Scientific Session 01 — Vascular/Interventional - Oncology and Tissue SamplingMonday, May 1, 2017
2897. Impact of Ultrasound-Guided Lymph Node Mapping and Biopsy on Managing Patients With Thyroid Cancer
Ehieli W*, Sosa J, Jaffe T. Duke University Medical Center, Durham, NC
Address correspondence to W. Ehieli (email@example.com)
Objective: The American Thyroid Association thyroid cancer guidelines recommend evaluation of central and lateral neck lymph nodes (LNs) with both physical examination (PE) and ultrasound (US) in patients undergoing surgical resection for or surveillance after resection of papillary thyroid carcinoma (PTC). The goal of this study was to evaluate the impact of US LN mapping and node biopsy on management of patients with PTC.
Materials and Methods: A HIPAA-compliant, institutional review board–approved retrospective study of 186 patients who underwent US LN mapping in the setting of known or suspected PTC between January 1, 2013, and September 15, 2015, was performed. Thirteen patients were excluded due to no final diagnosis of thyroid cancer, biopsy demonstrating alternate malignancy (lymphoma, parathyroid carcinoma), or no treatment planned due to a separate metastatic malignancy. Demographic data including age and sex were recorded. US LN mapping included scanning of central, lateral, and posterior compartment LNs. Abnormal LN appearance included size greater than 1 cm, calcifications, cystic changes, increased echogenicity, abnormal findings on color Doppler sonography, and loss of echogenic hilum. US-guided biopsy on abnormal LNs was attempted if amenable. Date and results of US LN mapping were examined; clinical data included PE findings before US LN mapping and results from biopsies and surgical specimens.
Results: In all, 127 women and 46 men were included (mean age, 51 years; range, 16–85 years). Thirty-four and 139 patients were scanned preoperatively and for postoperative surveillance, respectively. Preoperatively, 19 (56%) patients had a normal PE and US, and proceeded with planned surgery. Eleven (32%) patients had a normal PE and abnormal US findings but benign biopsy and proceeded with planned surgery. One (3%) patient had a normal PE but abnormal US and biopsy findings, which changed planned surgery to include modified radical neck dissection (MRND). Two (6%) patients had an abnormal PE and US findings and malignant biopsy, confirming the need for MRND. One (3%) patient had an abnormal PE and US findings but negative biopsy, allowing a limited surgery to be performed. Postoperatively, 85 (61%) patients had a normal PE and no abnormal findings on US surveillance. Nineteen (14%) patients had a normal PE and abnormal US findings but nothing amenable to biopsy; close follow-up was recommended. Twenty (14%) patients had a normal PE but abnormal US findings with biopsy yielding benign pathology findings; patients returned to regular screening. Seven (5%) patients had a normal PE and abnormal US and pathology findings, which caused a change in management in either follow-up interval or additional surgery. Two (1%) patients had an abnormal PE and US findings; however, biopsy was not performed (due to stability of the abnormal LN or prior benign biopsy). Six (4%) patients had an abnormal PE findings but normal US findings, allowing return to regular screening and obviating additional surgery.
Conclusion: Dedicated US LN mapping in patients with a diagnosis of PTC alters preoperative surgical planning in up to 12% of patients, alters surveillance interval and management in up to 23% of patients, and should be included as part of routine clinical management in PTC.