Bulent Colakoglu, Deniz Alis* and Hulya Seymen Pages 1 - 7 ( 7 )
Aims: To evaluate the diagnostic accuracy of ultrasound (US) is 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 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.
Conclusions: US performed a skilled operator has an excellent diagnostic accuracy for the evaluation of lateral cervical lymph nodes in primary PTC; thus, might enable precise tailoring the management strategies. Moreover, the high incidence of level V involvement favors MLND over selective approaches.
Papillary thyroid cancer, diagnostic accuracy, ultrasound, lateral neck metastasis, lymph node metastasis
Vehbi KoÃ�Â§ Foundation American Hospital, Department of Radiology, Istanbul, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Radiology, Halkali/Istanbul, Koc University, School of medicine, Department of Nuclear imaging, Istanbul