Опухоли ГОЛОВЫ и ШЕИ HEAD and NECK tumors Том 9 Vol. 9 4'2019 Диагностика и лечение опухолей головы и шеи 17 Ультразвуковая диагностика метастазов в лимфатических узлах шеи II-IV уровней у больных с впервые установленным диагнозом папиллярного рака щитовидной железы В. С. Паршин, А. А. Веселова, В. С. Медведев, С. А. Иванов, А. Д. Каприн Медицинский радиологический научный центр им. А. Ф. Цыба -филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России; Россия, 249036 Обнинск, ул. Королева, 4 Контакты: Владимир Сергеевич Паршин parshin@mrrc.obninsk.ru Цель исследования -оценить возможности ультразвукового исследования (УЗИ) в диагностике метастазов папиллярного рака щитовидной железы (ПРЩЖ) в лимфатических узлах (ЛУ) шеи II-IV уровней. Материалы и методы. У 97 пациентов с впервые установленным диагнозом ПРЩЖ выполнено хирургическое удаление подкожной жировой клетчатки шеи II-IV уровней. В дооперационный период у всех пациентов проведено УЗИ шеи. Результаты верифицированы гистологическим методом. Результаты. Метастазы в ЛУ шеи II-IV уровней выявлены по данным УЗИ у 82 (84,5 %) пациентов, по гистологическим данным -у 86 (88,6 %). Чувствительность УЗИ составила 93 %, специфичность -81 %, точность -91 %, прогностическая ценность положительного результата -97 %, отрицательного результата -60 %. В 443 (27,3 %) из 1620 удаленных ЛУ метастазы были подтверждены гистологическим методом. При этом по данным УЗИ они имелись в 422 (26,0 %) ЛУ. При внутриорганных опухолях метастазы наблюдались в 94,1 % случаев, при внеорганных -в 87,5 %. Солитарные опухоли давали метастазы в 86,5 % случаев, мультицентрические -в 92,1 %. Множественные метастазы выявлены в 89,5 %, одиночные -в 10,5 %. Заключение. УЗИ оказалось высокоинформативным методом выявления метастазов ПРЩЖ в ЛУ шеи II-IV уровней шеи и может стать базовым методом достижения данной диагностической цели. Ключевые слова: папиллярный рак щитовидной железы, метастазы II, III, IV уровней шеи, ультразвуковое исследование, гистологическая верификация Для цитирования: Паршин В. С., Веселова А. А., Медведев В. С. и др. Ультразвуковая диагностика метастазов в лимфатических узлах шеи II-IV уровней у больных с впервые установленным диагнозом папиллярного рака щитовидной железы. Опухоли головы и шеи 2019;9(4):17-23. The study objective is to explore the potentialities of ultrasound in the detection of metastasis from papillary thyroid cancer (PTC) to cervical lymph nodes in levels II-IV. Materials and methods. In 97 patients with first diagnosed PTC, surgical removal of the cervical lymph node-bearing fat at levels II-IV was performed. All patients underwent preoperative neck ultrasound. The results were verified by histology. Results. Cervical levels II-IV lymph node metastases were revealed in 82 (84,5 %) cases by sonography and in 86 (88,6 %) cases by histology. Ultrasound showed a sensitivity of 93 %, specificity of 81 %, accuracy of 91 %, positive predictive value of 97 % and negative predictive value of 60 %. Of 1620 removed lymph nodes, 443 (27,3 %)...

Purpose of the study. To evaluate the potentialities of ultrasound method in diagnosing cervical lymph node metastasis in patients with first diagnosed papillary thyroid cancer (group 1) and in patients previously treated surgically at different clinics of the Russian Federation and subsequently admitted to the A.F.Tsyb Medical Radiological Research Center — Branch of the National Medical Research Radiological Center to receive radioactive iodine therapy (group 2).Patients and methods. Patients with PTC were divided into two groups. Group 1 included 649 patients with first diagnosed PTC. All the patients underwent thyroidectomy and level VI lymph node neck dissection at the clinic of the A.F.Tsyb Medical Radiological Research Center — Branch of the National Medical Research Radiological Center. Of these patients, 92 patients underwent cervical lymph node dissection including levelsII–III–IV and 9 patients underwent cervical lymph node dissection including level VB. Group 2 consisted of 2875 patients who had previously received surgery at different clinics of the Russian Federation. Subsequently, they were admitted to our institution to receive radioactive iodine therapy. In 291 of these patients, cervical lymph node metastases were found and reoperations were performed: in 89 cases at level VI, in 170 cases at levels II–III–IV and in 32 cases at level VB. The detected metastases were verified histologically.Results. Histology confirmed the presence of nodal metastasis in 57.6% of 649 patients in group 1, and in 10.1% of 241 patients in group 2. In group 1, the incidence of metastatic disease in level VI nodes was 73% and in group 2, it was 30.6%. Metastases in levels II–III–IV were noted in 24.6% of patients in group 1, and in 58.4% of patients in group 2. Level VB metastasis was found in 2.4% of patients in group 1, and in 11% of patients in group 2. Multiple metastases were detected in 75.4% of patients in group 1, and in 20.3% of patients in group 2.Conclusion. Central lymph node metastasis was observed in 73% of patients who were first diagnosed with PTC and treated with thyroidectomy and prophylactic level VI cervical lymph node dissection. In group 2, solitary metastases to lateral lymph nodes occurred more frequently after surgical treatment for PTC, which suggested that the primary treatment was insufficiently radical.

