Ultrasound Criteria of Malignancy for Cervical Lymph Nodes in Patients Followed Up for Differentiated Thyroid Cancer

Context: Neck ultrasonography (US) has become a keystone in the follow-up of patients with differentiated thyroid cancer. Objective: The aim of this study was to determine specificity and sensitivity of ultrasound criteria of malignancy for cervical lymph nodes (LNs) in patients with differentiated...

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Bibliographic Details
Published in:The journal of clinical endocrinology and metabolism 2007-09, Vol.92 (9), p.3590-3594
Main Authors: Leboulleux, Sophie, Girard, Elizabeth, Rose, Mathieu, Travagli, Jean Paul, Sabbah, Nadia, Caillou, Bernard, Hartl, Dana M, Lassau, Nathalie, Baudin, Eric, Schlumberger, Martin
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Carcinoma - diagnostic imaging
Carcinoma - pathology
Carcinoma - surgery
Disease Progression
Endocrinopathies
Feeding. Feeding behavior
Female
Follow-Up Studies
Fundamental and applied biological sciences. Psychology
Humans
Lymph Node Excision
Lymph Nodes - diagnostic imaging
Lymph Nodes - surgery
Lymphatic Metastasis - diagnostic imaging
Male
Malignant tumors
Medical sciences
Middle Aged
Neck
Sensitivity and Specificity
Thyroid Neoplasms - diagnostic imaging
Thyroid Neoplasms - pathology
Thyroid Neoplasms - surgery
Thyroid. Thyroid axis (diseases)
Ultrasonography
Vertebrates: anatomy and physiology, studies on body, several organs or systems
Vertebrates: endocrinology
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Summary:Context: Neck ultrasonography (US) has become a keystone in the follow-up of patients with differentiated thyroid cancer. Objective: The aim of this study was to determine specificity and sensitivity of ultrasound criteria of malignancy for cervical lymph nodes (LNs) in patients with differentiated thyroid cancer. Design: We prospectively studied 19 patients referred to the Institut Gustave Roussy for neck LN dissection. All patients underwent a neck US within 4 d prior to surgery. Only LNs that were unequivocally matched between US and pathology were taken into account for the analysis. Results: One hundred three LNs were detected on US, 578 LNs were surgically removed, and 56 LNs were analyzed (28 benign and 28 malignant). Sensitivity and specificity were 68 and 75% for the long axis (≥1 cm), 61 and 96% for the short axis (>5 mm), 46 and 64% for the round shape (long to short axis ratio < 2), 100 and 29% for the loss of fatty hyperechoic hilum, 39 and 18% for hypoechogenicity, 11 and 100% for cystic appearance, 46 and 100% for hyperechoic punctuations, and 86 and 82% for peripheral vascularization. Conclusion: Cystic appearance, hyperechoic punctuations, loss of hilum, and peripheral vascularization can be considered as major ultrasound criteria of LN malignancy. LNs with cystic appearance or hyperechoic punctuations are highly suspicious of malignancy. LNs with a hyperechoic hilum should be considered as benign. Peripheral vascularization has the best sensitivity-specificity compromise. Round shape, hypoechogenicity, and the loss of hilum taken as single criteria are not specific enough to suspect malignancy.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.2007-0444