Preoperative ultrasound evaluation of laterocervical lymph nodes: timing and experience modify the treatment of patients with differentiated thyroid cancer


Since laterocervical lymphadenectomy is never routinely performed, all patients who undergo thyroidectomy for differentiated cancer must have an ultrasound examination (US). The aim of this study is to assess the accuracy of the preoperative US conducted at the time of surgery as a staging US (time 0) compared to the US performed sometime before in a location other than the surgical department as screening/diagnostic US (time − 1), to determine the necessity of always performing a preoperative US before surgery. 4060 patients with cytologic diagnosis (FNAB) of differentiated thyroid neoplasm (Tyr 4 and Tyr 5) were recruited at Surgery 2 of the Department of General and Specialist Surgery of the Tertiary Care Hospital “A. Cardarelli” of Naples. All patients had a screening US prior to admission into our hospital (time − 1) and were rescanned in the operating room before surgery (time 0) by the same team of surgeons experienced in the field of thyroid diseases. The examinations conducted at time 0 revealed a sensitivity of 100% and a specificity of 92.3%, while examinations performed at time − 1 showed a sensitivity of 22.8% and a specificity of 72.7%. The statistical analysis shows how the diagnostic timing and the experience of the examiner can make a difference both in terms of PPV and NPV to not only to assist in identifying all the lymph node lesions that would remain indeterminate if not specifically researched during surgery, but also helps avoid surgical overtreatment. The systematic execution of a staging US (time 0) in addition to a screening/diagnostic US (time − 1) results in forming a more appropriate therapeutic plan.

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  1. 1.

    AIRTUM Working Group, et al: Italian Cancer figures, report 2014: prevalence and cure of cancer in Italy 2014

  2. 2.

    Avenia N, Bastagli A, Bellantone R et al (2008) Trattato italiano di Endocrinochirurgia. Club delle UEC 1:185–186

    Google Scholar 

  3. 3.

    Marotta V, Sciammarella C, Capasso M et al (2017) Germline polymorphisms of VEGF pahway predicts recurrence in nonadvanced differentiated thyroid cancer. J Clin Endocrinol Metabol 102(2):661–671

    Google Scholar 

  4. 4.

    Robbins KT, Clayman G, Pa Levine et al (2002) Neck dissection classification update: revisions proposed by the American head and neck Society and the American Academy of Otolaryngology-Head and Neck surgery. Arch Otolaryngol Head Neck Surg 128(7):751–758

    Article  Google Scholar 

  5. 5.

    Avenia N, Bastagli A, Bellantone R et al (2008) Trattato italiano di Endocrinochirurgia. Club delle UEC 1:373–374

    Google Scholar 

  6. 6.

    Conzo G, Avenia N, Ansaldo GL et al (2017) Surgical treatment of thyroid follicular neoplasm: results of a retrospective analysis of a large clinical series. Endocrine 55(2):530–538

    CAS  Article  Google Scholar 

  7. 7.

    Li ZJ, An CM, Yan DG et al (2013) Significance of selective neck dissection in patient with N0 thyroid carcinoma. Surgery 35(10):783–786

    Google Scholar 

  8. 8.

    Avenia N, Bastagli A, Bellantone R et al (2008) Trattato italiano di Endocrinochirurgia. Club delle UEC 1:370–371

    Google Scholar 

  9. 9.

    Avenia N, Bastagli A, Bellantone R et al (2008) Trattato italiano di Endocrinochirurgia. Club delle UEC 1:55–56

    Google Scholar 

  10. 10.

    Grant CS (2014) Papillary thyroid cancer: strategies for optimal individualized surgical management. Clin Ther 36(7):1117–1126

    Article  Google Scholar 

  11. 11.

    American Thyroid Association Surgery Working Group, American association of Endocrine Surgeons, American Academy of Otolaryngology Head and Neck Surgery et al (2009) Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid 19(11):1153–1158

    Article  Google Scholar 

  12. 12.

    Yto 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  Google Scholar 

  13. 13.

    Lee CY, Snyder SK, Lairmore TC, Dupont SC, Jupiter DC (2012) Utility of surgeon-performed ultrasound assessment of the lateral neck for metastatic papillary thyroid cancer. J Oncol 2012:973124

    PubMed  PubMed Central  Google Scholar 

  14. 14.

    Marotta V, Sciammarella C, Chiofalo MG et al (2017) Hascimoto thyroiditi’s predicts outcome in intrathyroidal papillary thyroid cancer. Endocr Relat Cancer 24(9):485–493

    CAS  Article  Google Scholar 

  15. 15.

