Advertisement

Ultrasonography of the Thyroid and Cervical Lymph Nodes

  • Enrico Papini
  • R. Guglielmi
  • Irene Misischi
  • Andrea Frasoldati
Chapter

Abstract

Due to its wide accessibility, easiness of use, and inexpensive cost, ultrasound (US) examination of the thyroid gland and cervical lymph nodes is commonly employed for the diagnosis of diffuse and nodular thyroid disease and for the pre-operatory staging and follow-up of patients with thyroid malignancy.

The present chapter is focused on the basic principles of US imaging, on thyroid US examination, and on the role of ultrasonography for the diagnosis of thyroid disease. Special attention will be devoted to thyroid nodular disease, to the identification of benign and malignant US findings, and to the use of US classification systems for the stratification of the risk of malignancy.

Lymph node anatomy and topography and the diagnostic approach to the imaging of regional thyroid metastases will be discussed in a dedicated section.

Learning objectives of this section are to make the reader familiar with main US assessment modalities, the use of an appropriate equipment, the correct diagnosis of thyroid and cervical lymph node abnormalities, and a reliable reporting system of neck US findings.

Keywords

Thyroid ultrasound Thyroid nodule Neck lymph nodes Thyroid malignancy 

References

  1. 1.
    Goldstein A, Powis RL. Medical ultrasonic diagnostics. Phys Acoustics. 1999;23:43–191.CrossRefGoogle Scholar
  2. 2.
    Carson P. Ultrasound tissue interactions. In: Goldman L, Fowlkes J, editors. Categorical course in diagnostic radiology physics: CT and US cross-sectional imaging. Oak Brook: Radiological Society of North America; 2000. p. 9–20.Google Scholar
  3. 3.
    Bushberg J, Seibert J, Leidholdt E, Boone J. The essential physics of medical imaging. Philadelphia: Lippincott Williams & Wilkins; 2002. p. 469–553.Google Scholar
  4. 4.
    Levine RA. Thyroid ultrasound physics. In: Baskin HJ, Duick DS, Levine RA, editors. Thyroid ultrasound and ultrasound-guided FNA. New York: Springer; 2008. p. 9–26.Google Scholar
  5. 5.
    Rizzatto G. Ultrasound transducers. Eur J Radiol. 1998;27(Suppl 2):S188–95.CrossRefGoogle Scholar
  6. 6.
    Thomenius K. Instrumentation for B-mode imaging. In: Goldman LW, Fowlles JB, editors. Categorical course in diagnostic radiology physics: CT and US cross-sectional imaging. Oak Brook: Radiological Society of North America; 2000. p. 21–32.Google Scholar
  7. 7.
    Burns PN. The physical principles of doppler and spectral analysis. J Clin Ultrasound. 1987;15:567–90.CrossRefGoogle Scholar
  8. 8.
    Nelson TR, Pretorius DH. The doppler signal: where does it come from and what does it mean? Am J Roentgenol. 1988;151:439–47.CrossRefGoogle Scholar
  9. 9.
    Rubin JM, Bude RO, Carson PL, Bree RL, Adler RS. Power doppler US: a potentially useful alternative to mean frequency-based color doppler US. Radiology. 1994;190:853–6.CrossRefGoogle Scholar
  10. 10.
    Bude RO, Rubin JM. Power doppler sonography. Radiology. 1996;200:21–3.CrossRefGoogle Scholar
  11. 11.
    Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedus L, et al. AACE/AME/ETA task force on thyroid nodules. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. J Endocrinol Invest. 2010;33(5 Suppl):1–50.Google Scholar
  12. 12.
    Solbiati L, Osti V, Cova L, Tonolini M. Ultrasound of thyroid, parathyroid glands and neck lymph nodes. Eur Radiol. 2001;11:2411–24.CrossRefGoogle Scholar
  13. 13.
    Stavros AT, Rapp CL, Thickman D. Sonography of inflammatory condition. Ultrasound Q. 1995;13:1–26.CrossRefGoogle Scholar
  14. 14.
