Clinical and imaging assessment of cervical lymph node metastasis in papillary thyroid carcinomas.
BACKGROUND
The goals of this study were to analyze clinical factors that affect cervical lymph node metastasis (LNM) in papillary thyroid cancer (PTC), and to evaluate the diagnostic accuracy of preoperative ultrasound (US) and computed tomography (CT) of the neck.


METHODS
The study sample included 589 consecutive patients who underwent surgery for PTC. Patient age and sex, number, size, and location of tumors, lymphovascular invasion, and extrathyroidal extension were evaluated as risk factors for central and lateral LNM.


RESULTS
Increased risk of lymph node metastasis was found for male patients, <45 years old, with tumor size >1 cm, lymphovascular invasion, and extrathyroidal invasion. Cancers located in the upper neck had a higher relative risk of lateral metastasis than cancers located in the lower neck. Sensitivity of both US and CT imaging was higher for lateral (70-80%) than for central (42-47%) LNM. Specificity of US and CT was high (92-97%) for both central and lateral LNM. Using central lymph node size of greater than 5 mm as an indicator of metastasis, preoperative US had 58.3% sensitivity and 71.4% specificity.


CONCLUSIONS
Preoperative US and CT imaging are useful for identifying features that indicate a high risk of LNM and for determining appropriate management of PTC.
Choi
Yoon Jung
YJ
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, 110-746, Korea. yoonchoi99@gmail.com
Yun
Ji Sup
JS
Kook
Shin Ho
SH
Jung
Eun Choel
EC
Park
Yong Lai
YL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D009361:Neoplasm Invasiveness; D011859:Radiography; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy; D014463:Ultrasonography; D055815:Young Adult