ULTRASONOGRAPHIC
FINDINGS SUSPICIOUS FOR LYMPH NODE METASTASES IN THYROID CANCER
Major ultrasonographic
(US) findings indicating lymph node metastasis of thyroid cancer include:
1.Calcifications
2.Cystic
degeneration
3.Loss of
echogenic fatty hilum
4.Hyperechogenicity
5.Round
shape
6.Abnormal
vascularity
Of these US
characteristics, calcification and cystic change have very high specificity and
PPV (positive predictive value). These US findings are not observed in normal
or reactive lymph nodes. Cystic degeneration in lymph node metastases from
thyroid cancer is observed in 10 – 25 % of cases (most commonly in papillary
thyroid cancer).
Suspicion
for malignant involvement of neck lymph node in patients with thyroid cancer should
be raised when the criterion involving at least one suspicious finding is
present on ultrasound. The accuracy of US identification of metastatic involvement
of neck lymph nodes increases by combining these diagnostic US criteria.
The role of
the radiologist performing preoperative neck ultrasonography is of crucial
importance. He/she should be able to recognize suspicious US findings and
provide the surgeon with a detailed and accurate US lymphatic mapping.
US-guided FNA of suspicious lymph nodes (for cytology and thyroglobulin [Tg]
measurement in the aspirate) could be performed in selected cases.
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