F. B. Karipineni1, Z. Sahli2, J. Canner3, A. Mathur3, J. Prescott3, R. Tufano4, M. Zeiger2 1UCSF Fresno,Department Of General Surgery,Fresno, CALIFORNIA, USA 2University Of Virginia,Department Of General Surgery,Charlottesville, VA, USA 3The Johns Hopkins University School Of Medicine,Department Of General Surgery,Baltimore, MD, USA 4The Johns Hopkins University School Of Medicine,Department Of Otolaryngology,Baltimore, MD, USA
Introduction:
Preoperative neck ultrasound (US) in patients with thyroid cancer can detect suspicious lymph nodes that may in turn result in a change in surgical management. However, in patients with indeterminate or malignant subcentimeter thyroid nodules, the role of neck ultrasound and extent of surgery is controversial. Our study evaluates the utility of preoperative neck ultrasonography in this subset of patients.
Methods:
Medical records of patients with biopsy-proven, unifocal Bethesda III, IV, V or VI thyroid nodules ≤ 1.0 centimeter between January 2006 and December 2016 were retrospectively reviewed. Patients with multifocal papillary thyroid carcinoma (PTC) or medullary carcinoma, those who did not undergo preoperative cervical US, and those who underwent prophylactic central lymph node dissection (CLND) were excluded. Clinical, radiologic, cytologic, and pathologic variables were analyzed to determine change in clinical management or operative approach based on US findings of suspicious cervical lymph nodes.
Results:
The records of 217 patients met study criteria. A total of 14 (6.5%) patients had suspicious lymphadenopathy on US, 5 (2.3%) in the central neck and 9 (4.1%) in the lateral neck. Of the 5 patients with suspicious central nodes, none underwent biopsy prior to surgery. Only 2 (0.9%) who had obvious lymphadenopathy at surgery underwent CLND; the other 3 had negative frozen section analysis and therefore did not undergo CLND. Of the 9 patients with suspicious lateral neck nodes, only one (0.4%) had a positive aspiration biopsy and underwent lateral selective neck dissection.
Conclusion:
Surgical approach was altered in only three patients (1.4%) as a result of preoperative neck ultrasonography in our cohort, thus challenging the need for routine preoperative neck US to evaluate for the presence of lymph node metastases in this patient population. The identification of cervical lymph node metastases in the 2 patients with positive central neck US in our cohort would have likely been achieved without the use of US. Further studies are needed to delineate whether performing routine neck US in patients with unifocal, subcentimeter indeterminate or malignant nodules is cost-effective.