![]() ![]() UltrasonographyĪll patients underwent US within 4 d prior to surgery. Our institutional review board approved the study, and all patients gave written informed consent. Patients referred to the Institut Gustave Roussy from February 2004 to January 2005 for surgical treatment of a neck recurrence of DTC were enrolled in this prospective study. We therefore assessed both sensitivity and specificity of US criteria based on pathology in patients planned to neck LN dissection for DTC neck recurrence. There is a need for specific criteria of malignancy otherwise, a majority of DTC patients will be submitted to FNAB, a stressful examination with potential morbidity. Confirmation of malignancy of suspicious LN found on US is usually recommended and consists in a fine-needle aspiration biopsy (FNAB) for cytology and thyroglobulin determination in the aspirate fluid ( 17). Specificity of US criteria based on pathology are, in fact, not available in DTC. The specificity of these US criteria in DTC is, however, not well known and difficult to assess on follow-up only because of the indolent nature of DTC. In DTC, metastatic LNs may also demonstrate specific features such as hyperechoic punctuations or microcalcifications and cystic appearance ( 14– 16). Metastatic lymph nodes (LNs) tend to be large, round, hypoechoic, and hypervascularized with a loss of hilar architecture ( 6– 13). Sensitivity of US for the diagnosis of neck recurrence ranges from 70 to 100% ( 3– 5). NECK ULTRASONOGRAPHY (US) has replaced radioactive iodine in the follow-up of patients with differentiated thyroid cancer (DTC) ( 1, 2). Round shape, hypoechogenicity, and the loss of hilum taken as single criteria are not specific enough to suspect malignancy. Peripheral vascularization has the best sensitivity-specificity compromise. LNs with a hyperechoic hilum should be considered as benign. LNs with cystic appearance or hyperechoic punctuations are highly suspicious of malignancy. Sensitivity and specificity were 68 and 75% for the long axis (≥1 cm), 61 and 96% for the short axis (>5 mm), 46 and 64% for the round shape (long to short axis ratio < 2), 100 and 29% for the loss of fatty hyperechoic hilum, 39 and 18% for hypoechogenicity, 11 and 100% for cystic appearance, 46 and 100% for hyperechoic punctuations, and 86 and 82% for peripheral vascularization.Ĭonclusion: Cystic appearance, hyperechoic punctuations, loss of hilum, and peripheral vascularization can be considered as major ultrasound criteria of LN malignancy. ![]() ![]() Results: One hundred three LNs were detected on US, 578 LNs were surgically removed, and 56 LNs were analyzed (28 benign and 28 malignant). Only LNs that were unequivocally matched between US and pathology were taken into account for the analysis. All patients underwent a neck US within 4 d prior to surgery. Objective: The aim of this study was to determine specificity and sensitivity of ultrasound criteria of malignancy for cervical lymph nodes (LNs) in patients with differentiated thyroid cancer.ĭesign: We prospectively studied 19 patients referred to the Institut Gustave Roussy for neck LN dissection. Context: Neck ultrasonography (US) has become a keystone in the follow-up of patients with differentiated thyroid cancer.
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