Preoperative High-Resolution Ultrasound for the Assessment of Malignant Central Compartment Lymph Nodes in Papillary Thyroid Cancer

被引:80
作者
Khokhar, Mamoona T. [1 ,5 ]
Day, Kristopher M. [1 ,5 ]
Sangal, Rohit B. [4 ]
Ahmedli, Nigar N. [4 ]
Pisharodi, Latha R. [2 ]
Beland, Michael D. [3 ]
Monchik, Jack M. [1 ,5 ]
机构
[1] Brown Univ, Dept Surg, Providence, RI 02912 USA
[2] Brown Univ, Dept Pathol, Providence, RI 02912 USA
[3] Brown Univ, Dept Radiol, Providence, RI 02912 USA
[4] Brown Univ, Warren Alpert Sch Med, Providence, RI 02912 USA
[5] Rhode Isl Hosp, Div Endocrine Surg, Providence, RI 02903 USA
关键词
SURGICAL-MANAGEMENT; PROGNOSTIC-SIGNIFICANCE; NECK DISSECTION; ULTRASONOGRAPHY; MICROCARCINOMA; METASTASES;
D O I
10.1089/thy.2015.0176
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The identification and removal of malignant central compartment lymph nodes (MCLN) is important to minimize the risk of persistent or recurrent local disease in patients with papillary thyroid cancer (PTC). While the diagnostic accuracy of preoperative ultrasound for the assessment of lateral compartment node metastases is well recognized, its role in the identification of central compartment node metastases in patients with PTC is less established. This study delineates the utility of high-resolution ultrasound (HUS) for the assessment of MCLN in patients with PTC. Methods: A retrospective chart review was performed of 227 consecutive patients who underwent total thyroidectomy for biopsy-proven PTC by a single endocrine surgeon in an academic tertiary care center between 2004 and 2014. Preoperative sonographic results were compared to postoperative pathology reports to determine the accuracy of HUS for the assessment of MCLN. Statistical analysis also included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: HUS identified abnormal central compartment nodes in 51 (22.5%) patients. All 227 patients underwent a careful central compartment node exploration. One hundred and four (45.8%) patients had MCLN identified by surgery, of whom 65 (62.5%) had a negative preoperative central compartment HUS. The sensitivity and specificity of preoperative HUS for the assessment of MCLN were 0.38 and 0.90, respectively. The PPV and NPV were 0.76 and 0.63, with an accuracy of 0.66. Conclusion: Preoperative HUS is quite specific for the identification of MCLN in patients with PTC. The present findings emphasize, however, that a negative HUS does not obviate the need for careful exploration of the central compartment to minimize the risk of persistent or recurrent local disease.
引用
收藏
页码:1351 / 1354
页数:4
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