Southwestern Surgical CongressThe role of lateral neck ultrasound in detecting single or multiple lymph nodes in papillary thyroid cancer

BackgroundLateral neck dissection (LND) for papillary thyroid cancer (PTC) transitioned from isolated lymphadenectomy or “berry picking” based on clinical examination to multicompartment lymphadenectomy. We aimed to assess ultrasound (US) as a predictor of solitary (SLN) or multiple lymph node (MLN) metastases.MethodsDemographics, US findings, extent of LND, and pathology were collected in patients with PTC who underwent LND. US sensitivity and specificity were calculated, and accuracy was correlated with US findings and patient characteristics.ResultsA total of 462 patients underwent 590 LNDs. US showed an SLN in 179 patients (30%) and MLNs in 411 patients (70%). Sensitivity, positive predictive value, and accuracy were 61%, 43%, and 75% for US detected SLN and 78%, 89%, and 75% for US detected MLNs. US accuracy for MLNs increased as node size increased (<10 mm, 63%; 10 to 20 mm, 71%; >20 mm, 89%; P < .0001).ConclusionsUS has limited accuracy in the detection SLN metastasis in the lateral neck. Care should be taken when considering a focused compartment dissection.