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Eur Arch Otorhinolaryngol. 2017 Nov;274(11):3977-3983. doi: 10.1007/s00405-017-4728-z. Epub 2017 Sep 2.

Accuracy of preoperative MRI to assess lateral neck metastases in papillary thyroid carcinoma.

Author information

1
Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland. suvi.renkonen@helsinki.fi.
2
Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden. suvi.renkonen@helsinki.fi.
3
Department of Radiology, HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
4
Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland.
5
Faculty of Medicine, University of Helsinki, Helsinki, Finland.
6
Department of Oncology, Nuclear Medicine, Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
7
Department of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA.

Abstract

Primary treatment of papillary thyroid carcinoma (PTC) with lateral lymph node metastasis is surgery, but the extent of lateral neck dissection remains undefined. Preoperative imaging is used to guide the extent of surgery, although its sensitivity and specificity for defining the number and level of affected lymph nodes on the lateral neck is relatively modest. Our aim was to assess the role of preoperative magnetic resonance imaging (MRI) in predicting the requisite levels of neck dissection in patients with regionally metastatic PTC, with a focus on Levels II and V. All patients with PTC and lateral neck metastasis who had undergone neck dissection at the Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland from 2013 to 2016 and had a preoperative MRI available were retrospectively reviewed. A head and neck radiologist re-evaluated all MRIs, and the imaging findings were compared with histopathology after neck dissection. In the cohort of 39 patients, preoperative MRI showed concordance with histopathology for Levels II and V as follows: sensitivity of 94 and 67%, specificity of 20 and 91%, positive predictive value of 56 and 75%, and negative predictive value of 75 and 87%, respectively. In PTC, MRI demonstrated fairly high specificity and negative predictive value for Level V metastasis, and future studies are needed to verify our results to omit prophylactic dissection of this level. Routine dissection of Level II in patients with regionally metastatic PTC needs to be considered, as MRI showed low specificity.

KEYWORDS:

Lateral neck metastasis; MRI; Neck dissection; Negative predictive value; Papillary thyroid carcinoma

PMID:
28866793
PMCID:
PMC5633621
DOI:
10.1007/s00405-017-4728-z
[Indexed for MEDLINE]
Free PMC Article

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