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Submitted on February 26, 2007
Accepted on June 26, 2007
Departments of Nuclear Medicine and Endocrine Oncology (SL, NS, EB, MS), Radiology (EG, NL), Statistics (MR), Surgical Oncology (JPT, DMH), Pathology (BC) Institut Gustave Roussy, 94805 Villejuif Cédex, France
* To whom correspondence should be addressed. E-mail: leboulleux{at}igr.fr.
Context: Neck ultrasonography (US) has become a keystone in the follow-up of patients with differentiated thyroid cancer (DTC).
Objective: The aim of this study was to determine specificity of ultrasound criteria of malignancy for cervical lymph nodes (LN) in patients with DTC.
Design: We prospectively studied 19 patients referred to the Institut Gustave Roussy for neck LN dissection. All patients underwent a neck US within 4 days prior to surgery. Only LN that were unequivocally matched between US and pathology were taken into account for the analysis.
Results: 103 LN were detected on US, 578 LN were surgically removed and 56 LN were analyzed (28 benign and 28 malignant). Sensitivity and specificity were 68% and 75% for the long axis (
1 cm), 61% and 96% for the short axis (> 5 mm), 46% and 64% for the round shape (long to short axis ratio < 2), 100% and 29% for the loss of fatty hyperechoic hilum, 39% and 18% for hypoechogenicity, 11% and 100% for cystic appearance, 46% and 100% for hyperechoic punctuations, 86% and 82% for peripheral vascularization.
Conclusion: Cystic appearance, hyperechoic punctuations, loss of hilum and peripheral vascularization can be considered as major ultrasound criteria of LN malignancy. LN with cystic appearance or hyperechoic punctuations are highly suspicious of malignancy. LN with a hyperechoic hilum should be considered as benign. Peripheral vascularization has the best sensitivity-specificity compromise. Round shape, hypoechogenicity and the loss of hilum taken as single criteria are not specific enough to suspect malignancy.
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