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The utility of routine preoperative cervical ultrasonography in patients undergoing thyroidectomy for differentiated thyroid cancer. Surgery 2013 Oct;154(4):697-701; discussion 701-3

Date

09/10/2013

Pubmed ID

24011674

DOI

10.1016/j.surg.2013.06.040

Scopus ID

2-s2.0-84884902392 (requires institutional sign-in at Scopus site)   40 Citations

Abstract

BACKGROUND: Preoperative ultrasonography (US) is recommended in all patients with differentiated thyroid cancer (DTC) to evaluate for clinically occult metastatic lymphadenopathy. The purpose of this study was to examine the influence of preoperative US findings on the initial operative management of patients with DTC.

METHODS: This is a retrospective review of 70 patients with biopsy-proven DTC who underwent total thyroidectomy between February 2010 and January 2012. All patients underwent preoperative cervical US (thyroid, central, and lateral neck lymph node compartments).

RESULTS: Palpable lateral neck adenopathy was thought to be present in 5 (7%) of the 70 patients, but confirmed by US in only 3; 2 patients avoided lateral compartment neck dissection (LCND). Of 65 patients with no palpable lymphadenopathy, 14 (22%) had abnormal lymphadenopathy on preoperative US. All 14 patients underwent total thyroidectomy with central compartment neck dissection (CCND); 12 patients with abnormal US findings in the lateral compartment(s) also underwent LCND. Metastatic disease was confirmed in 13 (93%) of the 14 patients: 13 of 14 who underwent CCND and 11 (92%) of 12 who underwent LCND.

CONCLUSION: This study confirms the importance of preoperative, high-quality cervical US in patients with DTC because it changed the operative management in 16 of 70 patients (23%); 13 had a more complete operation for pathologically confirmed, clinically occult, lymph node metastases, 2 avoided nontherapeutic LCND, and 1 had false-positive US results.

Author List

O'Connell K, Yen TW, Quiroz F, Evans DB, Wang TS

Authors

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Biopsy, Fine-Needle
Female
Humans
Lymph Node Excision
Lymphatic Metastasis
Male
Middle Aged
Neck
Retrospective Studies
Thyroid Neoplasms
Thyroidectomy
Ultrasonography