title: Predictive factors for detecting malignancy in central and lateral cervical lymph nodes in papillary carcinoma of the thyroid.
abstract: OBJECTIVE
  To determine the factors for predicting malignant diagnosis and limitations in ultrasonography guided fine-needle aspiration cytology of central and lateral cervical lymph nodes in patients with primary differentiated thyroid papillary carcinoma.
  
  
  METHODS
  Biopsies of cervical lymph nodes were performed in 120 patients, 31 of whom had subsequent surgical diagnoses. Factors examined were patient's age and gender of the patients, location (central and lateral compartments), hypoechogenicity with loss of hilum, microcalcification, cystic feature, minimum and maximum diameters and index value (minimum/maximum diameter).
  
  
  RESULTS
  The mean minimum diameter and index value of the lymph nodes were 9.9 ± 4.9 mm and 0.60 ± 0.19, respectively. Microcalcifications and cystic parts were specific findings with rates of 93.9% and 95.1%, respectively. Microcalcification, cystic feature, minimum diameter and index value were poor predictors of malignancy. The predictors were central location (P = 0.031) and hypoechogenicity with loss of hilum in lateral neck (P = 0.019). Central nodes led to a major problem for biopsy success due to postoperative changes and anatomic position. Nondiagnostic (30%) nodes were therefore mostly central.
  
  
  CONCLUSIONS
  The involvement of the central neck should be a major indication of lymph node biopsy and pathological diagnosis regardless of the imaging findings. In the lateral compartment, hypoechogenicity with loss of hilum, microcalcifications, cystic parts and an index value ≥ 0.51 are indications of a lymph node biopsy to rule out malignancy.
authors: Department of Radiology, Dr Abdurrahman Yurtarslan Ankara Oncology Education and Research Hospital, Ankara, Turkey. bilginaribas@hotmail.com
authors: Bilgin Kadri
authors: BK
authors: Aribaş
authors: Kemal
authors: K
authors: Arda
authors: Nazan
authors: N
authors: Çiledağ
authors: Elif
authors: E
authors: Aktaş
authors: Mehmet Faik
authors: MF
authors: Çetindağ
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014463:Ultrasonography; D055815:Young Adult