    Schiefer R, Dean DS. Thyroiditis. In: Baskin HJ, Duick DS, Levine RA, editors. Thyroid ultrasound and ultrasound-guided FNA. New York: Springer; 2008. p. 63–76.CrossRefGoogle Scholar
  15. 15.
    Kim EK, Park CS, Chung WY, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. Am J Roentgenol. 2002;178:687–91.CrossRefGoogle Scholar
  16. 16.
    Papini E, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-doppler features. J Clin Endocrinol Metab. 2002;87:1941–6.CrossRefGoogle Scholar
  17. 17.
    Frates MC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2005;237:794–800.CrossRefGoogle Scholar
  18. 18.
    Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al, Thyroid Study Group, Korean Society of Neuro- and Head and Neck Radiology. Benign and malignant thyroid nodules: US differentiationmulticenter retrospective study. Radiology. 2008;247:762–770.CrossRefGoogle Scholar
  19. 19.
    American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and Italian Association of Clinical Endocrinologists (AME) Clinical Practice Guidelines for the Diagnosis and Management of Thyroid Nodules 2016 Update. Endocrine Practice 2016.Google Scholar
  20. 20.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle M, Wartofsky L. 2015. American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Wienke JR, Chong WK, Fielding JR, Zou KH, Mittelstaedt CA. Sonographic features of benign thyroid nodules: interobserver reliability and overlap with malignancy. J Ultrasound Med. 2003;22:1027–31.CrossRefGoogle Scholar
  22. 22.
    Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011;260:892–9.CrossRefGoogle Scholar
  23. 23.
    Moon WJ, Jung SL, Lee JH, et al. Benign and malignant thyroid nodules: US differentiation—multicenter retrospective study. Radiology. 2008;247:762–70.CrossRefGoogle Scholar
  24. 24.
    Campanella P, Ianni F, Rota CA, Corsello SM, Pontecorvi A. Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: a systematic review and meta-analysis. Eur J Endocrinol. 2014;170:203–11.CrossRefGoogle Scholar
  25. 25.
    McHenry CR, Huh ES, Machekano RN. Is nodule size an independent predictor of thyroid malignancy? Surgery. 2008;144:1062–8.CrossRefGoogle Scholar
  26. 26.
    Verburg FA, Mader U, Luster M, Reiners C. Primary tumour diameter as a risk factor for advanced disease features of differentiated thyroid carcinoma. Clin Endocrinol (Oxf). 2009;71:291–7.CrossRefGoogle Scholar
  27. 27.
    Papini E, Petrucci L, Guglielmi R, Panunzi C, Rinaldi R, Bacci V, et al. Long-term changes in nodular goiter: a 5-year prospective randomized trial of levothyroxine suppressive therapy for benign cold thyroid nodules. J Clin Endocrinol Metab. 1998;83(3):780.CrossRefGoogle Scholar
  28. 28.
    Alexander EK, Hurwitz S, Heering JP, Benson CB, Frates MC, Doubilet PM, et al. Natural history of benign solid and cystic thyroid nodules. Ann Intern Med. 2003;138:315–8.CrossRefGoogle Scholar
  29. 29.
    Ito Y, Miyauchi A, Inoue H, Fukushima M, Kihara M, Higashiyama T, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg. 2010;34:28–35.CrossRefGoogle Scholar
  30. 30.
    DeLellis RA, International Agency for Research on Cancer; World Health Organization; International Academy of Pathology; International Association for the Study of Lung Cancer. Pathology and genetics of tumours of endocrine organs. Lyon: IARC Press; 2004.Google Scholar
  31. 31.
    Brauer VF, Eder P, Miehle K, Wiesner TD, Hasenclever H, Paschke R. Interobserver variation for ultrasound determination of thyroid nodule volumes. Thyroid. 2005;15:1169–75.CrossRefGoogle Scholar
  32. 32.
    Mandel SJ. Diagnostic use of ultrasonography in patients with nodular thyroid disease. Endocr Pract. 2004;10:246–52.CrossRefGoogle Scholar
  33. 33.
    Choi SH, Kim EK, Kwak JY, Kim MJ, Son EJ. Interobserver and intraobserver variations in ultrasound assessment of thyroid nodules. Thyroid. 2010:167–72.CrossRefGoogle Scholar
  34. 34.
