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Ultrasound and Mapping of Neck Lymph Nodes

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Thyroid and Parathyroid Ultrasound and Ultrasound-Guided FNA

Abstract

Papillary thyroid carcinoma (PTC) frequently metastasizes to regional cervical lymph nodes, with incidence rates ranging from 12 to 80% of PTC patients. Macroscopic nodal disease (as opposed to microscopic) has been shown to increase the risk of nodal recurrence. Preoperative identification of lymph node metastases is essential to allow for adequate surgical planning by determining extent of initial surgery, thereby optimizing recurrence-free survival outcomes. Postoperatively, surveillance of neck nodes allows for early detection of disease recurrence. Neck sonography, by virtue of its ease of use and ability to screen the neck for abnormal lymph nodes, is the primary imaging modality employed for screening, mapping, and surveying neck lymph nodes in patients with thyroid carcinoma.

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References

  1. Haugen BR, et al. 2015 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.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Carty SE, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009;19(11):1153–8.

    Article  PubMed  Google Scholar 

  3. Wittekind C, et al. TNM supplement: a commentary on uniform use. New York: Wiley-Liss; 2002.

    Google Scholar 

  4. Robbins KT, et al. Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg. 2008;134(5):536–8.

    Article  PubMed  Google Scholar 

  5. Qubain SW, et al. Distribution of lymph node micrometastasis in pN0 well-differentiated thyroid carcinoma. Surgery. 2002;131(3):249–56.

    Article  PubMed  Google Scholar 

  6. Dralle H, et al. Compartment-oriented microdissection of regional lymph nodes in medullary thyroid carcinoma. Surg Today. 1994;24(2):112–21.

    Article  CAS  PubMed  Google Scholar 

  7. Cunnane M, et al. A novel thyroid cancer nodal map classification system to facilitate nodal localization and surgical management. Laryngoscope. 2016. [Epub ahead of print].

    Google Scholar 

  8. Goyal N, et al. Mapping the distribution of nodal metastases in papillary thyroid carcinoma: where exactly are the nodes? Laryngoscope. 2017;127(8):1959–1964. (accepted Jan 2017).

    Article  PubMed  Google Scholar 

  9. Steinkamp HJ, Cornehl M, Hosten N, et al. Cervical lymphadenopathy: ratio of long- to short-axis diameter as a predictor of malignancy. Br J Radiol. 1995;68(3):266–70.

    Article  CAS  PubMed  Google Scholar 

  10. Leboulleux S, et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab. 2007;92(9):3590–4.

    Article  CAS  PubMed  Google Scholar 

  11. Lee YJ, et al. Pre-operative ultrasound diagnosis of nodal metastasis in papillary thyroid carcinoma patients according to nodal compartment. Ultrasound Med Biol. 2015;41(5):1294–300.

    Article  PubMed  Google Scholar 

  12. Ahuja A, et al. Lymph node hilus: gray scale and power Doppler sonography of cervical nodes. J Ultrasound Med. 2001;20(9):987–92; quiz 994.

    Article  CAS  PubMed  Google Scholar 

  13. Ahuja AT, et al. Power Doppler sonography of metastatic nodes from papillary carcinoma of the thyroid. Clin Radiol. 2001;56(4):284–8.

    Article  CAS  PubMed  Google Scholar 

  14. Ahuja A, Ying M. An overview of neck node sonography. Investig Radiol. 2002;37(6):333–42.

    Article  Google Scholar 

  15. Bellantone R, et al. Management of cystic or predominantly cystic thyroid nodules: the role of ultrasound-guided fine-needle aspiration biopsy. Thyroid. 2004;14(1):43–7.

    Article  PubMed  Google Scholar 

  16. Frasoldati A, et al. Role of thyroglobulin measurement in fine-needle aspiration biopsies of cervical lymph nodes in patients with differentiated thyroid cancer. Thyroid. 1999;9(2):105–11.

    Article  CAS  PubMed  Google Scholar 

  17. Pacini F, et al. Detection of thyroglobulin in fine needle aspirates of nonthyroidal neck masses: a clue to the diagnosis of metastatic differentiated thyroid cancer. J Clin Endocrinol Metab. 1992;74(6):1401–4.

