Ultrasonographic Evaluation of Cervical Lymph Nodes in Thyroid Cancer.
Objective To determine what ultrasonographic features can identify metastatic cervical lymph nodes, both preoperatively and in recurrences after complete thyroidectomy. Study Design Prospective. Setting Outpatient clinic, Department of Head and Neck Surgery, School of Medicine, University of São Paulo, Brazil. Subjects and Methods A total of 1976 lymph nodes were evaluated in 118 patients submitted to total thyroidectomy with or without cervical lymph node dissection. All the patients were examined by cervical ultrasonography, preoperatively and/or postoperatively. The following factors were assessed: number, size, shape, margins, presence of fatty hilum, cortex, echotexture, echogenicity, presence of microcalcification, presence of necrosis, and type of vascularity. The specificity, sensitivity, positive predictive value, and negative predictive value of each variable were calculated. Univariate and multivariate logistic regression analyses were conducted. A receiver operator characteristic (ROC) curve was plotted to determine the best cutoff value for the number of variables to discriminate malignant lymph nodes. Results Significant differences were found between metastatic and benign lymph nodes with regard to all of the variables evaluated ( P < .05). Logistic regression analysis revealed that size and echogenicity were the best combination of altered variables (odds ratio, 40.080 and 7.288, respectively) in discriminating malignancy. The ROC curve analysis showed that 4 was the best cutoff value for the number of altered variables to discriminate malignant lymph nodes, with a combined specificity of 85.7%, sensitivity of 96.4%, and efficiency of 91.0%. Conclusion Greater diagnostic accuracy was achieved by associating the ultrasonographic variables assessed rather than by considering them individually.
1 Department of Radiology and Oncology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
Maria Regina Marrocos
MR
Machado
2 Department of Head & Neck Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
Marcos Roberto
MR
Tavares
1 Department of Radiology and Oncology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
Carlos Alberto
CA
Buchpiguel
1 Department of Radiology and Oncology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
Maria Cristina
MC
Chammas
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging*; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy; D014463:Ultrasonography / Q000379:methods*
cervical lymph nodes; metastases; pathology-thyroid; radiology; thyroid cancer