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Papillary thyroid carcinoma nodal surgery directed by a preoperative radiographic map utilizing CT scan and ultrasound in all primary and reoperative patients
Author(s) -
Lesnik David,
Cunnane Mary Elizabeth,
Zurakowski David,
Acar Gul Ozbilen,
Ecevit Cenk,
Mace Alasdair,
Kamani Dipti,
Randolph Gregory W.
Publication year - 2014
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.23277
Subject(s) - medicine , thyroid carcinoma , radiology , lymph node , ultrasound , nodal , prospective cohort study , head and neck squamous cell carcinoma , carcinoma , radiography , preoperative care , thyroid , surgery , head and neck cancer , radiation therapy
Background To study the diagnostic accuracy of physical examination (PE), ultrasonography (US), contrastenhanced computed tomography (CT) and in preoperative detection of macroscopic nodal metastasis in primary/recurrent papillary thyroid carcinoma (PTC) patients to determine if the routine addition of CT would be beneficial in accurate preoperative lymph‐node surgery planning. Methods In a tertiary center prospective study, 162 PTC patients underwent preoperative lymph‐node evaluation by PE, US, and CT. Sensitivity, specificity, positive/negative predictive value (PPV/NPV) of each nodal detection technique were calculated in central/lateral cervical compartments. The gold standard for diagnostic‐accuracy was surgical pathology. Results In patients undergoing primary (Group I)/revision (Group II) surgical treatment for PTC, combined US/CT yielded significantly higher sensitivity for macroscopic lymph‐node detection in both lateral and central neck, most marked in Group I‐central compartment. Conclusions Combined preoperative US/CT provides reliable, objective, preoperative macroscopic nodal metastasis map to design rational nodal surgery in primary/revision PTC patients. © 2013 Wiley Periodicals, Inc. Head Neck 36: 191–202, 2014