Skip to main content
SpringerLink
Log in

Clinical and Imaging Assessment of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinomas

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The goals of this study were to analyze clinical factors that affect cervical lymph node metastasis (LNM) in papillary thyroid cancer (PTC), and to evaluate the diagnostic accuracy of preoperative ultrasound (US) and computed tomography (CT) of the neck.

Methods

The study sample included 589 consecutive patients who underwent surgery for PTC. Patient age and sex, number, size, and location of tumors, lymphovascular invasion, and extrathyroidal extension were evaluated as risk factors for central and lateral LNM.

Results

Increased risk of lymph node metastasis was found for male patients, <45 years old, with tumor size >1 cm, lymphovascular invasion, and extrathyroidal invasion. Cancers located in the upper neck had a higher relative risk of lateral metastasis than cancers located in the lower neck. Sensitivity of both US and CT imaging was higher for lateral (70-80%) than for central (42-47%) LNM. Specificity of US and CT was high (92-97%) for both central and lateral LNM. Using central lymph node size of greater than 5 mm as an indicator of metastasis, preoperative US had 58.3% sensitivity and 71.4% specificity.

Conclusions

Preoperative US and CT imaging are useful for identifying features that indicate a high risk of LNM and for determining appropriate management of PTC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. 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 866)

    Article  CAS  PubMed  Google Scholar 

  2. Caron NR, Clark OH (2005) Papillary thyroid cancer: surgical management of lymph node metastases. Curr Treat Options Oncol 6:311–322

    Article  PubMed  Google Scholar 

  3. Kupferman ME, Patterson M, Mandel SJ et al (2004) Patterns of lateral neck metastasis in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 130:857–860

    Article  PubMed  Google Scholar 

  4. Roh JL, Kim JM, Park CI (2008) Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol 15:1177–1182

    Article  PubMed  Google Scholar 

  5. 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 567–558)

    Article  CAS  PubMed  Google Scholar 

  6. Sivanandan R, Soo KC (2001) Pattern of cervical lymph node metastases from papillary carcinoma of the thyroid. Br J Surg 88:1241–1244

    Article  CAS  PubMed  Google Scholar 

  7. Noguchi S, Murakami N (1987) The value of lymph-node dissection in patients with differentiated thyroid cancer. Surg Clin North Am 67:251–261

    CAS  PubMed  Google Scholar 

  8. Cooper DS, Doherty GM, Haugen BR et al (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:109–142

    Article  PubMed  Google Scholar 

  9. 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 141:489–494 (discussion 494–486)

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. Kim E, Park JS, Son KR et al (2008) Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography. Thyroid 18:411–418

    Article  CAS  PubMed  Google Scholar 

  12. Kuna SK, Bracic I, Tesic V et al (2006) Ultrasonographic differentiation of benign from malignant neck lymphadenopathy in thyroid cancer. J Ultrasound Med 25:1531–1537 quiz 1538-1540

    PubMed  Google Scholar 

  13. Park JS, Son KR, Na DG et al (2009) Performance of preoperative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC/UICC TNM classification system. AJR Am J Roentgenol 192:66–72

    Article  PubMed  Google Scholar 

  14. Roh JL, Park JY, Kim JM et al (2009) Use of preoperative ultrasonography as guidance for neck dissection in patients with papillary thyroid carcinoma. J Surg Oncol 99:28–31

    Article  PubMed  Google Scholar 

  15. Shimamoto K, Satake H, Sawaki A et al (1998) Preoperative staging of thyroid papillary carcinoma with ultrasonography. Eur J Radiol 29:4–10

    Article  CAS  PubMed  Google Scholar 

  16. Kessler A, Rappaport Y, Blank A et al (2003) Cystic appearance of cervical lymph nodes is characteristic of metastatic papillary thyroid carcinoma. J Clin Ultrasound 31:21–25

    Article  PubMed  Google Scholar 

  17. Antonelli A, Miccoli P, Ferdeghini M et al (1995) Role of neck ultrasonography in the follow-up of patients operated on for thyroid cancer. Thyroid 5:25–28

    Article  CAS  PubMed  Google Scholar 

  18. Steinkamp HJ, Cornehl M, Hosten N et al (1995) Cervical lymphadenopathy: ratio of long- to short-axis diameter as a predictor of malignancy. Br J Radiol 68:266–270

    Article  CAS  PubMed  Google Scholar 

  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 15:1123–1128

    CAS  PubMed  Google Scholar 

  20. Sywak M, Cornford L, Roach P et al (2006) Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery 140:1000–1005 (discussion 1005–1007)

    Article  PubMed  Google Scholar 

  21. Son YI, Jeong HS, Baek CH et al (2008) Extent of prophylactic lymph node dissection in the central neck area of the patients with papillary thyroid carcinoma: comparison of limited versus comprehensive lymph node dissection in a 2-year safety study. Ann Surg Oncol 15:2020–2026

    Article  PubMed  Google Scholar 

  22. Rosario PW, 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 24:1385–1389

    PubMed  Google Scholar 

  23. Binyousef HM, Alzahrani AS, Al-Sobhi SS et al (2004) Preoperative neck ultrasonographic mapping for persistent/recurrent papillary thyroid cancer. World J Surg 28:1110–1114

    Article  PubMed  Google Scholar 

  24. Gonzalez HE, Cruz F, O’Brien A et al (2007) Impact of preoperative ultrasonographic staging of the neck in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 133:1258–1262

    Article  PubMed  Google Scholar 

  25. Clark OH (1996) Predictors of thyroid tumor aggressiveness. West J Med 165:131–138

    CAS  PubMed  Google Scholar 

  26. Alzahrani AS, Al Mandil M, Chaudhary MA et al (2002) Frequency and predictive factors of malignancy in residual thyroid tissue and cervical lymph nodes after partial thyroidectomy for differentiated thyroid cancer. Surgery 131:443–449

    Article  PubMed  Google Scholar 

  27. Yamashita H, Noguchi S, Murakami N et al (1999) Extracapsular invasion of lymph node metastasis. A good indicator of disease recurrence and poor prognosis in patients with thyroid microcarcinoma. Cancer 86:842–849

    Article  CAS  PubMed  Google Scholar 

  28. Davidson HC, Park BJ, Johnson JT (2008) Papillary thyroid cancer: controversies in the management of neck metastasis. Laryngoscope 118:2161–2165

    Article  PubMed  Google Scholar 

  29. Frilling A, Tecklenborg K, Gorges R et al (2001) Preoperative diagnostic value of [(18)F] fluorodeoxyglucose positron emission tomography in patients with radioiodine-negative recurrent well-differentiated thyroid carcinoma. Ann Surg 234:804–811

    Article  CAS  PubMed  Google Scholar 

  30. Yoon DY, Hwang HS, Chang SK et al (2009) CT, MR, US, (18)F-FDG PET/CT, and their combined use for the assessment of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Eur Radiol 19(3):634–642

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, 110-746, Korea

    Yoon Jung Choi, Shin Ho Kook & Eun Choel Jung

  2. Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, 110-746, Korea

    Ji Sup Yun & Yong Lai Park

Authors
  1. Yoon Jung Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ji Sup Yun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shin Ho Kook
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eun Choel Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yong Lai Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ji Sup Yun.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Choi, Y.J., Yun, J.S., Kook, S.H. et al. Clinical and Imaging Assessment of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinomas. World J Surg 34, 1494–1499 (2010). https://doi.org/10.1007/s00268-010-0541-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-010-0541-1

Keywords

Search

Navigation