title: Preoperative High-Resolution Ultrasound for the Assessment of Malignant Central Compartment Lymph Nodes in Papillary Thyroid Cancer.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Department of Surgery, Brown University , Providence, Rhode Island.|2 Division of Endocrine Surgery, Rhode Island Hospital , Providence, Rhode Island.
authors.forename: Mamoona T
authors.initials: MT
authors.lastname: Khokhar
authors.affiliation: 1 Department of Surgery, Brown University , Providence, Rhode Island.|2 Division of Endocrine Surgery, Rhode Island Hospital , Providence, Rhode Island.
authors.forename: Kristopher M
authors.initials: KM
authors.lastname: Day
authors.affiliation: 3 Warren Alpert School of Medicine, Brown University , Providence, Rhode Island.
authors.forename: Rohit B
authors.initials: RB
authors.lastname: Sangal
authors.affiliation: 3 Warren Alpert School of Medicine, Brown University , Providence, Rhode Island.
authors.forename: Nigar N
authors.initials: NN
authors.lastname: Ahmedli
authors.affiliation: 4 Department of Pathology, Brown University , Providence, Rhode Island.
authors.forename: Latha R
authors.initials: LR
authors.lastname: Pisharodi
authors.affiliation: 5 Department of Radiology, Brown University , Providence, Rhode Island.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Beland
authors.affiliation: 1 Department of Surgery, Brown University , Providence, Rhode Island.|2 Division of Endocrine Surgery, Rhode Island Hospital , Providence, Rhode Island.
authors.forename: Jack M
authors.initials: JM
authors.lastname: Monchik
mesh_terms: D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002291:Carcinoma, Papillary; D005260:Female; D005629:Frozen Sections; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D037981:Neck Dissection; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy; D014463:Ultrasonography