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Current Medical Imaging

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ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

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General Research Article

Diagnostic Accuracy of Ultrasound for the Evaluation of Lateral Compartment Lymph Nodes in Papillary Thyroid Carcinoma

Author(s): Bulent Colakoglu, Deniz Alis* and Hulya Seymen

Volume 16, Issue 4, 2020

Page: [459 - 465] Pages: 7

DOI: 10.2174/1573405615666190619093618

Price: $65

Abstract

Aims: To evaluate the diagnostic accuracy of ultrasound (US) assessing the lateral compartment lymph node metastasis in patients with primary papillary thyroid carcinoma (PTC), and to demonstrate the incidence and patterns of the lateral lymph node metastasis.

Methods: We retrospectively reviewed 198 patients with primary PTC who underwent thyroidectomy in addition to modified lateral neck dissections (MLND) involving level II to level V due to clinically positive lateral neck disease. A skilled and experienced single operator performed all US examinations. Surgical pathology results were accepted as the reference method and sensitivity, specificity, and diagnostic accuracy of US in detecting metastatic lymph nodes established using level-by-level analysis.

Results: In the study cohort, 10.1% of the patients had lateral compartment lymph node metastases without any central compartment involvement. For the lateral compartment, 48.5% had level II, 74.7% had level III, 64.6% had level IV, and 29.3% of the patients had level V metastasis. None of the patients had isolated level V metastasis. The sensitivity, specificity, and diagnostic accuracy of US in identifying lateral lymph compartment metastasis ranged from 87% to 91.4%, 92% to 98.6% 92.4% to 96%, respectively. However, the sensitivity (74.7%) and diagnostic accuracy (76.2%) of US significantly decreased for the central compartment while specificity (90%) remained similar.

Conclusion: US performed by a skilled operator has an excellent diagnostic accuracy for the evaluation of lateral cervical lymph nodes in primary PTC; thus, might enable precise tailoring of the management strategies. Moreover, the high incidence of level V involvement favors MLND over selective approaches.

Keywords: Papillary thyroid cancer, diagnostic accuracy, ultrasound, lateral neck metastasis, lymph node metastasis.