    CAS  PubMed  Google Scholar 

  18. Baskin HJ. Detection of recurrent papillary thyroid carcinoma by thyroglobulin assessment in the needle washout after fine-needle aspiration of suspicious lymph nodes. Thyroid. 2004;14(11):959–63.

    Article  PubMed  Google Scholar 

  19. Lee MJ, et al. Fine-needle biopsy of cervical lymph nodes in patients with thyroid cancer: a prospective comparison of cytopathologic and tissue marker analysis. Radiology. 1993;187(3):851–4.

    Article  CAS  PubMed  Google Scholar 

  20. Cignarelli M, et al. Diagnostic utility of thyroglobulin detection in fine-needle aspiration of cervical cystic metastatic lymph nodes from papillary thyroid cancer with negative cytology. Thyroid. 2003;13(12):1163–7.

    Article  CAS  PubMed  Google Scholar 

  21. Gemsenjager E, et al. Lymph node surgery in papillary thyroid carcinoma. J Am Coll Surg. 2003;197(2):182–90.

    Article  PubMed  Google Scholar 

  22. Bardet S, et al. Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma. Eur J Endocrinol. 2008;158(4):551–60.

    Article  CAS  PubMed  Google Scholar 

  23. Cranshaw IM, Carnaille B. Micrometastases in thyroid cancer. An important finding? Surg Oncol. 2008;17(3):253–8.

    Article  PubMed  Google Scholar 

  24. Yamashita H, et al. Extracapsular invasion of lymph node metastasis. A good indicator of disease recurrence and poor prognosis in patients with thyroid microcarcinoma. Cancer. 1999;86(5):842–9.

    Article  CAS  PubMed  Google Scholar 

  25. Baudin E, et al. Microcarcinoma of the thyroid gland: the Gustave-Roussy institute experience. Cancer. 1998;83(3):553–9.

    Article  CAS  PubMed  Google Scholar 

  26. Chow SM, et al. Papillary microcarcinoma of the thyroid-prognostic significance of lymph node metastasis and multifocality. Cancer. 2003;98(1):31–40.

    Article  PubMed  Google Scholar 

  27. Ito Y, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid. 2003;13(4):381–7.

    Article  PubMed  Google Scholar 

  28. Wada N, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003;237(3):399–407.

    PubMed  PubMed Central  Google Scholar 

  29. Roti E, et al. Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. J Clin Endocrinol Metab. 2006;91(6):2171–8.

    Article  CAS  PubMed  Google Scholar 

  30. Hay ID. Management of patients with low-risk papillary thyroid carcinoma. Endocr Pract. 2007;13(5):521–33.

    Article  PubMed  Google Scholar 

  31. Mazzaferri EL. Management of low-risk differentiated thyroid cancer. Endocr Pract. 2007;13(5):498–512.

    Article  PubMed  Google Scholar 

  32. Hay ID, et al. Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery. 2008;144(6):980–7; discussion 987-8.

    Article  PubMed  Google Scholar 

  33. Noguchi S, et al. Papillary microcarcinoma. World J Surg. 2008;32(5):747–53.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Giordano D, et al. Treatment and prognostic factors of papillary thyroid microcarcinoma. Clin Otolaryngol. 2010;35(2):118–24.

    Article  CAS  PubMed  Google Scholar 

  35. So YK, et al. Subclinical lymph node metastasis in papillary thyroid microcarcinoma: a study of 551 resections. Surgery. 2010;148(3):526–31.

    Article  PubMed  Google Scholar 

  36. Zetoune T, et al. Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. Ann Surg Oncol. 2010;17(12):3287–93.

    Article  PubMed  Google Scholar 

  37. Randolph GW, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012;22(11):1144–52.

    Article  PubMed  Google Scholar 

  38. Noguchi M, et al. Indications for bilateral neck dissection in well-differentiated carcinoma of the thyroid. Jpn J Surg. 1987;17(6):439–44.

