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Preoperative Cervical USG Mapping in a Patient Undergoing Thyroidectomy for Malignant Cytological Findings

  • Seyfettin Ilgan
Chapter

Abstract

Papillary thyroid carcinoma has a propensity for early spread to regional lymph nodes but a low incidence of distance metastases. Cervical lymph nodes are involved in 20–60% of patients in most series using standard pathologic techniques. Although lymph node metastases are more common with increased tumor size and extrathyroidal extension, it may be present with small, intrathyroidal tumors. Since the lymph node metastases are the most common independent risk factor for persistent and recurrent disease, identification and removal of the locoregional disease remains an essential component of initial surgical treatment. Hence, optimal management of thyroid cancer is highly dependent on accurate staging of the extent of disease before surgery. It is known that preoperative physical examination is inadequate for the detection of cervical lymph node metastases in both lateral and central compartments and preoperative staging and follow-up should depend on better diagnostic tools in patients with thyroid cancer. Neck ultrasound is generally considered to be the most sensitive imaging modality to assess the primary tumor and identify lymph node metastases. Though sonography is becoming widely accepted as the technique of choice for staging papillary thyroid carcinoma, assessment of lymph nodes is more challenging compared to thyroid nodule evaluation. While missed findings on preoperative USG may lead to understaging and inadequate surgical management, excessively skeptical reporting of nodal findings may result in submission of the majority of patients to fine needle aspiration biopsy, causing anxiety and extended preoperative workup with many unnecessary biopsies.

Keywords

Thyroid cancer Ultrasonography Lymph node Metastases 

References

  1. 1.
    Amin MB, Edge SB, Greene FL, Compton CC, Gershenwald JE, Brookland RK, et al., editors. AJCC cancer staging manual. 8th ed. New York: Springer; 2017.Google Scholar
  2. 2.
    Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.Google Scholar
  3. 3.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, 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;26:1–133.  https://doi.org/10.1089/thy.2015.0020.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Scheumann G, Gimm O, Wegener G, Hundeshagen H, Dralle H. Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg. 1994;18:559–67; discussion 567–8.CrossRefGoogle Scholar
  5. 5.
    Ito Y, Uruno T, Nakano K, Takamura Y, Miya A, Kobayashi K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid. 2003;13:381–7.CrossRefGoogle Scholar
  6. 6.
    Chow S, Law S, Chan J, Au S, Yau S, Lau W. Papillary microcarcinoma of the thyroid – prognostic significance of lymph node metastasis and multifocality. Cancer. 2003;98:31–40.CrossRefGoogle Scholar
  7. 7.
    Hay ID, Grant CS, van Heerden JA, Goellner JR, Ebersold JR, Bergstralh EJ. Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery. 1992;112:1139–46; discussion 1146–7.PubMedGoogle Scholar
  8. 8.
    Morita S, Mizoguchi K, Suzuki M, Iizuka K. The accuracy of (18)[F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography, ultrasonography, and enhanced computed tomography alone in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma. World J Surg. 2010;34:2564–9.  https://doi.org/10.1007/s00268-010-0733-8.CrossRefPubMedGoogle Scholar
  9. 9.
    Hwang H, Orloff L. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis form thyroid cancer. Laryngoscope. 2011;121:487–91.  https://doi.org/10.1002/lary.21227.CrossRefPubMedGoogle Scholar
  10. 10.
    Lee D, Ji Y, Sung E, Park JS, Lee YJ, Park DW, et al. Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma. Eur J Surg Oncol. 2013;39:191–6.  https://doi.org/10.1006/j.ejso.2012.07.119.CrossRefPubMedGoogle Scholar
  11. 11.
    Kouvaraki MA, Shapiro SE, Fornage BD, Edeiken-Monro BS, Sherman SI, Vassilopoulou-Sellin R, et al. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003;134:946–54; discussion 954–5.CrossRefGoogle Scholar
  12. 12.
    Leboulleux S, Girard E, Rose M, Travagli JP, Sabbah N, Caillou B, 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
  13. 13.
    Machens A, Hinze R, Thomusch O, Dralle H. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg. 2002;26:22–8.CrossRefGoogle Scholar
  14. 14.
    Park JH, Lee YS, Kim BW, Chang HS, Park CS. Skip lateral neck node metastases in papillary thyroid carcinoma. World J Surg. 2012;36:743–7.  https://doi.org/10.1007/s00268-012-1476-5.CrossRefPubMedGoogle Scholar
  15. 15.
    Ahuja AT, Ying M, Ho SY, Antonio G, Lee YP, King AD, et al. Ultrasound of malignant cervical lymph nodes. Cancer Imaging. 2008;8:48–56.  https://doi.org/10.1102/1470-7330.2008.0006.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Qualliotine JR, Coquia SF, Hamper UM, Fakhry C. Association of ultrasound characteristics with extranodal extension in metastatic papillary thyroid carcinoma. JAMA Otolaryngol Head Neck Surg. 2016;142:263–9.  https://doi.org/10.1001/jamaoto.2015.3558.CrossRefPubMedGoogle Scholar
  17. 17.
    Malhi H, Beland MD, Cen SY, Allgood E, Daley K, Martin SE, et al. Echogenic foci in thyroid nodules: significance of posterior acoustic artifacts. AJR Am J Roentgenol. 2014;203:1310–6.  https://doi.org/10.2214/AJR-13.11934.CrossRefPubMedGoogle Scholar
  18. 18.
    Giovanella L, Ceriani L, Maffioli M. Postsurgery serum thyroglobulin disappearance kinetic in patients with differentiated thyroid carcinoma. Head Neck. 2010;32:568–71.  https://doi.org/10.1002/hed.21214.CrossRefPubMedGoogle Scholar
  19. 19.
    Ibrahimpasic T, Nixon IJ, Palmer FL, Whitcher MM, Tuttle RM, Shaha A, et al. Undetectable thyroglobulin after total thyroidectomy in patients with low- and intermediate-risk papillary thyroid cancer—is there a need for radioactive iodine therapy? Surgery. 2012;152:1096–105.  https://doi.org/10.1016/j.surg.2012.08.034.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Seyfettin Ilgan
    • 1
  1. 1.Department of Nuclear MedicineGüven HospitalAnkaraTurkey

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