Khokhar Mamoona T, Day Kristopher M, Sangal Rohit B, Ahmedli Nigar N, Pisharodi Latha R, Beland Michael D, Monchik Jack M
1 Department of Surgery, Brown University , Providence, Rhode Island.
2 Division of Endocrine Surgery, Rhode Island Hospital , Providence, Rhode Island.
Thyroid. 2015 Dec;25(12):1351-4. doi: 10.1089/thy.2015.0176. Epub 2015 Nov 20.
The identification and removal of malignant central compartment lymph nodes (MCLN) is important to minimize the risk of persistent or recurrent local disease in patients with papillary thyroid cancer (PTC). While the diagnostic accuracy of preoperative ultrasound for the assessment of lateral compartment node metastases is well recognized, its role in the identification of central compartment node metastases in patients with PTC is less established. This study delineates the utility of high-resolution ultrasound (HUS) for the assessment of MCLN in patients with PTC.
A retrospective chart review was performed of 227 consecutive patients who underwent total thyroidectomy for biopsy-proven PTC by a single endocrine surgeon in an academic tertiary care center between 2004 and 2014. Preoperative sonographic results were compared to postoperative pathology reports to determine the accuracy of HUS for the assessment of MCLN. Statistical analysis also included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
HUS identified abnormal central compartment nodes in 51 (22.5%) patients. All 227 patients underwent a careful central compartment node exploration. One hundred and four (45.8%) patients had MCLN identified by surgery, of whom 65 (62.5%) had a negative preoperative central compartment HUS. The sensitivity and specificity of preoperative HUS for the assessment of MCLN were 0.38 and 0.90, respectively. The PPV and NPV were 0.76 and 0.63, with an accuracy of 0.66.
Preoperative HUS is quite specific for the identification of MCLN in patients with PTC. The present findings emphasize, however, that a negative HUS does not obviate the need for careful exploration of the central compartment to minimize the risk of persistent or recurrent local disease.
识别并清除恶性中央区淋巴结（MCLN）对于降低甲状腺乳头状癌（PTC）患者局部疾病持续或复发的风险至关重要。虽然术前超声对评估侧方区淋巴结转移的诊断准确性已得到充分认可，但其在识别PTC患者中央区淋巴结转移中的作用尚不太明确。本研究阐述了高分辨率超声（HUS）在评估PTC患者MCLN中的应用价值。
对2004年至2014年间在一家学术性三级医疗中心由一名内分泌外科医生为经活检证实的PTC患者进行全甲状腺切除术的227例连续患者进行回顾性病历审查。将术前超声检查结果与术后病理报告进行比较，以确定HUS评估MCLN的准确性。统计分析还包括敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
HUS在51例（22.5%）患者中发现中央区淋巴结异常。所有227例患者均接受了仔细的中央区淋巴结探查。104例（45.8%）患者经手术发现有MCLN，其中65例（62.5%）术前中央区HUS检查为阴性。术前HUS评估MCLN的敏感性和特异性分别为0.38和0.90。PPV和NPV分别为0.76和0.63，准确率为0.66。
术前HUS对识别PTC患者的MCLN具有较高的特异性。然而，目前的研究结果强调，HUS检查结果为阴性并不能排除仔细探查中央区以降低局部疾病持续或复发风险的必要性。
