Advertisement

World Journal of Surgery

, 32:1552 | Cite as

Diagnostic Accuracy of CT and Ultrasonography for Evaluating Metastatic Cervical Lymph Nodes in Patients with Thyroid Cancer

  • Ji Eun Ahn
  • Jeong Hyun Lee
  • Jong Sook Yi
  • Young Ki Shong
  • Seok Joon Hong
  • Deok Hee Lee
  • Choong Gon Choi
  • Sang Joon Kim
Article

Abstract

Background

The present study was designed to investigate the diagnostic ability of computed tomography (CT) and ultrasonography (USG) in the preoperative evaluation of the cervical nodal status of patients with thyroid cancer.

Methods

The study population consisted of 37 consecutive patients (female:male = 30:7, age range: 20–68 years) who subsequently underwent total thyroidectomy and neck dissection for thyroid cancer. The results of the review of the preoperative CT and those of the original USG reports were compared with the histopathologic results. The accuracy was evaluated by “per level” and “per patient” analyses of whether the CT or USG results had or had not altered the choice of surgical method.

Results

By “per level” analysis, the sensitivities, specificities, and diagnostic accuracies were 77%, 70%, 74% for CT and 62%, 79%, 68% for USG, respectively, with a significant difference in the sensitivities (p = 0.002). When the lymph node levels were grouped into central and lateral compartments, all of the values for the lateral compartment tended to be higher than those for the central compartment for both CT (78%, 78%, 78% versus 74%, 44%, 64%) and USG (65%, 82%, 71 versus 55%, 69%, 60%). By per patient analysis, the sensitivities, specificities, and diagnostic accuracies of CT and USG were 100%, 90%, 97% and 100%, 80%, 95%, respectively.

Conclusion

Despite of very high accuracy of USG by per patient analysis, the superior sensitivity of CT on the per level analysis may enable CT to play a complementary role for determining the surgical extent in selected patients with thyroid cancer.

Keywords

Diagnostic Accuracy Thyroid Cancer Papillary Thyroid Carcinoma Neck Dissection Central Compartment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors thank Bonnie Hami, MA, Department of Radiology, University Hospitals Health System, Cleveland, Ohio, for her editorial assistance in preparing the manuscript.