Graphical Abstract

[1]
Hundahl SA, Fleming ID, Fremgen AM, et al. A national cancer database report on 53,856 cases of thyroid carcinoma treated in the U.S. 1985-1995. Cancer 1998; 83: 2638-48.
[http://dx.doi.org/10.1002/(SICI)1097-0142(19981215)83:12<2638:AID-CNCR31>3.0.CO;2-1] [PMID: 9874472]
[2]
Gilliland FD, Hunt WC, Morris DM, Key CR. Prognostic factors for thyroid carcinoma. A population-based study of 15,698 cases from the Surveillance, Epidemiology and End Results (SEER) program 1973-1991. Cancer 1997; 79(3): 564-73.
[http://dx.doi.org/10.1002/(SICI)1097-0142(19970201)79:3<564:AID-CNCR20>3.0.CO;2-0] [PMID: 9028369]
[3]
Myers EN, Suen JY. Cancer of the Head and Neck. Philadelphia, PA: WB Saunders Co. 1996.
[4]
Shaha AR, Shah JP, Loree TR. Patterns of nodal and distant metastasis based on histologic varieties in differentiated carcinoma of the thyroid. Am J Surg 1996; 172(6): 692-4.
[http://dx.doi.org/10.1016/S0002-9610(96)00310-8] [PMID: 8988680]
[5]
Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994; 97(5): 418-28.
[http://dx.doi.org/10.1016/0002-9343(94)90321-2] [PMID: 7977430]
[6]
Hay ID, Thompson GB, Grant CS, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940-1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg 2002; 26(8): 879-85.
[http://dx.doi.org/10.1007/s00268-002-6612-1] [PMID: 12016468]
[7]
Grant CS, Hay ID, Gough IR, Bergstralh EJ, Goellner JR, McConahey WM. Local recurrence in papillary thyroid carcinoma: is extent of surgical resection important? Surgery 1988; 104(6): 954-62.
[PMID: 3194847]
[8]
Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery 1988; 104(6): 947-53.
[http://dx.doi.org/10.1016/S0039-6060(98)70034-0] [PMID: 3194846]
[9]
Kupferman ME, Patterson M, Mandel SJ, LiVolsi V, Weber RS. Patterns of lateral neck metastasis in papillary thyroid carcinoma. Arch Otolaryngol Head and Neck Surg 2004; 130(7): 857-60.
[10]
Roh JL, Kim JM, Park CI. Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol 2008; 15(4): 1177-82.
[http://dx.doi.org/10.1245/s10434-008-9813-5] [PMID: 18253801]
[11]
Noguchi S, Murakami N, Yamashita H, Toda M, Kawamoto H. Papillary thyroid carcinoma: modified radical neck dissection improves prognosis. Arch Surg 1998; 133(3): 276-80.
[http://dx.doi.org/10.1001/archsurg.133.3.276] [PMID: 9517740]
[12]
Ito Y, Fukushima M, Tomoda C, et al. Prognosis of patients with papillary thyroid carcinoma having clinically apparent metastasis to the lateral compartment. Endocr J 2009; 56(6): 759-66.
[http://dx.doi.org/10.1507/endocrj.K09E-025] [PMID: 19506324]
[13]
Sugitani I, Fujimoto Y, Yamada K, Yamamoto N. Prospective outcomes of selective lymph node dissection for papillary thyroid carcinoma based on preoperative ultrasonography. World J Surg 2008; 32(11): 2494-502.
[http://dx.doi.org/10.1007/s00268-008-9711-9] [PMID: 18784956]
[14]
Ito Y, Tomoda C, Uruno T, et al. Ultrasound-detectable and anatomopathological-detectable node metastasis in the lateral compartment as indicators of worse relapse-free survival in patients with papillary carcinoma. World J Surg 2005; 29: 917-92.
[http://dx.doi.org/10.1007/s00268-005-7789-x] [PMID: 15951927]
[15]
Davidson HC, Park BJ, Johnson JT. Papillary thyroid cancer: controversies in the management of neck metastasis. Laryngoscope 2008; 118(12): 2161-5.
[http://dx.doi.org/10.1097/MLG.0b013e31818550f6] [PMID: 19029855]
[16]
Haugen BR, Alexander EK, Bible KC, et al. American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016; 26(1): 1-133.
[http://dx.doi.org/10.1089/thy.2015.0020] [PMID: 26462967]
[17]
Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006; 16(2): 109-42.
[http://dx.doi.org/10.1089/thy.2006.16.109] [PMID: 16420177]
[18]
The NCCN Clinical Practice Guidelines in Oncology. Thyroid Carcinoma (V.1.2009). 2009 National Comprehensive Cancer Network, Inc. Available at: NCCN.org [Accessed March 17, 2009]
[19]
González HE, Cruz F, O’Brien A, et al. Impact of preoperative ultrasonographic staging of the neck in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 2007; 133(12): 1258-62.
[http://dx.doi.org/10.1001/archotol.133.12.1258] [PMID: 18086969]
[20]
Marshall CL, Lee JE, Xing Y, et al. Routine pre-operative ultrasonography for papillary thyroid cancer: effects on cervical recurrence. Surgery 2009; 146(6): 1063-72.
[http://dx.doi.org/10.1016/j.surg.2009.09.027] [PMID: 19958933]
[21]
Stulak JM, Grant CS, Farley DR, et al. Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg 2006; 141(5): 489-94.
[http://dx.doi.org/10.1001/archsurg.141.5.489] [PMID: 16702521]
[22]
Robbins KT, Clayman G, Levine PA, et al. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg 2002; 128: 751-8.
[http://dx.doi.org/10.1001/archotol.128.7.751]
[23]
Liu Z, Zeng W, Liu C, et al. Diagnostic accuracy of ultrasonographic features for lymph node metastasis in papillary thyroid microcarcinoma: a single-center retrospective study. World J Surg Oncol 2017; 15(1): 32.
[http://dx.doi.org/10.1186/s12957-017-1099-2] [PMID: 28125992]
[24]
