrasound (SUS) of the lateral neck preoperatively. Fine needle aspiration was performed on suspicious lateral lymph nodes. SUS findings were compared with FNA cytology and results of postoperative imaging studies. The sensitivity and negative predictive value of SUS were 88% and 97%, respectively. Four patients were found to have missed metastatic disease within 6 months. No patient underwent a nontherapeutic neck dissection. SUS combined with US-guided FNA of suspicious lymph nodes can accurately stage PTC to reliably direct surgical management.

2013 European Thyroid Association Guidelines for Cervical Ultrasound Scan and Ultrasound-Guided Techniques in the Postoperative Management of Patients with Thyroid Cancer

“…In experienced hands, neck US is the most valuable tool for detecting locoregional and thyroid bed metastases, whether preoperatively or during short- or long-term postoperative follow-up [36,37,38,39,40,41]. …”

All Thyroid Ultrasound Evaluations are Not Equal: Sonographers Specialized in Thyroid Cancer Correctly Label Clinical N0 Disease in Well Differentiated Thyroid Cancer

“…Surgeons have access to all pertinent clinical information at time of US, excellent understanding of the local anatomy, as well as feedback from final pathologic results to continue to learn the finer nuances of ultrasound findings within the neck 3, 4, 15, 18, 20 . Radiology educational literature emphasizes the importance of repetition, in addition to familiarity with the key imaging characteristics, for greater accuracy of thyroid US interpretation 24, 25 .…”

“…Access to a specialized thyroid sonographer is not available at all institutions. In cases where the department of radiology does not have the resources to dedicate a single individual or team with expertise in thyroid imaging, the surgeon sonographer with specialization in the care of thyroid cancer can provide consistency in interpretation and expertise in thyroid imaging 3, 11, 12, 15, 18, 20, 26 .…”

All Cervical Sonography Is Not Created Equal

“…12,13,18,19 The findings from some studies suggest that surgeon-performed ultrasound, may even be superior to…”

“…12,13,18,19 The findings from some studies suggest that surgeon-performed ultrasound, may even be superior to ultrasound performed in radiology departments in some institutions. 12,20 Oltmann and colleagues expand on this concept and take their hypothesis one step further.…”