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Ultrasound
Diagnosis
Head and Neck
Lymph Nodes
Nodal Differentiated Thyroid Carcinoma
Nodal Differentiated Thyroid Carcinoma
Eunice Y. L. Dai, MBBS, FRCR; Yolanda Y. P. Lee, MBChB, FRCR; Anil T. Ahuja, MD, FRCR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Differentiated thyroid carcinoma (DTCa)

            • Definitions

              • Metastatic node(s) from papillary thyroid carcinoma (PCTa) or follicular thyroid carcinoma (FTCa)
                • Papillary (80-90%) more common than follicular (5%)

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • CT Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Microscopic Features

                              • Staging, Grading, & Classification

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Liu Z et al: Diagnostic accuracy of ultrasonographic features for lymph node metastasis in papillary thyroid microcarcinoma: a single-center retrospective study. World J Surg Oncol. 15(1):32, 2017
                                          2. Kim DW et al: Sonographic features of cervical lymph nodes after thyroidectomy for papillary thyroid carcinoma. J Ultrasound Med. 32(7):1173-80, 2013
                                          3. Yoo YH et al: Sonographic findings predictive of central lymph node metastasis in patients with papillary thyroid carcinoma: influence of associated chronic lymphocytic thyroiditis on the diagnostic performance of sonography. J Ultrasound Med. 32(12):2145-51, 2013
                                          4. Lee YYP et al: Ultrasound in head and neck cancer. In Glastonbury CM et al: Head and neck cancer: state of the art diagnosis, staging, and surveillance. Specialty Imaging. Philadelphia: Lippincott Williams & Wilkins, 1-18-25, 2012
                                          5. Lim YC et al: Occult lymph node metastases in neck level V in papillary thyroid carcinoma. Surgery. 147(2):241-5, 2010
                                          6. Sohn YM et al: Diagnostic approach for evaluation of lymph node metastasis from thyroid cancer using ultrasound and fine-needle aspiration biopsy. AJR Am J Roentgenol. 194(1):38-43, 2010
                                          7. Kaplan SL et al: The role of MR imaging in detecting nodal disease in thyroidectomy patients with rising thyroglobulin levels. AJNR Am J Neuroradiol. 30(3):608-12, 2009
                                          8. Lim YC et al: Central lymph node metastases in unilateral papillary thyroid microcarcinoma. Br J Surg. 96(3):253-7, 2009
                                          9. Roh JL et al: Use of preoperative ultrasonography as guidance for neck dissection in patients with papillary thyroid carcinoma. J Surg Oncol. 99(1):28-31, 2009
                                          10. Rotstein L: The role of lymphadenectomy in the management of papillary carcinoma of the thyroid. J Surg Oncol. 99(4):186-8, 2009
                                          11. Schmidt D et al: Impact of 131I SPECT/spiral CT on nodal staging of differentiated thyroid carcinoma at the first radioablation. J Nucl Med. 50(1):18-23, 2009
                                          12. Ahuja AT et al: Ultrasound of malignant cervical lymph nodes. Cancer Imaging. 8:48-56, 2008
                                          13. Roh JL et al: Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis. Ann Surg Oncol. 15(9):2482-6, 2008
                                          14. Roh JL et al: Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol. 15(4):1177-82, 2008
                                          15. Soler ZM et al: Utility of computed tomography in the detection of subclinical nodal disease in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 134(9):973-8, 2008
                                          16. Sugitani I et al: Prospective outcomes of selective lymph node dissection for papillary thyroid carcinoma based on preoperative ultrasonography. World J Surg. 32(11):2494-502, 2008
                                          17. Yanir Y et al: Regional metastases in well-differentiated thyroid carcinoma: pattern of spread. Laryngoscope. 118(3):433-6, 2008
                                          18. de Bondt RB et al: Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging. Eur J Radiol. 64(2):266-72, 2007
                                          19. Leboulleux S et al: Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab. 92(9):3590-4, 2007
                                          20. Roh JL et al: Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg. 245(4):604-10, 2007
                                          21. Watkinson JC et al: Detection and surgical treatment of cervical lymph nodes in differentiated thyroid cancer. Thyroid. 16(2):187-94, 2006
                                          22. Wong KT et al: Ultrasound of thyroid cancer. Cancer Imaging. 5:157-66, 2005
                                          23. Ahuja AT et al: Metastatic cervical nodes in papillary carcinoma of the thyroid: ultrasound and histological correlation. Clin Radiol. 50(4):229-31, 1995
                                          24. Evans RM et al: The linear echogenic hilus in cervical lymphadenopathy--a sign of benignity or malignancy? Clin Radiol. 47(4):262-4, 1993
                                          25. van den Brekel MW et al: Lymph node staging in patients with clinically negative neck examinations by ultrasound and ultrasound-guided aspiration cytology. Am J Surg. 162(4):362-6, 1991
                                          26. Tohnosu N et al: Ultrasonographic evaluation of cervical lymph node metastases in esophageal cancer with special reference to the relationship between the short to long axis ratio (S/L) and the cancer content. J Clin Ultrasound. 17(2):101-6, 1989
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Differentiated thyroid carcinoma (DTCa)

