title: The significance of enlarged cervical lymph nodes in diagnosing thyroid cancer.
abstract: BACKGROUND
  We aim to investigate the significance of enlarged cervical lymph nodes (ECLN) identified by initial surgeon-performed ultrasound (US) as a tool for determining the risk of malignancy in the patients presenting with suspicious thyroid nodules.
  
  
  METHODS
  Radiological and surgical reports were retrospectively reviewed for the patients with suspicious thyroid nodules who underwent thyroidectomy and preoperative comprehensive neck US. Ultrasonographic features of the identified cervical lymph nodes were correlated with the final pathology report. Patients with malignancy other than papillary thyroid cancer (PTC) were excluded.
  
  
  RESULTS
  The study consisted of 440 patients. On final pathology, PTC was found in 142 patients (32.3%), the remaining 298 (67.7%) exhibited benign findings. ECLN (>1 cm) were found in 66 (46.5%) patient with PTC compared to only 53 (17.8%) patients with benign nodules (P < 0.001). Of the 119 patients with ECLN, 54.6% had benign appearing ECLN with no suspicious features, 26.1% had one suspicious feature, and 19.3% had more than one suspicious features. Benign appearing ECLN had a positive predictive value (PPV) of 41.54%, negative predictive value (NPV) of 59.02%, sensitivity of 51.92%, and specificity of 48.65% in predicting malignancy as opposed to the absence of ECLN. While as opposed to benign looking ECLN, ECLN with only one suspicious feature had a PPV of 70.97%, NPV of 50.00%, sensitivity of 33.33%, and specificity of 83.02%, and ECLN with two or more suspicious feature had a PPV of 73.91%, NPV of 48.96%, sensitivity of 25.76%, and specificity of 88.68%.
  
  
  CONCLUSIONS
  ECLN are associated with an increased likelihood of thyroid malignancy in the patients undergoing evaluation of a suspicious nodule. The risk of malignancy in thyroid nodules increases with the presence of suspicious ultrasonographic features on cervical lymph nodes.
authors.affiliation: Department of Surgery, Division of Endocrine and Oncological Surgery, School of Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Hossam Eldin
authors.initials: HE
authors.lastname: Mohamed
authors.affiliation: Department of Surgery, Division of Endocrine and Oncological Surgery, School of Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Salah Eldin
authors.initials: SE
authors.lastname: Mohamed
authors.affiliation: Department of Surgery, Division of Endocrine and Oncological Surgery, School of Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Muhammad Ahmed Farooq
authors.initials: MA
authors.lastname: Anwar
authors.affiliation: Department of Surgery, Division of Endocrine and Oncological Surgery, School of Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Al-Qurayshi
authors.affiliation: Department of Surgery, Division of Endocrine and Oncological Surgery, School of Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Sholl
authors.affiliation: Department of Surgery, Division of Endocrine and Oncological Surgery, School of Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Thethi
authors.affiliation: Department of Surgery, Division of Endocrine and Oncological Surgery, School of Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Amna
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Surgery, Division of Endocrine and Oncological Surgery, School of Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Aslam
authors.affiliation: Department of Surgery, Division of Endocrine and Oncological Surgery, School of Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000175:diagnosis; D002291:Carcinoma, Papillary; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis*; D016606:Thyroid Nodule / Q000175:diagnosis; D014463:Ultrasonography