Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Validation of Ultrasound and Computed Tomography-Based Risk Stratification System and Biopsy Criteria for Cervical Lymph Nodes in Preoperative Patients With Thyroid Cancer

  • Young Hun Jeon (Department of Radiology, Seoul National University Hospital) ;
  • Ji Ye Lee (Department of Radiology, Seoul National University Hospital) ;
  • Roh-Eul Yoo (Department of Radiology, Seoul National University Hospital) ;
  • Jung Hyo Rhim (Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Cente) ;
  • Kyung Hoon Lee (Department of Radiology, Soonchunhyang University Seoul Hospital) ;
  • Kyu Sung Choi (Department of Radiology, Seoul National University Hospital) ;
  • Inpyeong Hwang (Department of Radiology, Seoul National University Hospital) ;
  • Koung Mi Kang (Department of Radiology, Seoul National University Hospital) ;
  • Ji-hoon Kim (Department of Radiology, Seoul National University College of Medicine)
  • Received : 2023.01.04
  • Accepted : 2023.07.15
  • Published : 2023.09.01
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Abstract

Objective: This study aimed to validate the risk stratification system (RSS) and biopsy criteria for cervical lymph nodes (LNs) proposed by the Korean Society of Thyroid Radiology (KSThR). Materials and Methods: This retrospective study included a consecutive series of preoperative patients with thyroid cancer who underwent LN biopsy, ultrasound (US), and computed tomography (CT) between December 2006 and June 2015. LNs were categorized as probably benign, indeterminate, or suspicious according to the current US- and CT-based RSS and the size thresholds for cervical LN biopsy as suggested by the KSThR. The diagnostic performance and unnecessary biopsy rates were calculated. Results: A total of 277 LNs (53.1% metastatic) in 228 patients (mean age ± standard deviation, 47.4 years ± 14) were analyzed. In US, the malignancy risks were significantly different among the three categories (all P < 0.001); however, CT-detected probably benign and indeterminate LNs showed similarly low malignancy risks (P = 0.468). The combined US + CT criteria stratified the malignancy risks among the three categories (all P < 0.001) and reduced the proportion of indeterminate LNs (from 20.6% to 14.4%) and the malignancy risk in the indeterminate LNs (from 31.6% to 12.5%) compared with US alone. In all image-based classifications, nodal size did not affect the malignancy risks (short diameter [SD] ≤ 5 mm LNs vs. SD > 5 mm LNs, P ≥ 0.177). The criteria covering only suspicious LNs showed higher specificity and lower unnecessary biopsy rates than the current criteria, while maintaining sensitivity in all imaging modalities. Conclusion: Integrative evaluation of US and CT helps in reducing the proportion of indeterminate LNs and the malignancy risk among them. Nodal size did not affect the malignancy risk of LNs, and the addition of indeterminate LNs to biopsy candidates did not have an advantage in detecting LN metastases in all imaging modalities.

Keywords

References

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