PREOPERATIVE DETECTION OF LYMPH NODES METASTASIS IN PATIENTS WITH PAPILLARY THYROID CARCINOMA

Osama F. Ibrahim*, Prof. Dr. Magdy M. Mostfa, Prof. Dr. Ashraf A. Abdulmoneim, Prof. Dr. Ibrahim H. Mohamed

ABSTRACT

Background: Thyroid cancer is the most common endocrine malignancy and there have been a steady increase in its incidence over the past 15-20 years, It accounts for approximately 1% of all malignancies in developed countries with an estimated annual incidence of 122,000 cases worldwide. Aim: The aim of this study is to assess the diagnostic efficiency of preoperative ultrasonography and FNAC to detect lymph node metastasis in patients with PTC. Patients and methods:- In randomized descriptive study, A total of 30 unselected patients suffering from papillary thyroid cancer were treated in Al-Azhar University hospital from 2013 to 2016; all were treated for curative intent. For all patients were subjected to proper history taking including age, sex, occupation, associated other medical illness and then proper general and local examination. Then thyroidectomy and central neck dissection in addition to ipsilateral neck dissection for all patients and proceed to contralateral neck dissection if ipsilateral lymph nodes are positive in ultrasound. Results: Of 30 patients, With known thyroid cancer, neck metastases are often not detectable on routine physical examination. Both the central and lateral neck compartments can harbor nonpalpable, occult metastases. Postoperative anatomic changes add to the challenge of detecting disease by physical examination alone. Various imaging modalities can assist in detecting occult metastases. Preoperative neck US is recommended to assess the thyroid lobes and cervical lymph nodes for all patients undergoing thyroidectomy for malignant cytological findings on biopsy. Conclusion: Preoperative Ultra-sound can detect cervical node metastasis with high sensitivity and specificity. Central lymph node dissection prevents nodal recurrence in the central compartment which carries a high incidence of morbidity during surgery for this recurrence.

Keywords: total thyroidectomy, central lymph node dissection, lateral lymph nodes dissection.