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Byeon, Choi, Park, Song, Yeo, Kong, Kang, and Lee: Diagnostic Accuracy of PET/MR for Evaluating Central Lymph Node Status in Patients with Papillary Thyroid Carcinoma
Original Article

J Endocr Surg. 2017;17(3):122-130.

Published online: 5 September 2017

DOI: https://doi.org/10.16956/jes.2017.17.3.122

Diagnostic Accuracy of PET/MR for Evaluating Central Lymph Node Status in Patients with Papillary Thyroid Carcinoma

Yoon Hyeong Byeon1, Jung Eun Choi1, Jeong Yeong Park1, Jeong Hyun Song1, Kyeong Jun Yeo1, Eun Jung Kong2, Su Hwan Kang1, Soo Jung Lee1

1Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea

2Department of Nuclear Medicine, Yeungnam University College of Medicine, Daegu, Korea

Correspondence to Soo Jung Lee Department of Surgery, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel: +82-53-620-3580 Fax: +82-53-624-1213 E-mail: crystallee@med.yu.ac.kr

Received 22 May 2017       Accepted 16 June 2017

Copyright © 2017 Korean Association of Thyroid and Endocrine Surgeons

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose

Ultrasonography and computed tomography of the neck are commonly used for preoperative evaluation of neck lymph node (LN) status in papillary thyroid carcinoma (PTC). This study evaluated the accuracy of preoperative positron emission tomography/magnetic resonance (PET/MR) imaging of cervical LN status in PTC.

Methods

A retrospective chart review of 285 patients who received PET/MR and underwent open thyroidectomy due to primary PTC between August 2012 and October 2013 was performed. Visual18 F-fluorodeoxyglucose uptake and preoperative morphologic abnormalities of nodal shape, cortical thickness, and the fatty hilum of neck nodes were analyzed using PET/MR imaging.

Results

Total thyroidectomy and lobectomy were conducted in 78.2% (223/285) and 21.8% (62/285) of cases, respectively. The status of central neck LN were evaluated in all patients during surgery and additional evaluation of lateral neck LN were conducted in 11.9% (34/285) of patients through selective sampling or modified radical neck dissection. In total, 36.1% (103/285) of patients had pathologic neck LN metastasis (LNM). PET/MR imaging showed an accuracy of 68.8%, sensitivity of 32.7%, and specificity of 88.6% for the detection of central neck LNM; moreover, an accuracy of 95.1%, sensitivity 68.4%, and specificity of 97.0% for lateral neck LNM. PET/MR imaging showed higher accuracy for detecting neck LNM in the 164 patients who did not have suspected clinical thyroiditis than others.

Conclusion

PET/MR has a high specificity for detecting central LNM, especially for patients diagnosed with PTC without pathologic thyroiditis.

Keywords: Lymphatic metastasis, Thyroid neoplasms, Positron-emission tomography

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Table 1.
Patient demographics and tumor characteristics
Characteristics No. of patients (n=285)
Tumor size (cm) 0.9±0.6
Age (yr) 48.5±11.4
 <45:≥45 100 (35.1):185 (64.9)
Female:male 243 (85.3):42 (14.7)
Lobectomy:total thyroidectomy 62 (21.8):223 (78.2)
CCND only:CCND+LND∗ 251 (88.1):34 (11.9)
N0:N1a:N1b 182 (63.9):84 (29.5):19 (6.7)
Presence of clinical thyroiditis 121 (42.5)
Presence of pathologic thyroiditis 76 (26.7)
Interval between PET/MR and operation (day) 21.3±16.7
Presence of suspicious main tumor on PET/MR 280 (98.2)
Presence of suspicious central LN on PET/MR 54 (18.9)
Presence of suspicious lateral LN on PET/MR 21 (7.4)
Presence of suspicious central LN on US 40 (14.0)
Presence of suspicious lateral LN on US 26 (9.1)
Presence of central LNM on pathology 101 (305.4)
Presence of lateral LNM on pathology 19 (6.7)

Values are presented as mean±standard deviation or number (%).

