Cancer Surgery Pre-Operative Lymph Node Evaluation is Important

With the new high frequency ultrasound machines, it is now possible to evaluate the lymph nodes in patients with proven papillary, follicular, or medullary cancer on FNA, prior to the surgery. This will allow the surgeon to add a lymph node removal to the total thyroidectomy and central compartment surgery.Here is a case.

61 Y/O female with FNA proven papillary thyroid cancer on USG FNA, returns for a pre-op neck US lymph node evaluation. There are 3 nodes located lateral to the primary thyroid cancer thyroid nodule. They are suspicious as they do not have hilar lines. These are found in benign nodes, and disappear in cancer nodes.There is chaiotic blood flow in the nodes, on power doppler. They are tall compared to width with a ratio >0.5. Biopsy was positive for papillary cancer, and the Thyroglobulin washings were positive for high levels of TG in the node. The surgeon was notified about positive nodes in zone 4 on the right lateral to the thyroid mass. He was advised to consider node removal along the whole right jugular chain at the time of the standard total thyroidectomy, and central compartment node removal.

What this means to patients with biopsy proven cancer, is that they need a diagnostic Neck lymph node ultrasound with new high frequency untrasound machines, and if a suspicious node is found, then an USguided FNA, and Cancer Tg washing should be done.
This will result in a change in the surgery if positive.


Dr.G.