    Lee MJ, Kim EK, Kwak JY, Kim MJ. Partially cystic thyroid nodules on ultrasound: probability of malignancy and sonographic differentiation. Thyroid. 2009;19:341–6.CrossRefGoogle Scholar
  35. 35.
    Chan BK, Desser TS, McDougall IR, Weigel RJ, Jeffrey RB Jr. Common and uncommon sonographic features of papillary thyroid carcinoma. J Ultrasound Med. 2003;22:1083–90.CrossRefGoogle Scholar
  36. 36.
    Moon WJ, Baek JH, Jung SL, Kim DW, Kim EK, Kim JY, et al. Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean J Radiol. 2011:12, 1–4.PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Jeh SK, Jung SL, Kim BS, Lee YS. Evaluating the degree of conformity of papillary carcinoma and follicular carcinoma to the reported ultrasonographic findings of malignant thyroid tumor. Korean J Radiol. 2007;8:192–7.PubMedCentralCrossRefPubMedGoogle Scholar
  38. 38.
    Kobayashi K, Fukata S, Miyauchi A. Diagnosis of follicular carcinoma of the thyroid: role of sonography in preoperative diagnosis of follicular nodules. J Med Ultrasonics. 2005;32:153–8.CrossRefGoogle Scholar
  39. 39.
    Khoo ML, Asa SL, Witterick IJ, Freeman JL. Thyroid calcification and its association with thyroid carcinoma. Head Neck. 2002;24:651–5.CrossRefGoogle Scholar
  40. 40.
    Taki S, Terahata S, Yamashita R, Kinuya K, Nobata K, Kakuda K, et al. Thyroid calcifications: sonographic patterns and incidence of cancer. Clin Imaging. 2004;28:368–71.CrossRefGoogle Scholar
  41. 41.
    Chammas MC, de Araujo Filho VJ, Moyses RA, Brescia MD, Mulatti GC, Brandao LG, et al. Predictive value for malignancy in the finding of microcalcifications on ultrasonography of thyroid nodules. Head Neck. 2008;30(9):1206–10.CrossRefGoogle Scholar
  42. 42.
    Hong YJ, Son EJ, Kim EK, Kwak JY, Hong SW, Chang HS. Positive predictive values of sonographic features of solid thyroid nodule. Clin Imaging. 2010;34(2):127–33.CrossRefGoogle Scholar
  43. 43.
    Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al, British Thyroid Association. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf). 2014;81 Suppl 1:1–122.CrossRefGoogle Scholar
  44. 44.
    Wu CW, Dionigi G, Lee KW, Hsiao PJ, Paul Shin MC, Tsai KB, et al. Calcifications in thyroid nodules identified on preoperative computed tomography: patterns and clinical significance. Surgery. 2012;151(3):464–70.CrossRefGoogle Scholar
  45. 45.
    Guglielmi R, Pacella CM, Bianchini A, Bizzarri G, Rinaldi R, Graziano FM, et al. Percutaneous ethanol injection treatment in benign thyroid lesions: role and efficacy. Thyroid. 2004;14(2):125–31.CrossRefGoogle Scholar
  46. 46.
    Yoon DY, Lee JW, Chang SK, Choi CS, Yun EJ, Seo YL, et al. Peripheral calcification in thyroid nodules: ultrasonographic features and prediction of malignancy. J Ultrasound Med. 2007;26:1349–55.CrossRefGoogle Scholar
  47. 47.
    Yuan WH, Chiou HJ, Chou YH, Hsu HC, Tiu CM, Cheng CY, et al. Gray-scale and color doppler ultrasonographic manifestations of papillary thyroid carcinoma: analysis of 51 cases. Clin Imaging. 2006;30(6):394–401.CrossRefGoogle Scholar
  48. 48.
    Moon HJ, Kwak JY, Kim MJ, Son EJ, Kim EK. Can vascularity at power doppler US help predict thyroid malignancy? Radiology. 2010;255(1):260–9.CrossRefGoogle Scholar
  49. 49.
