PATIENTS
A prospective study was conducted and we investigated 94 necks of postoperative patients of thyroid cancer,
determining ultrasonography characteristics of malignant lymph nodes,
from February 2012 to September 2013 in the University State of São Paulo (USP).
Institutional review board approval was obtained for this study.
Sonographic images of the cervical lymph nodes of patients in this study were obtained from B-mode and color Doppler amplitude. Ultrasound was held at E9 equipment - GE or Phillips iU22,
equipped with a multifrequency linear probe 7-12 MHz,
with the use of trapezoidal image.
The number of lymph nodes present,
node size and malignancy status were recorded by ultrasound.
We had 22 necks with ultrasonographic characteristics of lymph node recurrence,
after confirmed by surgery and histologic examination.
11,12,13
ULTRASOUND
The performance of the test was standardized as follow: patient supine with a roll under the shoulders and neck in hyperextension of approximately 45o.
The devices were pre-adjusted for thyroid ultrasound.
The transducer unit was lightly resting on the skin without pressuring her to not interfere in the evaluation of the vascularity of the parenchyma,
due to compression of the vessels10.
In the presence of cervical lymph nodes,
they were classified according to location (according to the levels I through VI)10,
number (if grouped or isolated),
form,
size,
echo texture / echogenicity,
central echogenic hilum,
cortex,
necrosis and / or internal bleeding,
contours (extra capsular spread) and presence of calcifications and standard vascularity.11,12,13
We had confirmed the suspect’s nodes with ultrasound guide fine needle aspiration biopsy (FNAB).14
The pathology reports were analyzed to determine the incidence of metastatic disease at each level of the neck.10 We also had information on post-surgical and post-radioactive iodine serum thyroglobulin levels,
neck control,
follow up,
and current disease status.15,16,17,18
Neck levels were considered positive for disease if they had at least one pathologically metastatic node.
Analyses were performed comparing the proportion of neck levels with positive disease.19,20