Sohn YM, Kwak JY, Kim EK, Moon HJ, Kim SJ, Kim MJ. Diagnostic approach for evaluation of lymph node metastasis from thyroid cancer using ultrasound and fine-needle aspiration biopsy. AJR Am J Roentgenol 2010; 194(1): 38-43.
[http://dx.doi.org/10.2214/AJR.09.3128] [PMID: 20028903]
[25]
Liao S, Shindo M. Management of well-differentiated thyroid cancer. Otolaryngol Clin North Am 2012; 45(5): 1163-79.
[http://dx.doi.org/10.1016/j.otc.2012.06.015] [PMID: 22980691]
[26]
Wu CH, Chang YL, Hsu WC, Ko JY, Sheen TS, Hsieh FJ. Usefulness of Doppler spectral analysis and power Doppler sonography in the differentiation of cervical lymphadenopathies. AJR Am J Roentgenol 1998; 171(2): 503-9.
[http://dx.doi.org/10.2214/ajr.171.2.9694484] [PMID: 9694484]
[27]
Javid M, Graham E, Malinowski J, et al. Dissection of levels II through V is required for optimal outcomes in patients with lateral neck lymph node metastasis from papillary thyroid carcinoma. J Am Coll Surg 2016; 222(6): 1066-73.
[http://dx.doi.org/10.1016/j.jamcollsurg.2016.02.006] [PMID: 27049777]
[28]
Sivanandan R, Soo KC. Pattern of cervical lymph node metastases from papillary carcinoma of the thyroid. Br J Surg 2001; 88(9): 1241-4.
[http://dx.doi.org/10.1046/j.0007-1323.2001.01843.x] [PMID: 11531874]
[29]
Park JY, Koo BS. Individualized optimal surgical extent of the lateral neck in papillary thyroid cancer with lateral cervical metastasis. Eur Arch Otorhinolaryngol 2014; 271(6): 1355-60.
[http://dx.doi.org/10.1007/s00405-013-2630-x] [PMID: 23857026]
[30]
Lim YC, Koo BS. Predictive factors of skip metastases to lateral neck compartment leaping central neck compartment in papillary thyroid carcinoma. Oral Oncol 2012; 48(3): 262-5.
[http://dx.doi.org/10.1016/j.oraloncology.2011.10.006] [PMID: 22047924]
[31]
Park JH, Lee YS, Kim BW, Chang HS, Park CS. Skip lateral neck node metastases in papillary thyroid carcinoma. World J Surg 2012; 36(4): 743-7.
[http://dx.doi.org/10.1007/s00268-012-1476-5] [PMID: 22354485]
[32]
Lee YS, Shin SC, Lim YS, et al. Tumor location-dependent skip lateral cervical lymph node metastasis in papillary thyroid cancer. Head Neck 2014; 36(6): 887-91.
[http://dx.doi.org/10.1002/hed.23391] [PMID: 23733708]
[33]
Lei J, Zhong J, Jiang K, Li Z, Gong R, Zhu J. Skip lateral lymph node metastasis leaping over the central neck compartment in papillary thyroid carcinoma. Oncotarget 2017; 8(16): 27022-33.
[http://dx.doi.org/10.18632/oncotarget.15388] [PMID: 28223546]
[34]
Inoue H, Nibu K, Saito M, et al. Quality of life after neck dissection. Arch Otolaryngol Head Neck Surg 2006; 132(6): 662-6.
[http://dx.doi.org/10.1001/archotol.132.6.662] [PMID: 16785413]
[35]
Terrell JE, Welsh DE, Bradford CR, et al. Pain, quality of life, and spinal accessory nerve status after neck dissection. Laryngoscope 2000; 110(4): 620-6.
[http://dx.doi.org/10.1097/00005537-200004000-00016] [PMID: 10764008]
[36]
Ferris R, Goldenberg D, Haymart MR, et al. American Thyroid Association consensus review of the anatomy, terminology and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid 2012.
[http://dx.doi.org/10.1089/thy.2011-0312] [PMID: 22435914]
[37]
Ahmadi N, Grewal A, Davidson BJ. Patterns of cervical lymph node metastases in primary and recurrent papillary thyroid cancer. J Oncol 2011; 2011735678
[http://dx.doi.org/10.1155/2011/735678]
[38]
Kupferman ME, Weinstock YE, Santillan AA, et al. Predictors of level V metastasis in well-differentiated thyroid cancer. Head & Neck J Sci Special Head Neck 2008; 3: 1469-74.
[http://dx.doi.org/10.1002/hed.20904]
[39]
Lee K, Kawata R, Nishikawa S, Yoshimura K, Takenaka H. Diagnostic criteria of ultrasonographic examination for lateral node metastasis of papillary thyroid carcinoma. Acta Otolaryngol 2010; 130(1): 161-6.
[http://dx.doi.org/10.3109/00016480903015143] [PMID: 19479461]
[40]
Choi JS, Kim J, Kwak JY, Kim MJ, Chang HS, Kim EK. Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol 2009; 193(3): 871-8.
[http://dx.doi.org/10.2214/AJR.09.2386] [PMID: 19696304]
[41]
Ahn JE, Lee JH, Yi JS, et al. Diagnostic accuracy of CT and ultrasonography for evaluating metastatic cervical lymph nodes in patients with thyroid cancer. World J Surg 2008; 32(7): 1552-8.
[http://dx.doi.org/10.1007/s00268-008-9588-7] [PMID: 18408961]
[42]
Jeong HS, Baek CH, Son YI, et al. Integrated 18F-FDG PET/CT for the initial evaluation of cervical node level of patients with papillary thyroid carcinoma: comparison with ultrasound and contrast-enhanced CT. Clin Endocrinol (Oxf) 2006; 65(3): 402-7.
[http://dx.doi.org/10.1111/j.1365-2265.2006.02612.x] [PMID: 16918964]
[43]
Hwang HS, Perez DA, Orloff LA. Comparison of positron emission tomography/computed tomography imaging and ultrasound in staging and surveillance of head and neck and thyroid cancer. Laryngoscope 2009; 119(10): 1958-65.
[http://dx.doi.org/10.1002/lary.20594] [PMID: 19688854]
[44]
Mizrachi A, Feinmesser R, Bachar G, Hilly O, Cohen M. Value of ultrasound in detecting central compartment lymph node metastases in differentiated thyroid carcinoma. Eur Arch Otorhinolaryngol 2014; 271(5): 1215-8.
[http://dx.doi.org/10.1007/s00405-013-2636-4] [PMID: 23880920]

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