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Keywords:
Metastases, Image verification, Cancer, Outcomes analysis, Localisation, Health policy and practice, Ultrasound-Colour Doppler, Ultrasound, Thyroid / Parathyroids, Head and neck, Anatomy
Authors:
M. R. M. Machado, M. C. Chammas, M. R. Tavares, G. G. Cerri; São Paulo/BR
DOI:
10.1594/ecr2015/C-0730
Aims and objectives
The incidence of thyroid cancer is rapidly rising at the rate of 4% per year.1 There are controversies connected with the surgical approach and follow-up after surgery of thyroid cancer.2,3 Assessment of cervical lymph nodes is essential for patients with head and neck carcinomas because it helps to determine the prognosis and select appropriate treatment.1
Differentiated thyroid cancers may be associated with regional lymph node metastases in 20-50% of cases.
Lymph node metastases are frequent (20-50%) and up to 15% of patients will develop a regional recurrence after total thyroidectomy.4,5,6 The central compartment (VI upper VII levels) is considered to be the first echelon of nodal metastases an all differentiated thyroid carcinoma.5
Recurrent or persistent disease can also present as distant metastases associated with increased morbidity and mortality and a decreased overall life expectancy compared with the general population.7
The American Thyroid Association defines disease-free survival as no evidence of tumor either clinically or on imaging by diagnostic whole body radioactive iodine scan or cervical chain lymph node mapping (LNM) ultrasonography and undetectable thyroglobulin (TG) levels during thyroid-stimulating hormone (TSH) suppression or stimulation.8
Previous studies have reported on the patterns of cervical lymph node metastases and have made recommendations regarding the neck treatment.
The American Thyroid Association (ATA) recommends preoperative cervical (central and lateral) lymph node ultrasound (US) on all patients with biopsy-proven thyroid malignancy and fine needle aspiration of all sonographically suspicious.
Lateral neck dissection is recommended for patients with biopsy-proven metastatic lymphadenopathy.
The ATA do not make specific recommendations regarding which neck levels should be operated on,
although favors “en bloc”.2,3 There are controversies regarding the surgical approach and follow-up after surgery of thyroid cancer.9,10
This study analyzes the frequencies on each level,
between cases of recurrent lymph nodes of thyroid tumors,
based on the Classification of Som et al.
(2000).10