Comparison of Diagnostic Values of Ultrasonography and Computed Tomography for Detecting Lateral Lymph Node Metastasis in N1b Papillary Thyroid Carcinoma
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: We focused on the comparison of the diagnostic accuracy of preoperative ultrasonography (US) with that of computed tomography (CT), especially for lateral lymph node metastasis (LLNM) in N1b papillary thyroid carcinoma (PTC). Methods: We conducted a retrospective cohort study at the Thyroid Cancer Center of Samsung Medical Center, a tertiary referral center in Korea, by analyzing data collected between January 1997 and June 2015. A total of 1,323 patients who met the following inclusion criteria were enrolled. Results: Diagnostic values were calculated on a “per level” basis by comparing the results of US, CT, and histopathology. Between US and CT, there was no significant difference in the sensitivity (59.3% vs. 61.0%, P=0.073), specificity (83.0% vs. 81.1%, P=0.051), or accuracy (68.6% vs. 68.9%, P=0.660). However, US+CT showed significantly higher sensitivity (74.6% vs. 59.3%, P<0.001) and accuracy (74.0% vs. 68.6%, P<0.001) compared to US alone. Conclusion: There was no significant difference in sensitivity, specificity, and diagnostic accuracy for LLNM between US and CT; however, a combination of CT and US had significantly higher sensitivity, specificity, and diagnostic accuracy in detection of LLNM compared to US or CT alone. We conclude that the strategy for the examination of the lateral neck in PTC patients can be effectively determined by the combination of CT and US rather than US or CT only.
Abstract
Purpose: We focused on the comparison of the diagnostic accuracy of preoperative ultrasonography (US) with that of computed tomography (CT), especially for lateral lymph node metastasis (LLNM) in N1b papillary thyroid carcinoma (PTC). Methods: We conducted a retrospective cohort study at the Thyroid Cancer Center of Samsung Medical Center, a tertiary referral center in Korea, by analyzing data collected between January 1997 and June 2015. A total of 1,323 patients who met the following inclusion criteria were enrolled. Results: Diagnostic values were calculated on a “per level” basis by comparing the results of US, CT, and histopathology. Between US and CT, there was no significant difference in the sensitivity (59.3% vs. 61.0%, P=0.073), specificity (83.0% vs. 81.1%, P=0.051), or accuracy (68.6% vs. 68.9%, P=0.660). However, US+CT showed significantly higher sensitivity (74.6% vs. 59.3%, P<0.001) and accuracy (74.0% vs. 68.6%, P<0.001) compared to US alone. Conclusion: There was no significant difference in sensitivity, specificity, and diagnostic accuracy for LLNM between US and CT; however, a combination of CT and US had significantly higher sensitivity, specificity, and diagnostic accuracy in detection of LLNM compared to US or CT alone. We conclude that the strategy for the examination of the lateral neck in PTC patients can be effectively determined by the combination of CT and US rather than US or CT only.
참고문헌 (16)
- Ito Y, "Preoperative ultrasonographic examination for lymph node metastasis: usefulness when designing lymph node dissection for papillary microcarcinoma of the thyroid", World J Surg, 28, pp.498~501 (2004)
- American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules, "Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer", Thyroid, 19, pp.1167~1214 (2009)
- Watkinson JC, "Detection and surgical treatment of cervical lymph nodes in differentiated thyroid cancer", Thyroid, 16, pp.187~194 (2006)
- Kwak JY, "Papillary microcarcinoma of the thyroid: predicting factors of lateral neck node metastasis", Ann Surg Oncol, 16, pp.1348~1355 (2009)
- Ahn JE, "Diagnostic accuracy of CT and ultrasonography for evaluating metastatic cervical lymph nodes in patients with thyroid cancer", World J Surg, 32, pp.1552~1558 (2008)
- Lesnik D, "Papillary thyroid carcinoma nodal surgery directed by a preoperative radiographic map utilizing CT scan and ultrasound in all primary and reoperative patients", Head Neck, 36, pp.191~202 (2014)
- Kim E, "Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography", Thyroid, 18, pp.411~418 (2008)
- Choi JS, "Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT", AJR Am J Roentgenol, 193, pp.871~878 (2009)
- Kim SK, "Influence of body mass index and body surface area on the behavior of papillary thyroid carcinoma", Thyroid, 26, pp.657~666 (2016)
- Robbins KT, "Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery", Arch Otolaryngol Head Neck Surg, 128, pp.751~758 (2002)
- Stack BC Jr, "American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer", Thyroid, 22, pp.501~508 (2012)
- Edge SB, "The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM", Ann Surg Oncol, 17, pp.1471~1474 (2010)
- Park JS, "Performance of preoperative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC", UICC TNM classification system, 2009, pp.192, 66~72
- Laurie AJ, "Contrast material iodides: potential effects on radioactive iodine thyroid uptake", J Nucl Med, 33, pp.237~238 (1992)
- Nygaard B, "Iohexol: effects on uptake of radioactive iodine in the thyroid and on thyroid function", Acad Radiol, 5, pp.409~414 (1998)
- Stulak JM, "Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer", Arch Surg, 141, pp.489~494 (2006)