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Kim, Lee, and Park: The Diagnostic Utility of Ultrasonography, CT and PET/CT for the Preoperative Evaluation of Cervical Lymph Node Metastasis in Papillary Thyroid Cancer Patients
Head and Neck Radiology
Original Article

Journal of the Korean Society of Radiology 2016; 75(2): 104-112.

Published online: 27 July 2016

DOI: https://doi.org/10.3348/jksr.2016.75.2.104

The Diagnostic Utility of Ultrasonography, CT and PET/CT for the Preoperative Evaluation of Cervical Lymph Node Metastasis in Papillary Thyroid Cancer Patients

Youngsang Kim, MD, Taehyun Lee, MD, Donghee Park, MD

Department of Radiology, Korea Cancer Center Hospital, Seoul, Korea.

Corresponding author: Taehyun Lee, MD. Radiology Reading Room, Korea Cancer Center Hospital, 75 Nowon-ro, Nowon-gu, Seoul 01812, Korea. Tel. 82-2-970-2114, Fax. 82-2-978-2005, haraww@gmail.com

Received 16 September 2014       Revised 24 February 2015       Accepted 22 October 2015

Copyright © 2016 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the diagnostic utility of ultrasonography (US), CT and positron emission tomography/CT (PET/CT) in the preoperative evaluation of cervical lymph node metastasis in patients with papillary thyroid carcinoma.

Materials and Methods

The study population consisted of 300 patients with pathologically diagnosed papillary thyroid carcinoma after thyroidectomy and neck dissection. Preoperative US, CT, and PET/CT findings were compared with pathologic outcomes after thyroidectomy and neck dissection.

Results

Sensitivity in detecting central lymph node metastasis (US 29.9%, CT 27.9%, PET/CT 18.8%) was lower than that for lateral lymph node metastasis (US 56.3%, CT 66.2%, PET/CT 43.7%). Specificity in detecting central lymph node metastasis (US 80.6%, CT 77.7%, PET/CT 83.0%) was lower than that for lateral lymph node metastasis (US 96.8%, CT 80.6%, PET/CT 95.2%). The combination of US and CT had higher specificity (77.3%) and higher sensitivity (33.1%) than US alone. PET/CT has no significant additional benefit over the combination of US and CT.

Conclusion

In preoperative evaluations of neck lymph node metastasis, US and CT and PET/CT are more useful in lateral lymph node areas than in central lymph node areas. The combination of US and CT has higher sensitivity than US alone.

Keywords: Thyroid Gland, Carcinoma, Papillary, Ultrasonography, Tomography, X-Ray Computed, Positron-Emission Tomography

Figures and Tables

Fig. 1

US image of a 64-year-old female with papillary thyroid carcinoma. A hyperechoic lymph node is shown (between +) in the right internal jugular chain. Histopathological analysis revealed a metastatic papillary carcinoma.

US = ultrasonography
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Fig. 2

US image of a 49-year-old male with papillary thyroid carcinoma. Microcalcification (between +) is shown (+) in the left lateral neck lymph node. Histopathological analysis revealed metastatic papillary carcinoma.

US = ultrasonography
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Fig. 3

US image of a 66-year-old male with papillary thyroid carcinoma. Cystic changes (between +) are observed in the lymph node. Histopathological analysis revealed metastatic papillary carcinoma.

US = ultrasonography
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Fig. 4

CT image of a 62-year-old male with papillary thyroid carcinoma. The right paratracheal lymph node is increased in size and shows calcification (arrow). Histopathological analysis revealed metastatic papillary carcinoma.

jksr-75-104-g004
Table 1

Patient Demographics and Tumor Characteristics (n= 300)

jksr-75-104-i001
No. of Patients %
Gender
 Male 46 15.3
 Female 254 84.7
Age
 ≤ 45 106 35.3
 > 45 194 64.7
 Median (range) 50 (21–80)
Primary tumor
 Size (median, range) 8 (2–60)
  Pathologic variant
   Follicular variant 12 4.0
   Tall cell variant 7 2.3
   Clear cell variant 1 0.3
   Solid variant 1 0.3
   Diffuse sclerosing type 1 0.3
  Multifocal 39 13.0
  Bilateral 75 25.0
  Extrathyroidal extension 168 56.0
Combined thyroiditis 92 30.6
Table 2

Numbers of Dissected Nodes and Positive Neck Nodes per Level and per Patient

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Location Per Level Per Patient
Number of Dissected Nodal Levels Number of Metastatic Nodal Levels Number of Patients with Neck Dissection Number of Patients with Metastatic Nodes
Central 396 154 300 131
Lateral 133 71 47 29
I 0 0 0 0
II 30 8 25 6
III 41 24 35 21
IV 37 28 31 25
V 25 11 22 9
Table 3

Sensitivity, Specificity, PPV, NPV, and Diagnostic Accuracy of Preoperative US, CT, and PET/CT per Level and per Patient (%)

jksr-75-104-i003
Sensitivity Specificity PPV NPV Accuracy
Per level
 Central US 29.9 80.6 49.5 64.4 60.8
CT 27.9 77.7 44.3 62.9 58.3
PET/CT 18.8 83.0 41.4 61.7 58.1
US + CT 33.1 77.3 48.1 64.5 60.1
US + CT + PET/CT 33.1 77.3 48.1 64.5 60.1
 Lateral US 57.7 96.8 95.2 65.9 75.2
CT 66.2 80.6 79.7 67.6 72.9
PET/CT 43.7 95.2 91.2 59.6 67.7
US + CT 70.4 79.0 79.4 70.0 74.4
US + CT + PET/CT 71.8 77.4 78.5 70.6 74.4
Per patient
 Central US 17.6 97.0 82.1 59.9 62.3
CT 15.3 92.9 62.5 58.6 59.0
PET/CT 4.6 100 100 57.5 58.3
US + CT 19.8 92.3 68.3 60.2 61.3
US + CT + PET/CT 19.8 92.3 68.3 60.2 61.3
 Lateral US 79.3 88.9 92.0 72.7 83.0
CT 86.2 38.8 69.4 63.6 68.0
PET/CT 53.3 88.2 88.9 51.7 66.0
US + CT 93.1 38.9 71.0 77.8 72.3
US + CT + PET/CT 93.1 33.3 69.2 75.0 70.2

NPV = negative predictive value, PET = positron emission tomography, PPV = positive predictive value, US = ultrasonography

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