Papillary thyroid carcinoma nodal surgery directed by a preoperative radiographic map utilizing CT scan and ultrasound in all primary and reoperative patients

Authors

  • David Lesnik MD,

    1. Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts
    Search for more papers by this author
  • Mary Elizabeth Cunnane MD,

    1. Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
    Search for more papers by this author
  • David Zurakowski PhD,

    1. Departments of Anesthesiology and Surgery, Children's Hospital, Harvard Medical School, Boston, Massachusetts
    Search for more papers by this author
  • Gul Ozbilen Acar MD,

    1. Department of Otorhinolaryngology, Goztepe Research and Education Hospital, Istanbul, Turkey
    Search for more papers by this author
  • Cenk Ecevit MD,

    1. Department of Otorhinolaryngology, Goztepe Research and Education Hospital, Istanbul, Turkey
    Search for more papers by this author
  • Alasdair Mace MD,

    1. Charing Cross Hospital and St. Mary's Hospital, Imperial College London, United Kingdom
    Search for more papers by this author
  • Dipti Kamani MD,

    1. Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts
    Search for more papers by this author
  • Gregory W. Randolph MD

    Corresponding author
    1. Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts
    2. Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
    Search for more papers by this author

Abstract

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

Ancillary