Accuracy of Intraoperative Determination of Central Node Metastasis by the Surgeon in Papillary Thyroid Carcinoma

作者：Ji Yong Bae; Lee Dong Won; Song Chang Myeon; Kim Kyung Rae; Park Chul Won; Tae Kyung^*

来源：Otolaryngology - Head and Neck Surgery, 2014, 150(4): 542-547.

DOI：10.1177/0194599813519405

• central lymph node metastasis
• papillary thyroid carcinoma
• thyroid cancer
• central neck dissection
• intraoperative assessment

Objective
Prophylactic central neck dissection (CND) in papillary thyroid carcinoma (PTC) remains controversial. If the presence of central lymph node metastasis could be assessed preoperatively or intraoperatively, unnecessary CND could be avoided. The aim of this study was to evaluate the accuracy of intraoperative determination of central lymph node metastasis by the surgeon using palpation and inspection in clinically node-negative PTC.
Study Design
Prospective study.
Setting
University tertiary care facility.
Subjects and Methods
A total of 122 consecutive patients with clinically node-negative PTC were enrolled. Any suspicious lymph nodes on intraoperative palpation or inspection were sent for frozen biopsy, and then bilateral CND with total thyroidectomy was carried out in all patients. The criteria for a suspicious lymph node included palpable hardness, dark discoloration, or size exceeding 5 mm in diameter. We compared the surgeon's judgments with the final pathologic results.
Results
Suspicious lymph nodes were found in 37 (30.3%) patients, and 15 of them had metastasis on permanent biopsy. Of 85 patients with no suspicious lymph nodes, 27 (31.8%) had metastasis on permanent biopsy. The sensitivity and specificity as well as positive and negative predictive values of intraoperative determination of central lymph node metastasis were 35.7%, 72.5%, 40.5%, and 68.2%, respectively. The positive predictive values of enlarged lymph nodes, dark discoloration, and hardness were 30.4%, 50.0%, and 78.6%, respectively.
Conclusion
Intraoperative determination of central lymph node metastasis by the surgeon is a limited guide for CND in clinically node-negative PTC because of its low sensitivity and specificity.

• 出版日期2014-4