Abstract
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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References
AIRTUM Working Group, et al: Italian Cancer figures, report 2014: prevalence and cure of cancer in Italy 2014
Avenia N, Bastagli A, Bellantone R et al (2008) Trattato italiano di Endocrinochirurgia. Club delle UEC 1:185–186
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
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
Avenia N, Bastagli A, Bellantone R et al (2008) Trattato italiano di Endocrinochirurgia. Club delle UEC 1:373–374
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
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
Avenia N, Bastagli A, Bellantone R et al (2008) Trattato italiano di Endocrinochirurgia. Club delle UEC 1:370–371
Avenia N, Bastagli A, Bellantone R et al (2008) Trattato italiano di Endocrinochirurgia. Club delle UEC 1:55–56
Grant CS (2014) Papillary thyroid cancer: strategies for optimal individualized surgical management. Clin Ther 36(7):1117–1126
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
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
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
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
Shaha AR (1996) Risk group stratification and prognostic factors in papillary carcinoma of thyroid. Ann Surg Onc 3(6):534–538
Saha AR (2004) Implications of prognostic factors and risk groups in the management of differentiated thyroid cancer. Laringoscope 114(3):393–502
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
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
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
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
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
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
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
Cappelli C, Castellano M, Pirola I et al (2006) Thyroid nodule shape suggests malignancy. Eur J Endocrinol 155(1):27–31
Moon WJ, So LJ, Jeong HL et al (2008) Benign and malignant thyroid nodules: US differentiation-multicenter retrospective study. Radiology 247(3):346–353
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
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
Marshall CL, Lee JE, Xing Y et al (2009) Routine pre-operative ultrasonography for papillary thyroid cancer. Surgery 146(6):1063–1072
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
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
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
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
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
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
Robbins KT (1998) Classification of neck dissection: current concepts and future considerations. Otolaryngol Clin N Am 31:639–655
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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). https://doi.org/10.1007/s13304-018-00618-9
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DOI: https://doi.org/10.1007/s13304-018-00618-9