Introduction. Cervical lymph node metastases can occur not only in patients when they are first diagnosed with papillary thyroid cancer but also in patients who have undergone thyroidectomy. Objective. The aim of this study was to assess the potential utility of neck ultrasound in diagnosing cervical lymph node metastases (levels I–VII) in patients who underwent surgical treatment for papillary thyroid cancer.Material and Methods. B-mode sonography of all nodal levels in the neck was performed using a linear array transducer in the frequency range of 7.5–13 MHz, power mapping and panoramic scan to locate regional lymph node metastases. All lymph nodes removed during reoperations were submitted for histological evaluation. Sonographic examinations of cervical lymph nodes of the levels I–VII were performed in 2875 patients who had undergone thyroidectomy in different regions of the Russian Federation. The patients were admitted to our clinic to receive radioactive iodine therapy. All neck levels were assessed by ultrasound.Results. Sonography revealed cervical lymph node metastases in 267 (9.2 %) of 2875 patients with papillary thyroid cancer who had undergone thyroidectomy. Nodal metastasis in level VI only occurred in 70 (2.4 %) patients, in levels II–III–IV only in 150 (5.21 %), in level VB only in 32 (1.11 %), and at the same time in level VI and in levels II–III–IV in 15 (0.52 %) patients. There were no metastases in levels I, VA, VII of the neck. Solitary metastases to all levels were found in 7.5 %, multiple metastases in 1.2 %, and conglomerates in 0.6 % of cases. Solitary metastases in level VI were noted in 56 (1.9 %), in levels II–III–IV in 125 (4.3 %), and in level VB in 29 (1.0 %) patients. Multiple metastases in level VI were detected in 11 (0.38 %), in levels II–III–IV in 21 (0.73 %), and in level VB in 3 (0.1 %) patients. Median metastasis size was 2.1 ± 1.6 cm.Conclusion. Post-thyroidectomy patients were found to have cervical lymph node metastases. Ultrasound scanning of the neck should be considered a key examination if there are cicatricial changes as it enables to identify metastasis and to determine its location. The maximal number of metastases was noted in levels II–III–IV. Cervical lymph node metastases occurred less frequently in the central level and level VB. The predominant metastatic pattern was solitary. There was an essential difference in metastatic spread to cervical lymph nodes between postthyroidectomy patients and patients who were first diagnosed with papillary thyroid cancer.

Purpose of the study. To assess ultrasound features and patterns of features for metastatic papillary thyroid cancer (PTC) in soft tissues of the neck.Materials and methods. The study included 335 histologically confirmed metastases and 102 benign lymph nodes (LN). Statistical processing was carried out in the SPSS program. The reliability between the groups was assessed by criterion t with a significance level of p < 0.05. The informative value of ultrasound signs and patterns of signs, and the probability of the presence of metastasis using binary logistic regression are calculated.Results. The 14 criteria for metastasis have been studied. There are 33 signs, i.e. types of criteria. During the statistical analysis, six most informative criteria were established: calcifications, contours, shape, depth-to-width ratio in the transverse scanning plane, state (differentiation) of the cortical and cerebral layers, echostructure. To create complexes (patterns) of ultrasonic signs, a combination of these signs was used among themselves, and five patterns were established. The first pattern, including the depth-to-width ratio in the transverse scanning plane and the echo structure, has a sensitivity (Se) of 97 %, diagnostic accuracy (Ac) of 96.5 %, area under the curve (AUC) of 96 %, the probability ranges from 95 to 99 %. The Se of the second pattern, including the ratio of depth to width in the transverse scanning plane, echostructure and shape, was 97.2 %, Ac – 96.8 %, AUC – 97.3 %, probability – 95–100 %. The third pattern, including the ratio of depth to width in the transverse scanning plane, nature, shape and contours, and the fourth pattern, including the following criteria, the ratio of depth to width in the transverse scanning plane, echostructure, shape, contours and differentiation into cortical and cerebral layers, have Se 96.9 %, Ac – 97.1 %, AUC – 98.7 %, probability – 88–100 %. The fifth pattern, including the ratio of depth to width in the transverse scanning plane, echostructure, shape; contours; state (differentiation) of the cortical and cerebral layers; calcinates, has Se – 99.6 %, Ac – 99.5 %, AUC – 99.9 %, probability – 94–100 %.Conclusion. Five patterns of metastatic involvement of lymph nodes in PTC were found. The informative value of US increased from the first to the fifth pattern achieving a Se of 99.6 %, Ac of 99.5 %, AUC of 99.9 %. The probability ranged from 94 % to 100 %.