                                                    • Definitions

                                                      • Metastatic node(s) from papillary thyroid carcinoma (PCTa) or follicular thyroid carcinoma (FTCa)
                                                        • Papillary (80-90%) more common than follicular (5%)

                                                    IMAGING

                                                    • General Features

                                                      • Ultrasonographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Microscopic Features

                                                                      • Staging, Grading, & Classification

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Liu Z et al: Diagnostic accuracy of ultrasonographic features for lymph node metastasis in papillary thyroid microcarcinoma: a single-center retrospective study. World J Surg Oncol. 15(1):32, 2017
                                                                                  2. Kim DW et al: Sonographic features of cervical lymph nodes after thyroidectomy for papillary thyroid carcinoma. J Ultrasound Med. 32(7):1173-80, 2013
                                                                                  3. Yoo YH et al: Sonographic findings predictive of central lymph node metastasis in patients with papillary thyroid carcinoma: influence of associated chronic lymphocytic thyroiditis on the diagnostic performance of sonography. J Ultrasound Med. 32(12):2145-51, 2013
                                                                                  4. Lee YYP et al: Ultrasound in head and neck cancer. In Glastonbury CM et al: Head and neck cancer: state of the art diagnosis, staging, and surveillance. Specialty Imaging. Philadelphia: Lippincott Williams & Wilkins, 1-18-25, 2012
                                                                                  5. Lim YC et al: Occult lymph node metastases in neck level V in papillary thyroid carcinoma. Surgery. 147(2):241-5, 2010
                                                                                  6. Sohn YM et al: Diagnostic approach for evaluation of lymph node metastasis from thyroid cancer using ultrasound and fine-needle aspiration biopsy. AJR Am J Roentgenol. 194(1):38-43, 2010
                                                                                  7. Kaplan SL et al: The role of MR imaging in detecting nodal disease in thyroidectomy patients with rising thyroglobulin levels. AJNR Am J Neuroradiol. 30(3):608-12, 2009
                                                                                  8. Lim YC et al: Central lymph node metastases in unilateral papillary thyroid microcarcinoma. Br J Surg. 96(3):253-7, 2009
                                                                                  9. Roh JL et al: Use of preoperative ultrasonography as guidance for neck dissection in patients with papillary thyroid carcinoma. J Surg Oncol. 99(1):28-31, 2009
                                                                                  10. Rotstein L: The role of lymphadenectomy in the management of papillary carcinoma of the thyroid. J Surg Oncol. 99(4):186-8, 2009
                                                                                  11. Schmidt D et al: Impact of 131I SPECT/spiral CT on nodal staging of differentiated thyroid carcinoma at the first radioablation. J Nucl Med. 50(1):18-23, 2009
                                                                                  12. Ahuja AT et al: Ultrasound of malignant cervical lymph nodes. Cancer Imaging. 8:48-56, 2008
                                                                                  13. Roh JL et al: Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis. Ann Surg Oncol. 15(9):2482-6, 2008
                                                                                  14. Roh JL et al: Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol. 15(4):1177-82, 2008
                                                                                  15. Soler ZM et al: Utility of computed tomography in the detection of subclinical nodal disease in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 134(9):973-8, 2008
                                                                                  16. Sugitani I et al: Prospective outcomes of selective lymph node dissection for papillary thyroid carcinoma based on preoperative ultrasonography. World J Surg. 32(11):2494-502, 2008
                                                                                  17. Yanir Y et al: Regional metastases in well-differentiated thyroid carcinoma: pattern of spread. Laryngoscope. 118(3):433-6, 2008
                                                                                  18. de Bondt RB et al: Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging. Eur J Radiol. 64(2):266-72, 2007
                                                                                  19. Leboulleux S et al: Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab. 92(9):3590-4, 2007
                                                                                  20. Roh JL et al: Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg. 245(4):604-10, 2007
                                                                                  21. Watkinson JC et al: Detection and surgical treatment of cervical lymph nodes in differentiated thyroid cancer. Thyroid. 16(2):187-94, 2006
                                                                                  22. Wong KT et al: Ultrasound of thyroid cancer. Cancer Imaging. 5:157-66, 2005
                                                                                  23. Ahuja AT et al: Metastatic cervical nodes in papillary carcinoma of the thyroid: ultrasound and histological correlation. Clin Radiol. 50(4):229-31, 1995
                                                                                  24. Evans RM et al: The linear echogenic hilus in cervical lymphadenopathy--a sign of benignity or malignancy? Clin Radiol. 47(4):262-4, 1993
                                                                                  25. van den Brekel MW et al: Lymph node staging in patients with clinically negative neck examinations by ultrasound and ultrasound-guided aspiration cytology. Am J Surg. 162(4):362-6, 1991
                                                                                  26. Tohnosu N et al: Ultrasonographic evaluation of cervical lymph node metastases in esophageal cancer with special reference to the relationship between the short to long axis ratio (S/L) and the cancer content. J Clin Ultrasound. 17(2):101-6, 1989