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Risk factors for metastasis in indeterminate lymph nodes in preoperative patients with thyroid cancer

  • Ultrasound
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Abstract

Objectives

To investigate the relevance of clinical and sonographic features as indicators of metastasis in indeterminate lymph node (LN), to determine possible indications for fine-needle aspiration (FNA).

Methods

Consecutive patients who underwent US-guided FNA for sonographic indeterminate LNs from differentiated thyroid carcinoma between January 2014 and December 2018 were retrospectively reviewed. Indeterminate LNs were defined as LNs which had neither an echogenic hilum nor hilar vascularity in the absence of any suspicious finding in accordance with the Korean Society of Thyroid Radiology (KSThR) guidelines. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors related to malignancy of indeterminate LNs.

Results

Of the 236 LNs in 212 patients enrolled in this study, 67 LNs (28.3%) were metastatic. The multivariate logistic regression analysis showed that the long diameter of LNs has a negative association with metastasis in indeterminate LNs and the sonographic features of extrathyroidal extension (ETE) and nonparallel orientation of the primary tumor are associated with metastasis in indeterminate LNs. The sensitivity and positive predictive value were increased when FNA was performed for LNs with primary tumors showing ETE or nonparallel orientation than when FNA was performed for LNs larger than 5 mm (59.7% and 40.4% vs. 11.94% and 15.69%).

Conclusions

The size of LNs has a negative association with metastasis in indeterminate LNs. Performing FNA for indeterminate LNs in patients whose primary tumor shows ETE or a nonparallel orientation can improve the diagnostic performance and decrease the rate of unnecessary FNA.

Key Points

• The size of lymph nodes was negatively related to the risk of metastasis in indeterminate lymph nodes.

• Extrathyroidal extension and a nonparallel orientation of the primary tumor were suggested as sonographic features predicting metastasis in indeterminate lymph nodes.

• The routine practice of FNA for large indeterminate lymph nodes detected during preoperative evaluation of thyroid cancer should be discouraged.

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Abbreviations

DTC:

Differentiated thyroid carcinoma

KSThR:

Korean Society of Thyroid Radiology

ETE:

Extrathyroidal extension

FNA:

Fine-needle aspiration

L/S:

Long-to-short diameter

LN:

Lymph node

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul, 05505, South Korea

    Sae Rom Chung, Jung Hwan Baek, Young Jun Choi & Jeong Hyun Lee

  2. Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Tae-Yon Sung

  3. Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Dong Eun Song

  4. Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Tae Yong Kim

Authors
  1. Sae Rom Chung
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  2. Jung Hwan Baek
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  3. Young Jun Choi
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  4. Tae-Yon Sung
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  5. Dong Eun Song
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  7. Jeong Hyun Lee
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Corresponding author

Correspondence to Jung Hwan Baek.

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The scientific guarantor of this publication is Jung Hwan Baek.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Methodology

•retrospective

•diagnostic study

•performed at one institution

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Chung, S.R., Baek, J.H., Choi, Y.J. et al. Risk factors for metastasis in indeterminate lymph nodes in preoperative patients with thyroid cancer. Eur Radiol 32, 3863–3868 (2022). https://doi.org/10.1007/s00330-021-08478-5

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  • DOI: https://doi.org/10.1007/s00330-021-08478-5

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