    Sillery JC, Reading CC, Charboneau JW, Henrichsen TL, Hay ID, Mandrekar JN. Thyroid follicular carcinoma: sonographic features of 50 cases. Am J Roentgenol. 2010;194:44–54.CrossRefGoogle Scholar
  50. 50.
    Lee SK, Rho BH, Woo SK. Hürthle cell neoplasm: correlation of gray-scale and power doppler sonographic findings with gross pathology. J Clin Ultrasound. 2010;38:169–76.Google Scholar
  51. 51.
    Shin JH, Han BK, Ko EY, Oh YL, Kim JH. Differentiation of widely invasive and minimally invasive follicular thyroid carcinoma with sonography. Eur J Radiol. 2010;74(3):453–7.CrossRefGoogle Scholar
  52. 52.
    Choi N, Moon WJ, Lee JH, Baek JH, Kim DW, Park SW. Ultrasonographic findings of medullary thyroid cancer: differences according to tumor size and correlation with fine needle aspiration results. Acta Radiol. 2011;52:312–6.CrossRefGoogle Scholar
  53. 53.
    Trimboli P, Giovanella L, Crescenzi A, Romanelli F, Valabrega S, Spriano G, et al. Medullary thyroid cancer diagnosis: an appraisal. Head Neck. 2014;36:1216–23.CrossRefGoogle Scholar
  54. 54.
    Rago T, Santini F, Scutari M, Pinchera A, Vitti P. Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab. 2007;92:2917–22.CrossRefGoogle Scholar
  55. 55.
    Azizi G, Keller J, Lewis M, Puett D, Rivenbark K, Malchoff C. Performance of elastography for the evaluation of thyroid nodules: a prospective study. Thyroid. 2013;23:734–40.CrossRefGoogle Scholar
  56. 56.
    Trimboli P, Guglielmi R, Monti S, Misischi I, Graziano F, Nasrollah N, et al. Ultrasound sensitivity for thyroid malignancy is increased by real-time elastography: a prospective multicenter study. J Clin Endocrinol Metab. 2012;97:4524–30.CrossRefGoogle Scholar
  57. 57.
    Ghajarzadeh M, Sodagari F, Shakiba M. Diagnostic accuracy of sonoelastography in detecting malignant thyroid nodules: a systematic review and meta-analysis. Am J Roentgenol. 2014;202:379–89.CrossRefGoogle Scholar
  58. 58.
    Russ G, Royer B, Bigorgne C, Rouxel A, Bienvenu-Perrard M, Leenhardt L. Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. Eur J Endocrinol. 2013;168:649–55.CrossRefGoogle Scholar
  59. 59.
    Zhang YF, Liu C, Xu HX, Xu JM, Zhang J, Guo LH, et al. Acoustic radiation force impulse imaging: a new tool for the diagnosis of papillary thyroid microcarcinoma. Biomed Res Int. 2014;2014:41–69.Google Scholar
  60. 60.
    Park AY, Son EJ, Han K, Youk JH, Kim JA, Park CS. Shear wave elastography of thyroid nodules for the prediction of malignancy in a large scale study. Eur J Radiol. 2015;84:407–12.CrossRefGoogle Scholar
  61. 61.
    Liu BJ, Xu HX, Zhang YF, Xu JM, Li DD, Bo XW, et al. Acoustic radiation force impulse elastography for differentiation of benign and malignant thyroid nodules with concurrent Hashimoto’s thyroiditis. Med Oncol. 2015;32:50.CrossRefGoogle Scholar
  62. 62.
    D’Orsi CJ, Sickles EA, Mendelson EB, Morris EA, et al. ACR BI-RADS® Atlas, breast imaging reporting and data system. 4th ed. Reston: American College of Radiology; 2003.Google Scholar
  63. 63.
    Russ G, Bigorgne C, Royer B, Rouxel A, Bienvenu-Perrard M. The Thyroid Imaging Reporting and Data System (TIRADS) for ultrasound of the thyroid. J Radiol. 2011;92:701–13.CrossRefGoogle Scholar
  64. 64.
    Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009;94:1748–51.CrossRefGoogle Scholar
  65. 65.
