Thyroid Research Thyroid Research Archive Thyroid Cancer

Ultrasonography is valuable for detecting lymph-node metastases and local recurrence in patients with thyroid carcinoma

(March 2004)

The background of the study. Many patients with thyroid carcinoma have tumor in lymph nodes in the neck. Later recurrence may be minimized by better detection of nodal involvement and resection of the nodes. This study evaluated the value of physical examination and ultrasonography for the detection of local and regional spread of tumor in patients with thyroid carcinoma.

How the study was done. The records of 212 patients with thyroid carcinoma who underwent ultrasonography of the neck before surgery between 1991 and 2003 were reviewed. The patients were divided into three groups according to whether their surgery was for initial therapy, persistent tumor (defined as reoperation within six months after initial surgery), or recurrent tumor (defined as reoperation more than six months after initial surgery).

The results of the study. Ultrasonography revealed lymph-node metastases or soft-tissue recurrence in 113 of the 212 patients (53 percent). The lymph-node metastases or local recurrence was not detected by physical examination in 34 percent of the patients with differentiated carcinoma and 49 percent of those with medullary carcinoma. Lymph nodes containing tumor or tumor involving soft tissue were removed from 183 of the 212 patients (86 percent). Ultrasonography proved to be a very sensitive test for detecting tumor in lymph nodes.

The conclusions of the study. In patients with thyroid carcinoma, ultrasonography of the neck often reveals tumor in lymph nodes and soft tissue of the neck that cannot be detected by physical examination, and therefore leads to more extensive tumor removal.

The original article. Kouvaraki MA, Shapiro SE, Fornage BD, Edeiken-Monro BS, Sherman SI, Vassilopoulou-Sellin R, Lee JE, Evans DB. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery 2003;134:946-55.