References

  1. 1.
    Grebe SK, Hay ID (1996) Thyroid cancer nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin North Am 5:43–63Google Scholar
  2. 2.
    Mazzaferri EL, Kloos RT (2001) Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 86:1447–1463PubMedCrossRefGoogle Scholar
  3. 3.
    Mazzaferri EL, Jhiang SM (1994) Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97:418–428PubMedCrossRefGoogle Scholar
  4. 4.
    McHenry CR, Rosen IB, Walfish PG (1991) Prospective management of nodal metastases in differentiated thyroid cancer. Am J Surg 162:353–356PubMedCrossRefGoogle Scholar
  5. 5.
    Noguchi S, Murakami N, Yamashita H et al (1998) Papillary thyroid carcinoma: modified radical neck dissection improves prognosis. Arch Surg 133:276–280PubMedCrossRefGoogle Scholar
  6. 6.
    Shah JP, Loree TR, Dharker D et al (1992) Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg 164:658–661PubMedCrossRefGoogle Scholar
  7. 7.
    Caron NR, Tan YY, Ogilvie JB et al (2006) Selective modified radical neck dissection for papillary thyroid cancer-is level I, II and V dissection always necessary? World J Surg 30:833–840PubMedCrossRefGoogle Scholar
  8. 8.
    Cheah WK, Arici C, Ituarte PH et al (2002) Complications of neck dissection for thyroid cancer. World J Surg 26:1013–1016PubMedCrossRefGoogle Scholar
  9. 9.
    Baatenburg de Jong RJ, Rongen RJ, Lameris JS et al (1989) Metastatic neck disease. Palpation vs ultrasound examination. Arch Otolaryngol Head Neck Surg 115:689–690Google Scholar
  10. 10.
    Haberal I, Celik H, Gocmen H et al (2004) Which is important in the evaluation of metastatic lymph nodes in head and neck cancer: palpation, ultrasonography, or computed tomography? Otolaryngol Head Neck Surg 130:197–201PubMedCrossRefGoogle Scholar
  11. 11.
    Watkinson JC, Franklyn JA, Olliff JF (2006) Detection and surgical treatment of cervical lymph nodes in differentiated thyroid cancer. Thyroid 16:187–194PubMedCrossRefGoogle Scholar
  12. 12.
    Kouvaraki MA, Shapiro SE, Fornage BD et al (2003) Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery 134:946–954; discussion 954–955PubMedCrossRefGoogle Scholar
  13. 13.
    Stulak JM, Grant CS, Farley DR et al (2006) Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg 141:489–496PubMedCrossRefGoogle Scholar
  14. 14.
    King AD, Tse GMK, Ahuja AT et al (2004) Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US radiology. Radiology 230:720–726PubMedCrossRefGoogle Scholar
  15. 15.
    Sarvanan K, Bapuraj JR, Sharma SC et al (2002) Computed tomography and ultrasonographic evaluation of metastatic cervical lymph nodes with surgicoclinicopathologic correlation. J Laryngol Otol 116:194–199PubMedCrossRefGoogle Scholar
  16. 16.
    Jeong H-S, Baek C-H, Son Y-I et al (2006) 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 65:402–407CrossRefGoogle Scholar
  17. 17.
    Senchenkov A, Staren ED (2004) Ultrasound in head and neck surgery: thyroid, parathyroid, and cervical lymph nodes. Surg Clin North Am 84:973–1000PubMedCrossRefGoogle Scholar
  18. 18.
    Som PM, Curtin HD, Mancuso AA (2000) Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR Am J Roentgenol 174:837–844PubMedGoogle Scholar
  19. 19.
    Som PM, Brandwein M, Lidov M et al (1994) The varied presentations of papillary thyroid carcinoma cervical nodal disease: CT and MR findings. AJNR Am J Neuroradiol 15:1123–1128PubMedGoogle Scholar
  20. 20.
    Ito Y, Tomoda C, Uruno T et al (2006) Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg 30:91–99PubMedCrossRefGoogle Scholar
  21. 21.
    Rosario PWS, de Faria S, Bicalho L et al (2005) Ultrasonographic differentiation between metastatic and benign lymph nodes in patients with papillary thyroid carcinoma. J Ultrasound Med 24:1385–1389PubMedGoogle Scholar
  22. 22.
    Scheumann GF, Gimm O, Wegener G et al (1994) Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg 18:559–567; discussion 567–568PubMedCrossRefGoogle Scholar
  23. 23.
    Simon D, Goretzki PE, Witte J et al (1996) Incidence of regional recurrence guiding radicality in differentiated thyroid carcinoma. World J Surg 20:860–866; discussion 866PubMedCrossRefGoogle Scholar
  24. 24.
    Noguchi S, Murakami N (1987) The value of lymph-node dissection in patients with differentiated thyroid cancer. Surg Clin North Am 67:251–261PubMedGoogle Scholar
  25. 25.
    Lee B-J, Wang S-G, Lee J-C et al (2007) Level IIb lymph node metastasis in neck dissection for papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 133:1028–1030PubMedCrossRefGoogle Scholar
  26. 26.
    Machens A, Holzhausen H-J, Dralle H (2004) Skip metastases in thyroid cancer leaping the central lymph node compartment. Arch Surg 139:43–45PubMedCrossRefGoogle Scholar
  27. 27.
    Dijkstra PU, van Wilgen PC, Buijs RP et al (2001) Incidence of shoulder pain after neck dissection: a clinical explorative study for risk factors. Head Neck 23:947–953PubMedCrossRefGoogle Scholar
  28. 28.
    Short SO, Kaplan JN, Laramore GE et al (1984) Shoulder pain and function after neck dissection with or without preservation of the spinal accessory nerve. Am J Surg 148:478–482PubMedCrossRefGoogle Scholar
  29. 29.
    Ahuja AT, Ying M (2005) Sonographic evaluation of cervical lymph nodes. AJR Am J Roentgenol 184:1691–1699PubMedGoogle Scholar
  30. 30.
    Ahuja AT, Ying M, Ho SS et al (2001) Distribution of intranodal vessels in differentiating benign from metastatic neck nodes. Clin Radiol 56:197–201PubMedCrossRefGoogle Scholar
  31. 31.
    Ariji Y, Kimura Y, Hayashi N et al (1998) Power Doppler sonography of cervical lymph nodes in patients with head and neck cancer. AJNR Am J Neuroradiol 19:303–307PubMedGoogle Scholar
  32. 32.
    Atula TS, Varpula MJ, Kurki TJ et al (1997) Assessment of cervical lymph node status in head and neck cancer patients: palpation, computed tomography and low field magnetic resonance imaging compared with ultrasound-guided fine-needle aspiration cytology. Eur J Radiol 25:152–161PubMedCrossRefGoogle Scholar
  33. 33.
    Chong VF, Fan YF, Khoo JB (1996) MRI features of cervical nodal necrosis in metastatic disease. Clin Radiol 51:103–109PubMedCrossRefGoogle Scholar
  34. 34.
    Curtin HD, Ishwaran H, Mancuso AA et al (1998) Comparison of CT and MR imaging in staging of neck metastases. Radiology 207:123–130PubMedGoogle Scholar
  35. 35.
    Don DM, Anzai Y, Lufkin RB et al (1995) Evaluation of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Laryngoscope 105:669–674PubMedCrossRefGoogle Scholar
  36. 36.
    Som PM (1992) Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR Am J Roentgenol 158:961–969PubMedGoogle Scholar
  37. 37.
    van den Brekel MW, Castelijns JA, Stel HV et al (1993) Modern imaging techniques and ultrasound-guided aspiration cytology for the assessment of neck node metastases: a prospective comparative study. Eur Arch Otorhinolaryngol 250:11–17PubMedCrossRefGoogle Scholar
  38. 38.
    Yousem DM, Som PM, Hackney DB et al (1992) Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes: MR imaging versus CT. Radiology 182:753–759PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Ji Eun Ahn
    • 1
  • Jeong Hyun Lee
    • 1
  • Jong Sook Yi
    • 2
  • Young Ki Shong
    • 3
  • Seok Joon Hong
    • 4
  • Deok Hee Lee
    • 1
  • Choong Gon Choi
    • 1
  • Sang Joon Kim
    • 1
  1. 1.Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea
  2. 2.University of Ulsan College of MedicineSeoulKorea
  3. 3.Department of EndocrinologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea
  4. 4.Department of SurgeryUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea

Personalised recommendations