Jornal de Distúrbios e Terapia da Tireóide
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Ultrasound Imaging of Nodal Metastases in the Central Compartment in Thyroid Cancer: is it Possible to Increase Sensitivity

Mohamed T. Hafez

Background and Purpose: Ultrasound imaging criteria for cervical lymph nodes were set mainly to increase sensitivity. However, unlike the lateral neck compartment, the challenge in the central compartment is the low sensitivity of Ultrasonography. We performed this study to evaluate whether the sensitivity of Ultrasonography could be increased by considering any detected lymph node in the central compartment as malignant.

Methods: Forty one patients with differentiated thyroid cancer underwent dedicated pre-operative Ultrasonography by one radiologist for detection of metastatic lymph nodes in the central compartment. Any lymph node detected was considered positive regardless of Ultrasound morphologic criteria. All patients underwent thyroidectomy with central node dissection (CND), unilateral in 31 and bilateral in 10 cases, based on tumor size and laterality. Ultrasound imaging results were compared to histopathologic results.

Results: The number of true positive cases by Ultrasonography was 13, false negative cases 8, true negative 15 and false positive 5 cases. The sensitivity of US was 61.9%, the specificity 75%, the positive predictive value 72.2% and the negative predictive value 65.2%.

Conclusions: The sensitivity of Ultrasonography for detection of metastatic lymph nodes in the central compartment in patients with DTC may be increased, compared to previously published data, by considering every detected node as positive rather than using the routine criteria for lymph node metastases in other neck levels.