    Article  CAS  PubMed  Google Scholar 

  39. Noguchi S, Murakami N. The value of lymph-node dissection in patients with differentiated thyroid cancer. Surg Clin North Am. 1987;67(2):251–61.

    Article  CAS  PubMed  Google Scholar 

  40. Mirallie E, et al. Localization of cervical node metastasis of papillary thyroid carcinoma. World J Surg. 1999;23(9):970–3. discussion 973-4.

    Article  CAS  PubMed  Google Scholar 

  41. Wang TS, et al. Incidence of metastatic well-differentiated thyroid cancer in cervical lymph nodes. Arch Otolaryngol Head Neck Surg. 2004;130(1):110–3.

    Article  PubMed  Google Scholar 

  42. Triponez F, et al. Hook needle-guided excision of recurrent differentiated thyroid cancer in previously operated neck compartments: a safe technique for small, nonpalpable recurrent disease. J Clin Endocrinol Metab. 2006;91(12):4943–7.

    Article  CAS  PubMed  Google Scholar 

  43. Ito Y, et al. Risk factors for recurrence to the lymph node in papillary thyroid carcinoma patients without preoperatively detectable lateral node metastasis: validity of prophylactic modified radical neck dissection. World J Surg. 2007;31(11):2085–91.

    Article  PubMed  Google Scholar 

  44. Lee SK, et al. Sentinel lymph node biopsy in papillary thyroid cancer: comparison study of blue dye method and combined radioisotope and blue dye method in papillary thyroid cancer. Eur J Surg Oncol. 2009;35(9):974–9.

    Article  CAS  PubMed  Google Scholar 

  45. Lim YC, et al. Central lymph node metastases in unilateral papillary thyroid microcarcinoma. Br J Surg. 2009;96(3):253–7.

    Article  CAS  PubMed  Google Scholar 

  46. Ross DS, et al. Recurrence after treatment of micropapillary thyroid cancer. Thyroid. 2009;19(10):1043–8.

    Article  PubMed  Google Scholar 

  47. Wang LY, et al. Preoperative neck ultrasound in clinical node-negative differentiated thyroid cancer. J Clin Endocrinol Metab. 2014;99(10):3686–93.

    Article  CAS  PubMed  Google Scholar 

  48. Moreno MA, et al. Preoperative lateral neck ultrasonography as a long-term outcome predictor in papillary thyroid cancer. Arch Otolaryngol Head Neck Surg. 2011;137(2):157–62.

    Article  PubMed  Google Scholar 

  49. Ito Y, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg. 2006;30(1):91–9.

    Article  PubMed  Google Scholar 

  50. Lesnik D, et al. Papillary thyroid carcinoma nodal surgery directed by a preoperative radiographic map utilizing CT scan and ultrasound in all primary and reoperative patients. Head Neck. 2014;36(2):191–202.

    Article  PubMed  Google Scholar 

  51. Ito Y, et al. Preoperative ultrasonographic examination for lymph node metastasis: usefulness when designing lymph node dissection for papillary microcarcinoma of the thyroid. World J Surg. 2004;28(5):498–501.

    Article  PubMed  Google Scholar 

  52. Caparevic Z, et al. Psychological evaluation of patients with a nodular goiter before and after surgical treatment. Med Pregl. 2002;55(9–10):401–5.

    Article  PubMed  Google Scholar 

  53. Pineda JD, et al. Iodine-131 therapy for thyroid cancer patients with elevated thyroglobulin and negative diagnostic scan. J Clin Endocrinol Metab. 1995;80(5):1488–92.

    CAS  PubMed  Google Scholar 

  54. Schumm-Draeger PM, Encke A, Usadel KH. Optimal recurrence prevention of iodine deficiency related goiter after thyroid gland operation. A prospective clinical study. Internist. 2003;44(4):420–6. 429-32.

    Article  CAS  PubMed  Google Scholar 

  55. Menendez Torre E, et al. Prognostic value of thyroglobulin serum levels and 131I whole-body scan after initial treatment of low-risk differentiated thyroid cancer. Thyroid. 2004;14(4):301–6.

