Thyroid cancer is the fastest rising cancer in women. Though thyroid cancer has an excellent prognosis with survival rates of >95%, spread of the cancer to the lymph nodes in the neck are common. While spread of the cancer to the lymph nodes does not usually affect the risk of death, there is an increased risk for recurrence of the cancer. Overall, up to 20% of patients with thyroid cancer will require additional treatment for spread of the cancer to lymph nodes.
Methods to evaluate lymph node involvement before surgery have included physical examination, CT scanning and ultrasound. Physical examination is not accurate enough to discover most lymph nodes. CT scanning involves radiation and contrast that contains iodine, which takes time to leave the system to allow radioactive iodine treatment for thyroid cancer, when indicated. Ultrasound is widely available, performs well in experienced hands, is useful to identify abnormal lymph nodes that may contain cancer and is recommended by the guidelines of the American Thyroid Association.
This study was done to evaluate the use of ultrasound to examine lymph nodes in the neck in surgical planning for thyroid cancer surgery and to identify which patients are best served by this approach.
THE FULL ARTICLE TITLE:
Kocharyan D et al. The relevance of preoperative ultrasound cervical mapping in patients with thyroid cancer. Can J Surg 2016;59:113-7.
SUMMARY OF THE STUDY
Medical records of 263 patients who had thyroid cancer surgeries performed at Centre hospitalier de l’Universite de Montreal from 2009-2013 were reviewed. All patients had lymph node mapping ultrasounds prior to surgery. Only positive ultrasound results were included. These results were divided into two groups: 1 or 2 suspicious lymph nodes vs 3 or more suspicious lymph nodes. Pathology results after surgery were divided into 3 groups: 0, 1 or 2, and 3 or more positive lymph nodes.