By Jill Stein
CHICAGO -- October 15, 2009 -- Researchers are reporting that ultrasound may play an important role in the preoperative evaluation of cervical lymph nodes in patients with suspicious or indeterminate thyroid fine needle aspiration (FNA) biopsy.
Erin Felger, MD, Johns Hopkins University School of Medicine, Baltimore, Maryland, presented the results on October 14 here at the American College of Surgeons (ACS) 95th Annual Clinical Congress.
Her team reviewed the medical records of 180 patients who presented at their institution over a recent 3.5-year period with indeterminate or suspicious FNA biopsy results. Of the 180 patients, 81 patients underwent a preoperative neck ultrasound to evaluate for abnormal cervical lymph nodes.
The role of preoperative ultrasound in the evaluation of cervical lymph nodes in patients with known thyroid cancer has been widely explored, Dr. Felger pointed out.
Available data show that preoperative ultrasound findings lead to changes in the surgical plan in a significant percentage (33% to 39%) of patients diagnosed preoperatively with papillary thyroid cancer. Thus, preoperative ultrasound in this population is an important tool for determining the extent of the proposed operation and for potentially decreasing local-regional recurrence.
No study, however, has examined the potential contribution of ultrasound in the preoperative evaluation of cervical lymph nodes in patients with suspicious or indeterminate thyroid FNA aspiration biopsy.
In the present study, the investigators reviewed cytology, ultrasound, operative, and final pathology reports for each patient to determine whether ultrasound influenced the extent of operation performed.
Overall, ultrasound identified suspicious cervical lymph nodes in 9 patients (11.1%) with suspicious or indeterminate pathology on thyroid FNA.
In 4 of 9 patients with abnormal cervical lymph nodes, or 44%, a diagnosis of metastatic disease was made on FNA, which, in turn, led to a modification in surgical management.
"We recommend ultrasound evaluation of cervical lymph nodes in all patients with suspicious or indeterminate results on thyroid nodule FNA," Dr. Felger said.
[Presentation title: Impact of Preoperative Neck Ultrasound on Surgical Procedure for Patients With Suspicious or Indeterminate Thyroid FNAs. Abstract SE115-W]
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