CCND = central compartment neck dissection; LND = lateral neck dissection; PET/MR = positron emission tomography/magnetic resonance; LN = lymph node; US = ultrasonography; LNM = lymph node metastasis.

∗ LND include selective level II, III, or IV LN dissection, or modified radical neck dissection.

Table 2.
Relationships between clinicopathologic factors and suspicious LN metastatic findings on PET/MR in central LNs on univariate and multivariate analysis
Factors Univariate Multivariate
  OR P value OR P value
Male 0.83 (0.32–1.89) 0.683 − −
Age ≥45 (yr) 0.56 (0.31–1.02) 0.057 − −
Tumor size 2.97 (1.84–4.95) <0.001 2.45 (1.43–4.32) 0.001
Clinical thyroiditis 2.55 (1.40–4.75) 0.003 − −
Pathological thyroiditis 3.36 (1.81–6.26) <0.001 4.12 (2.11–8.21) <0.001
Extracapsular invasion 1.38 (0.76–2.50) 0.291 − −
LVI 2.10 (0.71–5.60) 0.154 − −
Multiplicity 1.22 (0.67–2.22) 0.509 − −
Pathological central LNM 3.77 (2.05–7.06) <0.001 2.77 (1.37–5.63) 0.005
Pathological lateral LNM 2.10 (0.71–5.60) 0.154 − −

Values are presented as OR (95% CI).

LN = lymph node; PET/MR = positron emission tomography/magnetic resonance; OR = odds ratio; CI = confidence interval; LVI = lymphovascular invasion; LNM = lymph node metastasis.

Table 3.
Clinicopathologic factors affecting the central LNM
Factors Univariate Multivariate
  OR P value OR P value
Male 1.62 (0.83–3.15) 0.153 2.02 (0.89–4.52) 0.088
Age ≥45 (yr) 0.38 (0.23–0.63) <0.001 0.48 (0.27–0.87) 0.015
Tumor size 5.38 (3.14–9.76) <0.001 3.12 (1.68–6.10) <0.001
Clinical thyroiditis 1.07 (0.66–1.75) 0.779 − −
Pathological thyroiditis 1.01 (0.58–1.73) 0.985 − −
Extrathyroidal invasion 2.55 (1.55–4.21) <0.001 1.58 (0.86–2.89) 0.135
LVI 7.85 (2.75–28.17) <0.001 2.97 (0.89–11.83) 0.091
Multiplicity 1.60 (0.98–2.61) 0.061 − −
Central LNM on PET/MR 3.77 (2.05–7.06) <0.001 2.02 (0.98–4.20) 0.057
Central LNM on US 2.90 (1.47–5.81) 0.002 − −
No. of retrieved LNs 1.12 (1.07–1.18) <0.001 1.09 (1.03–1.16) 0.002

Values are presented as OR (95% CI).

PET/MR = positron emission tomography/magnetic resonance; OR = odds ratio; CI = confidence interval; LVI = lymphovascular invasion; LNM = lymph node metastasis; US = ultrasonography; LN = lymph node.

Table 4.
Prevalence of LNM according to the PET/MR and US finding
Findings Central LNM Lateral LNM
  Yes (n=101) No (n=184) P value Yes (n=19) No (n=266) P value
Suspicious LNM on PET/MR     <0.001     <0.001
 Yes 33 (32.7) Yes 21 (11.4)   13 (68.4) 8 (3.0)  
 NO 68 (67.3) No 163 (88.6)   6 (31.6) 258 (97.0)  
Suspicious LNM on US     0.003     <0.001
 yes 23 (22.8) Yes 17 (9.2)   10 (52.6) 16 (6.0)  
 No 78 (77.2) No 167 (90.8)   9 (47.4) 250 (94.0)  

Values are presented as number (%).

PET/MR = positron emission tomography/magnetic resonance; US = ultrasonography; LNM = lymph node metastasis.

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