    Shaha AR (1996) Risk group stratification and prognostic factors in papillary carcinoma of thyroid. Ann Surg Onc 3(6):534–538

    CAS  Article  Google Scholar 

  16. 16.

    Saha AR (2004) Implications of prognostic factors and risk groups in the management of differentiated thyroid cancer. Laringoscope 114(3):393–502

    Article  Google Scholar 

  17. 17.

    Sundram F, Robinson BG, Kung A et al (2006) Well differentiated epithelial thyroid cancer management in the Asia Pacific region: a report and clinical practice guideline. Thyroid 16(5):461–469

    Article  Google Scholar 

  18. 18.

    Chan BK, Desser TS, McDougall IR et al (2003) Common and uncommon sonographic features of papillary thyroid carcinoma. J Ultrasound Med 22(10):1083–1090

    Article  Google Scholar 

  19. 19.

    Frates MC, Benson CB, Charboneau JW et al (2005) Management of thyroid nodules detected at US: society of radiologists in ultrasound consensus conference statement. Radiology 237(3):794–800

    Article  Google Scholar 

  20. 20.

    Kim WW, Park HY, Jung JH (2013) Surgical extent of central lymph node dissection in clinically node-negative papillary thyroid cancer. Head Neck 35(11):1616–1620

    Article  Google Scholar 

  21. 21.

    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

    CAS  Article  Google Scholar 

  22. 22.

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

    CAS  Article  Google Scholar 

  23. 23.

    Cappelli C, Castellano M, Pirola I et al (2007) The predictive values of ultrasound findings in the management of thyroid nodules. QJM 100(1):29–35

    CAS  Article  Google Scholar 

  24. 24.

    Cappelli C, Castellano M, Pirola I et al (2006) Thyroid nodule shape suggests malignancy. Eur J Endocrinol 155(1):27–31

    CAS  Article  Google Scholar 

  25. 25.

    Moon WJ, So LJ, Jeong HL et al (2008) Benign and malignant thyroid nodules: US differentiation-multicenter retrospective study. Radiology 247(3):346–353

    Article  Google Scholar 

  26. 26.

    Hay ID, Thompson GB, Grant CS et al (2002) Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg 26(8):879–885

    Article  Google Scholar 

  27. 27.

    Nixon IJ, Ganly I, Patel S et al (2011) The impact of microscopic extrathyroid extension on outcome in patients with clinical T1 e T2 well-differentiated thyroid cancer. Surgery 150(6):1242–1249

    Article  Google Scholar 

  28. 28.

    Marshall CL, Lee JE, Xing Y et al (2009) Routine pre-operative ultrasonography for papillary thyroid cancer. Surgery 146(6):1063–1072

    Article  Google Scholar 

  29. 29.

    Stulak JM, Grant CS, Farley DR et al (2006) Value of pre-operative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg 141(5):489–496

    Article  Google Scholar 

  30. 30.

    Gonzalez HE, Cruz F, O’Brien A et al (2007) Impact of pre-operative ultrasonographic staging of the neck in papillary thyroid carcinoma. Arch Otolaryngol 133(12):1258–1262

    Article  Google Scholar 

  31. 31.

    Park JS, Son KR, Dong GN, Kim E, Kim S (2009) Performance of pre-operative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC/UICC TMN classification system. Am J Roentgenol 192(1):66–72

    Article  Google Scholar 

  32. 32.

    Choi YJ, Yun JS, Kook SH et al (2010) Clinical and imaging assessment of cervical lymph node metastatic in thyroid carcinomas. World J Surg 34(7):1494–1499

    Article  Google Scholar 

  33. 33.

    Moreno MA, Agarwal G, De Luna R et al (2011) Preoperative lateral neck ultrasonography as a long-term outcome predictor in papillary thyroid cancer. Arch Otolaryngol 137(2):157–162

    Article  Google Scholar 

  34. 34.

    Hwang HS, Orloff LA (2011) Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope 121(3):487–491

    Article  Google Scholar 

  35. 35.

    Robbins KT (1998) Classification of neck dissection: current concepts and future considerations. Otolaryngol Clin N Am 31:639–655

    CAS  Article  Google Scholar 

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Correspondence to Marica Grasso.

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Grasso, M., Puzziello, A. & De Palma, M. Preoperative ultrasound evaluation of laterocervical lymph nodes: timing and experience modify the treatment of patients with differentiated thyroid cancer. Updates Surg 71, 711–715 (2019).

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  • Thyroid cancer
  • Ultrasound examination
  • Lymph nodes
  • Metastases