    Lee YH, Kim DW, In HS, Park JS, Kim SH, Eom JW, et al. Differentiation between benign and malignant solid thyroid nodules using an US classification system. Korean J Radiol. 2011;12:559–67.PubMedCentralCrossRefPubMedGoogle Scholar
  66. 66.
    Robbins KT, Medina JE, Wolfe GT, et al. Standardizing neck dissection terminology. Official report of the Academy’s Committee for head and neck surgery and oncology. Arch Otolaryngol Head Neck Surg. 1991;117:601–5.CrossRefGoogle Scholar
  67. 67.
    Som PM, Curtin HD, Mancuso AA. Imaging-based nodal classification for evaluation of neck metastatic adenopathy. Am J Roentgenol. 2000;174:837–44.CrossRefGoogle Scholar
  68. 68.
    Robbins KT, Shaha AR, Medina JE, et al. Consensus statement on the classification and terminology of neck dissection: committee for neck dissection classification, American Head and Neck Society. Arch Otolaryngol Head Neck Surg. 2008;134:536–8.CrossRefGoogle Scholar
  69. 69.
    Shaha AR. TNM classification of thyroid carcinoma. World J Surg. 2007;31:879–87.CrossRefGoogle Scholar
  70. 70.
    Edge SB, Byrd DR, Compton CC, et al., editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2010. p. 87–96.Google Scholar
  71. 71.
    Carty SE, Cooper DS, Doherty GM, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009;19:1153–8.CrossRefGoogle Scholar
  72. 72.
    Stack BC Jr, Ferris RL, Goldenberg D, Haymart M, Shaha A, Sheth S, Sosa JA, Tufano RP, American Thyroid Association Surgical Affairs Committee. American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid. 2012;22:501–8.CrossRefGoogle Scholar
  73. 73.
    Randolph G, Sacks B, Baskin HJ. Ultrasound and mapping of the neck lymph nodes. In: Baskin HJ, Duick DS, Levine RA, editors. Thyroid ultrasound and ultrasound-guided FNA. 3rd ed. New York: Springer; 2013. p. 149–77.CrossRefGoogle Scholar
  74. 74.
    Shaha AR, Shah JP, Loree TR. Patterns of nodal and distant metastasis based on histological varieties in differentiated carcinoma of the thyroid. Am J Surg. 1996;172:692–4.CrossRefGoogle Scholar
  75. 75.
    Gimm O, Rath FW, Fralle H. Pattern of lymph node metastases in papillary thryoid carcinoma. Br J Surg. 1998;85:252–4.CrossRefGoogle Scholar
  76. 76.
    Sivanandan R, Soo KC. Pattern of cervical lymph node metastases from papillary carcinoma of the thyroid. Br J Surg. 2001;88:1241–4.CrossRefGoogle Scholar
  77. 77.
    Machens A, Hinze R, Thomusch O, et al. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg. 2002;26:22–8.CrossRefGoogle Scholar
  78. 78.
    Wada N, Duh QY, Sugino K, 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;237:399–407.PubMedCentralPubMedGoogle Scholar
  79. 79.
    Kupferman ME, Patterson M, Mandel SJ, et al. Patterns of lateral neck metastasis in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2004;130:857–60.CrossRefGoogle Scholar
  80. 80.
    Roh J-L, Kim J-M, Park C. Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol. 2008;15:1177–82.CrossRefGoogle Scholar
  81. 81.
    Yüce I, Çağlı S, Ali Bayram A, et al. Regional metastatic pattern of papillary thyroid carcinoma. Eur Arch Oto Rhino Laryngol. 2010;267:437–41.CrossRefGoogle Scholar
  82. 82.
    Yanir Y, Doweck I. Regional metastases in well-differentiated thyroid carcinoma: pattern of spread. Laryngoscope. 2008;118:433–6.CrossRefGoogle Scholar
  83. 83.
    Pfister DG, Ang K-K, Brizel DM, et al. Head and neck cancers. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2011;6:596–650.CrossRefGoogle Scholar
  84. 84.