    Article  PubMed  Google Scholar 

  56. Park HM, et al. Influence of diagnostic radioiodines on the uptake of ablative dose of iodine-131. Thyroid. 1994;4(1):49–54.

    Article  CAS  PubMed  Google Scholar 

  57. Frasoldati A, et al. Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma. Cancer. 2003;97(1):90–6.

    Article  PubMed  Google Scholar 

  58. Vali R, et al. The role of ultrasound in the follow-up of children with differentiated thyroid cancer. Pediatr Radiol. 2015;45(7):1039–45.

    Article  PubMed  Google Scholar 

  59. Peiling Yang S, et al. Frequent screening with serial neck ultrasound is more likely to identify false-positive abnormalities than clinically significant disease in the surveillance of intermediate risk papillary thyroid cancer patients without suspicious findings on follow-up ultrasound evaluation. J Clin Endocrinol Metab. 2015;100(4):1561–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Phelan E, et al. Neural monitored revision thyroid cancer surgery: surgical safety and thyroglobulin response. Otolaryngol Head Neck Surg. 2013;149(1):47–52.

    Article  PubMed  Google Scholar 

  61. Salari B, et al. Revision neural monitored surgery for recurrent thyroid cancer: safety and thyroglobulin response. Laryngoscope. 2016;126(4):1020–5.

    Article  CAS  PubMed  Google Scholar 

  62. Chuang YC, Huang SM. Protective effect of intraoperative nerve monitoring against recurrent laryngeal nerve injury during re-exploration of the thyroid. World J Surg Oncol. 2013;11:94.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Chan WF, Lang BH, Lo CY. The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk. Surgery. 2006;140(6):866–72; discussion 872-3.

    Article  PubMed  Google Scholar 

  64. Amin MR. Thyrohyoid approach for vocal fold augmentation. Ann Otol Rhinol Laryngol. 2006;115(9):699–702.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Catherine F. Sinclair BMBS (Hons), FRACS, BSc (Biomed)

  2. Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

    Dipti Kamani MD

  3. Thyroid Surgery Oncology, Harvard Medical School, Boston, MA, USA

    Gregory W. Randolph MD, FACS, FACE

  4. Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

    Gregory W. Randolph MD, FACS, FACE

  5. Department of Surgery, Endocrine Surgery Service, Massachusetts General Hospital, Boston, MA, USA

    Gregory W. Randolph MD, FACS, FACE

  6. Beth Israel Deaconess Medical Center, Natick, MA, USA

    Barry Sacks MD

  7. University of Central Florida College of Medicine, Orlando, FL, USA

    H. Jack Baskin Sr. MD, MACE

Authors
  1. Catherine F. Sinclair BMBS (Hons), FRACS, BSc (Biomed)
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  2. Dipti Kamani MD
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  3. Gregory W. Randolph MD, FACS, FACE
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  4. Barry Sacks MD
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  5. H. Jack Baskin Sr. MD, MACE
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Corresponding author

Correspondence to Gregory W. Randolph MD, FACS, FACE .

Editor information

Editors and Affiliations

  1. University of Arizona, College of Medicine, Phoenix, AZ, USA

    Daniel S. Duick

  2. Geisel School of Medicine at Dartmouth, Thyroid Center of New Hampshire, St. Joseph Hospital, Nashua, NH, USA

    Robert A. Levine

  3. Florida State University, College of Medicine, Tallahassee, FL, USA

    Mark A. Lupo

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Sinclair, C.F., Kamani, D., Randolph, G.W., Sacks, B., Jack Baskin, H. (2018). Ultrasound and Mapping of Neck Lymph Nodes. In: Duick, D., Levine, R., Lupo, M. (eds) Thyroid and Parathyroid Ultrasound and Ultrasound-Guided FNA . Springer, Cham. https://doi.org/10.1007/978-3-319-67238-0_8

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  • DOI: https://doi.org/10.1007/978-3-319-67238-0_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-67237-3

  • Online ISBN: 978-3-319-67238-0

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