FNA CYTOLOGY OF SUSPICIOUS LYMPH NODES IN THYROID CANCER
Ultrasound (US) and US-guided Fine-Needle Aspiration (FNA) cytology are the main diagnostic tools for detecting cervical metastases of thyroid cancer (TC) either preoperatively or during follow-up (recurrence after surgery). Results of US-guided FNA cytology in US suspicious lymph nodes can be categorized as:
I.Presence of malignant cells (frequency of metastases [FM] 96 %)
II.Presence of macrophages without malignant cells (FM 87.5 %)
III.Cell paucity (FM 71.4 %)
IV.Negative for malignancy (FM=35 %).
Obviously, when metastatic lymph nodes are diagnosed on cytology, concomitant lymph node dissection should be performed at the time of thyroidectomy (preferentially, selective or compartment-oriented). In the case of regional recurrence, lymph node’ size is another important factor which should be taken into consideration to select optimal treatment strategy. However, given the high false-negative rates, it should be emphasized that ultrasonographically suspicious lymph nodes should not be neglected, even when FNA cytology is negative for malignancy. Thyroglobulin (Tg) measurement in the washout may increase the diagnostic accuracy of FNA.
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