    Caron NR, Tan YY, Ogilvie JB, et al. Selective modified radical neck dissection for papillary thyroid cancer—is level I, II and V dissection always necessary? World J Surg. 2006;30:833–40.CrossRefGoogle Scholar
  85. 85.
    Kupferman ME, Weinstock YE, Santillan AA, et al. Predictors of level V metastasis in well-differentiated thyroid cancer. Head Neck. 2008;30:1469–74.CrossRefGoogle Scholar
  86. 86.
    Oh EM, Chung YS, Lee YD. Clinical significance of Delphian lymph node metastasis in papillary thyroid carcinoma. World J Surg. 2013.  https://doi.org/10.1007/s00268-013-2157-8.CrossRefGoogle Scholar
  87. 87.
    Ahuja AT, Chow L, Chick W, et al. Metastatic cervical nodes in papillary carcinoma of the thyroid: ultrasound and histological correlation. Clin Radiol. 1995;50:229–31.CrossRefGoogle Scholar
  88. 88.
    Frasoldati A, Valcavi R. Challenges in neck ultrasonography: lymphadenopathy and parathyroid glands. Endocr Pract. 2004;10:261–8.CrossRefGoogle Scholar
  89. 89.
    Sousa do Rosario PW, de Faria S, Bicalho L, et al. Ultrasonographic differentiation between metastatic and benign lymph nodes in patients with papillary thyroid carcinoma. J Ultrasound Med. 2005;24:1385–9.CrossRefGoogle Scholar
  90. 90.
    Kuna SK, Bracic I, Tesic V, et al. Ultrasonographic differentiation of benign from malignant neck lymphadenopathy in thyroid cancer. J Ultrasound Med. 2006;25:1531–7.CrossRefGoogle Scholar
  91. 91.
    Leboulleux S, Girard E, Rose M, et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab. 2007;92:3590–4.CrossRefGoogle Scholar
  92. 92.
    Fish SA, Langer JE, Mandel SJ. Sonographic imaging of thyroid nodules and cervical lymph nodes. Endocrinol Metab Clin North Am. 2008;37:401–17.CrossRefGoogle Scholar
  93. 93.
    Ahuja AT, Ying M, Ho SY, et al. Ultrasound of malignant cervical lymph nodes. Cancer Imaging. 2008;8:48–56.PubMedCentralCrossRefPubMedGoogle Scholar
  94. 94.
    Lee K, Kawata R, Nishikawa S, et al. Diagnostic criteria of ultrasonographic examination for lateral node metastasis of papillary thyroid carcinoma. Acta Otolaryngol. 2010;130:161–6.CrossRefGoogle Scholar
  95. 95.
    Ying M, Ahuja A. Sonography of neck lymph nodes. I. Normal lymph nodes. Clin Radiol. 2003;58:351–8.CrossRefGoogle Scholar
  96. 96.
    Park JS, Son KR, Na DG, et al. Performance of preoperative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC/UICC TNM classification system. Am J Roentgenol. 2009;192:66–72.CrossRefGoogle Scholar
  97. 97.
    Paksoy N, Yazal K. Cervical lymphadenopathy associated with Hashimoto’s thyroiditis: an analysis of 22 cases by fine needle aspiration cytology. Acta Cytol. 2009;53:491–6.CrossRefGoogle Scholar
  98. 98.
    King AD. Imaging for staging and management of thyroid cancer. Cancer Imaging. 2008;8:57–69.PubMedCentralCrossRefPubMedGoogle Scholar
  99. 99.
    Sipos JA. Advances in ultrasound for the diagnosis and management of thyroid cancer. Thyroid. 2009;9:1363–72.CrossRefGoogle Scholar
  100. 100.
    Lew JI, Solorzano CC. Use of ultrasound in the management of thyroid cancer. Oncologist. 2010;15:253–8.PubMedCentralCrossRefPubMedGoogle Scholar
  101. 101.
    Sheth S. Role of ultrasonography in thyroid disease. Otolaryngol Clin North Am. 2010;43:239–55.CrossRefGoogle Scholar
  102. 102.
