Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun;32(6):3863-3868.
doi: 10.1007/s00330-021-08478-5. Epub 2022 Jan 6.

Risk factors for metastasis in indeterminate lymph nodes in preoperative patients with thyroid cancer

Sae Rom Chung  1 , Jung Hwan Baek  2 , Young Jun Choi  1 , Tae-Yon Sung  3 , Dong Eun Song  4 , Tae Yong Kim  5 , Jeong Hyun Lee  1
Affiliations

Risk factors for metastasis in indeterminate lymph nodes in preoperative patients with thyroid cancer

Sae Rom Chung et al. Eur Radiol. 2022 Jun.

Abstract

Objectives: To investigate the relevance of clinical and sonographic features as indicators of metastasis in indeterminate lymph node (LN), to determine possible indications for fine-needle aspiration (FNA).

Methods: Consecutive patients who underwent US-guided FNA for sonographic indeterminate LNs from differentiated thyroid carcinoma between January 2014 and December 2018 were retrospectively reviewed. Indeterminate LNs were defined as LNs which had neither an echogenic hilum nor hilar vascularity in the absence of any suspicious finding in accordance with the Korean Society of Thyroid Radiology (KSThR) guidelines. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors related to malignancy of indeterminate LNs.

Results: Of the 236 LNs in 212 patients enrolled in this study, 67 LNs (28.3%) were metastatic. The multivariate logistic regression analysis showed that the long diameter of LNs has a negative association with metastasis in indeterminate LNs and the sonographic features of extrathyroidal extension (ETE) and nonparallel orientation of the primary tumor are associated with metastasis in indeterminate LNs. The sensitivity and positive predictive value were increased when FNA was performed for LNs with primary tumors showing ETE or nonparallel orientation than when FNA was performed for LNs larger than 5 mm (59.7% and 40.4% vs. 11.94% and 15.69%).

Conclusions: The size of LNs has a negative association with metastasis in indeterminate LNs. Performing FNA for indeterminate LNs in patients whose primary tumor shows ETE or a nonparallel orientation can improve the diagnostic performance and decrease the rate of unnecessary FNA.

Key points: • The size of lymph nodes was negatively related to the risk of metastasis in indeterminate lymph nodes. • Extrathyroidal extension and a nonparallel orientation of the primary tumor were suggested as sonographic features predicting metastasis in indeterminate lymph nodes. • The routine practice of FNA for large indeterminate lymph nodes detected during preoperative evaluation of thyroid cancer should be discouraged.

Keywords: Lymph nodes; Lymphatic metastasis; Thyroid neoplasms; Ultrasonography.

PubMed Disclaimer

References

    1. Grebe SKG, Hay ID (1996) Thyroid cancer nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin N Am 5:43–63 - DOI
    1. Scheumann GF, Gimm O, Wegener G, Hundeshagen H, Dralle H (1994) Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg 18:559–567
    1. Maksimovic S, Jakovljevic B, Gojkovic Z (2018) Lymph node metastases papillary thyroid carcinoma and their importance in recurrence of disease. Med Arch 72:108–111
    1. Suh CH, Baek JH, Choi YJ, Lee JH (2017) Performance of CT in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid cancer: a systematic review and meta-analysis. AJNR Am J Neuroradiol 38:154–161 - DOI
    1. Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133 - DOI

LinkOut - more resources