Correlation between sonographic features and pathological findings of cervical lymph node metastasis of differentiated thyroid carcinoma

Xiaofeng Wu; Lihong Zhang; Jie Sun; Ying Huang; Enqiao Yu; Dongmei Gu; Wei Wang; Mengyao Sun; Kai Wang; Jie Wang; Mengshang Hu; Mengqi Zhou; Jianxia Liu; Fenglin Dong

doi:10.21037/gs-21-253

Correlation between sonographic features and pathological findings of cervical lymph node metastasis of differentiated thyroid carcinoma

Gland Surg. 2021 May;10(5):1736-1743. doi: 10.21037/gs-21-253.

Authors

Xiaofeng Wu¹, Lihong Zhang¹, Jie Sun², Ying Huang¹, Enqiao Yu², Dongmei Gu³, Wei Wang¹, Mengyao Sun¹, Kai Wang¹, Jie Wang¹, Mengshang Hu¹, Mengqi Zhou¹, Jianxia Liu², Fenglin Dong¹

Affiliations

¹ Department of Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou, China.
² Department of General Surgery, the First Affiliated Hospital of Soochow University, Suzhou, China.
³ Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou, China.

Abstract

Background: The aim of this study is to evaluate the relationship between the sonographic features and pathological findings of cervical lymph node metastasis of differentiated thyroid carcinoma (DTC).

Methods: A total of 49 patients who had thyroid surgery and lateral or central cervical lymph node dissection from October to December 2019 in our hospital were selected. All the lymph nodes included in the dissection were examined by intraoperative ultrasound and were divided into 5 groups according to the sonographic characteristics (A: overall hyperechoic group; B: hypoechoic with punctate hyperechoic group; C: mass hyperechoic group; D: cystic degeneration group; E: hypoechoic group without punctate hyperecho). All samples were sent to the Pathology Department according to the area of origin and classified and numbered for comparative analysis of the microscopic pathology and the sonogram.

Results: A total of 120 suspicious metastatic lymph nodes were finally screened out by intraoperative ultrasound. The sonographic signs of these suspicious metastatic lymph nodes in the lateral and central regions of the neck were significantly different from the normal lymph nodes. Besides, the indicators including sensitivity, specificity, accuracy, positive predictive value and negative predictive value of intraoperative ultrasound for detecting lateral and central lymph nodes were 89.04% vs. 82.98%, 93.83% vs. 80.00%, 90.97% vs. 81.10%, 92.86% vs. 70.91%, and 90.48% vs. 88.89%, respectively. The pathological features of metastatic lymph nodes were shown as follows: group A, diffuse distribution of follicular structure; group C, focal distribution of follicular structure; group B and E, atypical follicular epithelial cells with or without papillary structure. Necrosis and liquefaction were observed in group D.

Conclusions: The relationship between sonographic features and follicular structure of metastatic lymph nodes are firmly related. A correct understanding of these features is practical to improve the diagnostic rate of conventional ultrasonography and reduce the incidences of misdiagnosis.

Keywords: Thyroid carcinoma; intraoperative ultrasound; lymph node metastasis.