    Ahuja A, Ying M, King A, Yuen HY. Lymph node hilus: gray scale and power doppler sonography of cervical nodes. J Ultrasound Med. 2001;20:987–92.CrossRefGoogle Scholar
  103. 103.
    Sohn Y-M, Kwak JY, Kim E-K, et al. Diagnostic approach for evaluation of lymph node metastasis from thyroid cancer using ultrasound and fine-needle aspiration biopsy. Am J Roentgenol. 2010;194:38–43.CrossRefGoogle Scholar
  104. 104.
    Ahuja A, Ng C, King W, Metreweli C. Solitary cystic nodal metastasis from occult papillary carcinoma of the thyroid mimicking a branchial cyst: a potential pitfall. Clin Radiol. 1998;53:61–3.CrossRefGoogle Scholar
  105. 105.
    Verge J, Guixá J, Alejo M, et al. Cervical cystic lymph node metastasis as first manifestation of occult papillary thyroid carcinoma: report of seven cases. Head Neck. 1999;21:370–4.CrossRefGoogle Scholar
  106. 106.
    Monchik JM, De Petris G, De Crea C. Occult papillary carcinoma of the thyroid presenting as a cervical cyst. Surgery. 2001;129:429–32.CrossRefGoogle Scholar
  107. 107.
    Seven H, Gurkan A, Cinar U, et al. Incidence of occult thyroid carcinoma metastases in lateral cervical cysts. Am J Otolaryngol. 2004;25:11–7.CrossRefGoogle Scholar
  108. 108.
    Wunderbaldinger P, Harisinghani M, Hahn P, et al. Cystic lymph node metastases in papillary thyroid carcinoma. Am J Roentgenol. 2002;178:693–7.CrossRefGoogle Scholar
  109. 109.
    Kessler A, Rappaport Y, Blank A, et al. Cystic appearance of cervical lymph nodes is characteristic of metastatic papillary thyroid carcinoma. J Clin Ultrasound. 2003;31:21–5.CrossRefGoogle Scholar
  110. 110.
    Landry CS, Grubbs EG, Busaidy NL, et al. Cystic lymph nodes in the lateral neck as indicators of metastatic papillary thyroid cancer. Endocr Pract. 2011;17:240–4.CrossRefGoogle Scholar
  111. 111.
    Choi EC, Moon WJ, Lim YC. Case report. Tuberculous cervical lymphadenitis mimicking metastatic lymph nodes from papillary thyroid carcinoma. Br J Radiol. 2009;82:208–11.CrossRefGoogle Scholar
  112. 112.
    Ahuja AT, Ying M, Yuen HY, Metreweli C. ‘Pseudocystic’ appearance of non-Hodgkin’s lymphomatous nodes: an infrequent finding with high-resolution transducers. Clin Radiol. 2001;56:111–5.CrossRefGoogle Scholar
  113. 113.
    Ahuja AT, Ying M. Evaluation of cervical lymph node vascularity: a comparison of colour doppler, power doppler and 3-D power doppler sonography. Ultrasound Med Biol. 2004;30:1557–64.CrossRefGoogle Scholar
  114. 114.
    Na DG, Lim HK, Byun HS, et al. Differential diagnosis of cervical lymphadenopathy: usefulness of color doppler sonography. Am J Roentgenol. 1997;168:1311–6.CrossRefGoogle Scholar
  115. 115.
    Johnson NA, Tublin ME. Postoperative surveillance of differentiated thyroid carcinoma: rationale, techniques, and controversies. Radiology. 2008;249:429–44.CrossRefGoogle Scholar
  116. 116.
    Lyshchik A, Higashi T, Asato R, et al. Cervical lymph node metastases: diagnosis at sonoelastography—initial experience. Radiology. 2007;243:258–67.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Enrico Papini
    • 1
    • 2
  • R. Guglielmi
    • 1
    • 2
  • Irene Misischi
    • 1
    • 2
  • Andrea Frasoldati
    • 1
    • 2
  1. 1.Department of EndocrinologyRegina Apostolorum HospitalRomeItaly
  2. 2.Department of EndocrinologyArcispedale Santa Maria NuovaReggio EmiliaItaly

Personalised recommendations