title: Papillary thyroid carcinoma nodal surgery directed by a preoperative radiographic map utilizing CT scan and ultrasound in all primary and reoperative patients.
abstract: BACKGROUND
  To study the diagnostic accuracy of physical examination (PE), ultrasonography (US), contrastenhanced computed tomography (CT) and in preoperative detection of macroscopic nodal metastasis in primary/recurrent papillary thyroid carcinoma (PTC) patients to determine if the routine addition of CT would be beneficial in accurate preoperative lymph-node surgery planning.
  
  
  METHODS
  In a tertiary center prospective study, 162 PTC patients underwent preoperative lymph-node evaluation by PE, US, and CT. Sensitivity, specificity, positive/negative predictive value (PPV/NPV) of each nodal detection technique were calculated in central/lateral cervical compartments. The gold standard for diagnostic-accuracy was surgical pathology.
  
  
  RESULTS
  In patients undergoing primary (Group I)/revision (Group II) surgical treatment for PTC, combined US/CT yielded significantly higher sensitivity for macroscopic lymph-node detection in both lateral and central neck, most marked in Group I-central compartment.
  
  
  CONCLUSIONS
  Combined preoperative US/CT provides reliable, objective, preoperative macroscopic nodal metastasis map to design rational nodal surgery in primary/revision PTC patients.
authors.affiliation: Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Lesnik
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Cunnane
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Gul Ozbilen
authors.initials: GO
authors.lastname: Acar
authors.forename: Cenk
authors.initials: C
authors.lastname: Ecevit
authors.forename: Alasdair
authors.initials: A
authors.lastname: Mace
authors.forename: Dipti
authors.initials: D
authors.lastname: Kamani
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
mesh_terms: D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000601:surgery*; D003287:Contrast Media; D006785:Hospitals, University; D006801:Humans; D037981:Neck Dissection / Q000379:methods; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D013965:Thyroidectomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media
keywords: CT scan; macroscopic nodal metastasis; neck dissection; papillary thyroid cancer; preoperative radiography; ultrasonography