Clinical and Imaging Assessment of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinomas

Background The goals of this study were to analyze clinical factors that affect cervical lymph node metastasis (LNM) in papillary thyroid cancer (PTC), and to evaluate the diagnostic accuracy of preoperative ultrasound (US) and computed tomography (CT) of the neck. Methods The study sample included...

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Bibliographic Details
Published in:World journal of surgery 2010-07, Vol.34 (7), p.1494-1499
Main Authors: Choi, Yoon Jung, Yun, Ji Sup, Kook, Shin Ho, Jung, Eun Choel, Park, Yong Lai
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Carcinoma, Papillary - diagnostic imaging
Carcinoma, Papillary - pathology
Carcinoma, Papillary - surgery
Cardiac Surgery
Cervical Lymph Node Metastasis
Endocrinopathies
Extrathyroidal Extension
Female
General aspects
General Surgery
Hematologic and hematopoietic diseases
Humans
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Logistic Models
Lymph Node Metastasis
Lymphatic Metastasis
Male
Malignant tumors
Medical sciences
Medicine
Medicine & Public Health
Middle Aged
Neck - diagnostic imaging
Neck Dissection
Neoplasm Invasiveness
Papillary Thyroid Cancer
Radiography
Risk Factors
Sensitivity and Specificity
Surgery
Thoracic Surgery
Thyroid Neoplasms - diagnostic imaging
Thyroid Neoplasms - pathology
Thyroid Neoplasms - surgery
Thyroid. Thyroid axis (diseases)
Thyroidectomy
Ultrasonography
Vascular Surgery
Young Adult
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Summary:Background The goals of this study were to analyze clinical factors that affect cervical lymph node metastasis (LNM) in papillary thyroid cancer (PTC), and to evaluate the diagnostic accuracy of preoperative ultrasound (US) and computed tomography (CT) of the neck. Methods The study sample included 589 consecutive patients who underwent surgery for PTC. Patient age and sex, number, size, and location of tumors, lymphovascular invasion, and extrathyroidal extension were evaluated as risk factors for central and lateral LNM. Results Increased risk of lymph node metastasis was found for male patients, 1 cm, lymphovascular invasion, and extrathyroidal invasion. Cancers located in the upper neck had a higher relative risk of lateral metastasis than cancers located in the lower neck. Sensitivity of both US and CT imaging was higher for lateral (70-80%) than for central (42-47%) LNM. Specificity of US and CT was high (92-97%) for both central and lateral LNM. Using central lymph node size of greater than 5 mm as an indicator of metastasis, preoperative US had 58.3% sensitivity and 71.4% specificity. Conclusions Preoperative US and CT imaging are useful for identifying features that indicate a high risk of LNM and for determining appropriate management of PTC.
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-010-0541-1