title: Thyroid lymphosonography: a novel method for evaluating lymphatic drainage.
abstract: OBJECTIVE
  We evaluated lymphosonography, or contrast-enhanced, ultrasonography (US)-guided sentinel lymph node (SLN) detection, as a technique for demonstrating the lymphatic drainage of the thyroid gland.
  
  
  METHODS
  In this prospective animal study, four 50-kg Yorkshire swine underwent transcutaneous injection of a US contrast agent and methylene blue dye into the thyroid gland. Contrast-enhanced US was used to identify draining lymphatic channels and SLNs. Sentinel node biopsy was conducted. Subsequently, bilateral neck and upper mediastinal dissection was carried out.
  
  
  RESULTS
  In 3 of 4 cases, a blue dye-positive and US contrast-positive SLN was identified. We identified SLNs in level IV in 2 cases. One case revealed 2 adjacent nodes in the superior mediastinum. In 1 case, a lymphatic channel was identified traveling into the mediastinum, but exposure of the SLN could not be obtained. No residual blue dye-positive or US contrast-positive nodes were identified on subsequent dissection.
  
  
  CONCLUSIONS
  Lymphosonography of the thyroid gland in a porcine model correlates well with blue dye-guided sentinel node biopsy and is technically feasible, although in some cases access to the SLN may be difficult. This technique could potentially enable a detailed analysis of thyroidal lymphatic drainage if applied to humans.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Curry
authors.forename: Waleed H
authors.initials: WH
authors.lastname: Ezzat
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Merton
authors.forename: Barry B
authors.initials: BB
authors.lastname: Goldberg
authors.forename: David M
authors.initials: DM
authors.lastname: Cognetti
authors.forename: David
authors.initials: D
authors.lastname: Rosen
authors.forename: Edmund A
authors.initials: EA
authors.lastname: Pribitkin
mesh_terms: D000818:Animals; D008196:Lymph / Q000502:physiology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008208:Lymphatic System / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D013552:Swine; D013961:Thyroid Gland / Q000000981:diagnostic imaging*; D014463:Ultrasonography