Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Ultrasonographic Indeterminate Lymph Nodes in Preoperative Thyroid Cancer Patients: Malignancy Risk and Ultrasonographic Findings Predictive of Malignancy

  • Roh-Eul Yoo (Department of Radiology, Seoul National University Hospital) ;
  • Ji-hoon Kim (Department of Radiology, Seoul National University Hospital) ;
  • Jeong Mo Bae (Department of Pathology, Seoul National University Hospital) ;
  • Inpyeong Hwang (Department of Radiology, Seoul National University Hospital) ;
  • Koung Mi Kang (Department of Radiology, Seoul National University Hospital) ;
  • Tae Jin Yun (Department of Radiology, Seoul National University Hospital) ;
  • Seung Hong Choi (Department of Radiology, Seoul National University Hospital) ;
  • Chul-Ho Sohn (Department of Radiology, Seoul National University Hospital) ;
  • Jung Hyo Rhim (Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center) ;
  • Sun-Won Park (Department of Radiology, Seoul National University College of Medicine)
  • Received : 2019.10.10
  • Accepted : 2020.01.05
  • Published : 2020.05.01
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Abstract

Objective: Proper management of lymph nodes (LNs) with ultrasonographic (US) indeterminate features in thyroid cancer patients remains elusive. We aimed to evaluate the malignancy risk and US findings predictive of malignancy for US indeterminate LNs in preoperative thyroid cancer patients through node-by-node correlation. Materials and Methods: A total of 348 LNs in 284 thyroid cancer patients, who underwent fine-needle aspiration or core-needle biopsy between December 2006 and June 2015, were included. We determined the malignancy risks for US probably benign, indeterminate, and suspicious categories. For US indeterminate LNs, which had neither echogenic hilum nor hilar vascularity in the absence of any suspicious finding, US findings were compared between benign and metastatic LNs using Mann-Whitney U test and Fisher's exact test. Results: US imaging diagnoses were probably benign in 20.7% (n = 72) cases, indeterminate in 23.6% (n = 82), and suspicious in 55.7% (n = 194). Malignancy risk of US indeterminate LNs (19.5% [16/82]) differed from those of the US probably benign (2.8% [2/72]) (p = 0.002) and US suspicious LNs (78.4% [152/194]) (p < 0.001). Among US indeterminate LNs, there were no significant differences in short, long, and long-to-short diameter (L/S) ratios between benign and metastatic LNs (3.9 vs. 3.8 mm, p = 0.619; 7.3 vs. 7.3 mm, p = 0.590; 1.9 vs. 1.9, p = 0.652). Conclusion: US indeterminate LNs were frequently encountered during preoperative evaluation and had intermediate malignancy risk. Given the lack of discriminative power of size criteria and L/S ratio, clinical factors such as surgical strategy and node size should be considered for proper triage of US indeterminate LNs in thyroid cancer.

Keywords

Acknowledgement

This study was supported by grant no. 05-2015-0050 from the SNUH Research Fund.

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