Thyroid Cancer 101: Failure to Study Lateral Neck During Inadequate Thyroid Ultrasound
- Preoperative ultrasound imaging of thyroid nodules of concern for malignancy rarely includes lateral neck imaging.
- Poor ultrasounds lead to incomplete surgeries, incomplete evaluation, persistent disease, and patient morbidity.
- Ultrasound of just the thyroid was the old standard.
- People with papillary thyroid cancer had lymph node involvement and about a third of patients who have a biopsy-proven thyroid cancer also wind up having lymph node involvement.
- Endocrine training and certification in endocrine neck ultrasound, ECNU includes the lateral neck.
- Find a specialist in endocrine neck to do your pre-surgery neck ultrasound. It can save you from multiple surgery in your future.
- Go to AACE.com and look for ECNU certified endcrinologist near you.
- Skipping lateral neck lymph nodes can and often does result in the need for additional surgery.
- 4/217— just 2% — of the ultrasound studies obtained prior to referral included analysis of any lateral neck lymph nodes.
- Example of a lateral neck cancer lymph node missed if just the thyroid was included in the study before surgery.
Inadequate Thyroid Ultrasound a ‘National Epidemic’ in US
This comes despite the accepted gold standard of the comprehensive evaluation of suspicious nodules to include the lateral neck, as well as the thyroid, as critical components of any such ultrasound, reported Gary L. Clayman, MD, of the Clayman Thyroid Surgery Center, Thyroid and Parathyroid Institute of Tampa General Hospital, Florida.
“This is clearly a glaring problem that is leading to incomplete surgeries, incomplete evaluation, persistent disease, and patient morbidity,” Clayman told Medscape Medical News.
The situation represents a “national epidemic” that needs to be addressed by the collective medical organizations involved in thyroid medicine, he added.
“This is a call to arms to bring about change through national diagnostic imaging organizations.”
Asked for comment, Gregory W. Randolph, MD, professor of otolaryngology, Harvard Medical School, in Boston, Massachusetts, noted that not long ago, ultrasound of just the thyroid was the standard.
“It used to be that 20 years ago you would just get a thyroid ultrasound, but then it became clear that a lot of people with papillary thyroid cancer had lymph node involvement and we now know that about a third of patients who have a biopsy-proven thyroid nodule also wind up having lymph node involvement in one or more areas of the neck,” Randolph, who is the Claire & John Bertucci Endowed Chair in Thyroid Surgical Oncology, told Medscape Medical News.
“So, knowing the importance of the lateral neck, I will get very meticulous neck ultrasounds,” he said. “I will even get CT scans of the neck and look at those. But not every center moves along at the same rate, and this paper is helpful in showing that.”
Thyroid Nodules and Cancers Diagnosed by Wide Variety of Specialists
Thyroid nodules and cancers are commonly diagnosed by wide-ranging practitioners, often including those outside of the fields of endocrinology, and even endocrinologists often do not perform their own ultrasound evaluations, resulting in varying levels of skill in the evaluations.
Meanwhile, with thyroid cancers commonly involving one or more areas including the lateral neck or lymph nodes, preoperative ultrasound imaging is only considered to be comprehensive if those areas are included — skipping them can and often does result in the need for additional surgery.
To determine how often the comprehensive evaluations of the neck are conducted in thyroid evaluations, Clayman and colleagues identified 217 patients who had been referred to their center in 2017 for management of primary thyroid malignancy and whose preoperative ultrasounds were obtained prior to the patients receiving definitive high-resolution ultrasound at their center.
Of the patients, 66 were men and 151 were women. They were a median age of 41 years (range 14 to 87).
The information the researchers received about the patients, which included ultrasound, histopathologic details, and cancer staging, showed that only four — just 2% — of the ultrasound studies obtained prior to referral included analysis of any lateral neck lymph nodes.