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Preoperative High Resolution Ultrasound for Assessment of Malignant Central Compartment Lymph Nodes In Papillary Thyroid Cancer
*Kristopher Day, *Mamoona Khokhar, *Rohit Sangal, *Nigar Ahmedli, *Latha Pisharodi, Jack Monchik
Brown University, Providence, RI

Objective: Central compartment node dissection is indicated when the surgeon identifies suspicious central compartment lymph nodes in a patient with papillary thyroid cancer (PTC). The diagnostic accuracy for preoperative ultrasound for lateral compartment lymphadenopathy is well established. High resolution cervical ultrasound (HUS) for identification of central compartment lymphadenopathy in patients with PTC is unknown. We investigate the accuracy of HUS for preoperative identification of malignant central compartment lymph nodes (MCLN).
Design: Retrospective chart review. Preoperative HUS results are compared to postoperative pathology results.
Setting: Academic tertiary care hospital.
Patients: 227 PTC patients from 2004 to 2014 who received thyroidectomy by a single endocrine surgeon.
Interventions: None.
Main Outcome Measures: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of preoperative HUS.
Results: The sensitivity and specificity of preoperative HUS for MCLN was 0.38 (95% CI 0.28, 0.48) and 0.90 (0.84, 0.95), respectively. The PPV and NPV were 0.76 (0.63, 0.87) and 0.63 (0.55, 0.70), with an accuracy of 0.66 (0.60, 0.70).
Conclusions: Preoperative HUS is highly specific for MCLN. A negative HUS does not obviate the need for careful exploration of the central compartment to determine the need for central compartment dissection.
Table I. Results of HUS Versus MCLN Identified by Pathology
+ MCLN- MCLNTotal
+HUS lymphadenopathy391251
-HUS lymphadenopathy65111176
Total104123227


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