US Centers Fail to Analyze Neck Lymph Nodes in Preoperative Ultrasounds for Thyroid Cancer

Ultrasound breast screenings for women with dense breast tissue improves cancer detection.
Ultrasound breast screenings for women with dense breast tissue improves cancer detection.
Most imaging centers in the United States fail to analyze lateral neck lymph nodes during preoperative ultrasounds in patients with thyroid cancer.
The following article features coverage from the American Thyroid Association (ATA) 2018 meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.

Most clinics across the United States fail to conduct a complete preoperative evaluation of the neck with high-resolution neck ultrasound of the central and lateral lymph nodes among patients with thyroid cancer, according to a study presented at the 88th  Annual Meeting for the American Thyroid Association in Washington, D.C.1

This “likely contributes to persistent thyroid malignancy, increased health care costs, and patient morbidity,” the authors wrote.

The standard of care for the evaluation of the thyroid and nearby lymph nodes is high-resolution ultrasound. The authors hypothesized that because of this — and  given that ultrasound can predict complete surgical resection and long-term disease-free regional control —ultrasound should be commonly used at US centers.

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The prospective study included 217 consecutive patients with a prior preoperative ultrasound  prior to treatment of their thyroid cancer. The study analyzed whether the prior ultrasound viewed the thyroid and central and lateral lymph nodes, as well as patient demographics, histopathologic variables, and disease stage.

The median age of the patients was 41 years and 70% were female. Patients originated from the southwest of the United States (31%) or other regions (69%).

The study found that just 2% of prior preoperative ultrasound studies evaluated any lateral neck lymph nodes. The high-resolution ultrasound performed as part of the study’s protocol identified neck metastasis in 18%, central lymph node disease in 28%, and contralateral second primary thyroid disease in 2% of patients.

In the study, 46% of patients had T1 disease, followed by 18% with T2, and 35% with T3 or T4.

The authors concluded that “preoperative analysis of suspicious and malignant thyroid nodules is inadequate in imaging centers throughout the United States.”

Read more of Cancer Therapy Advisor‘s coverage of the ATA 2018 meeting by visiting the conference page.


  1. Clayman GL, Bushuev D, Green L, Norman J. A national epidemic of inadequate preoperative neck ultrasound in the evaluation of suspicious or malignant thyroid nodules and cervical lymph nodes. Presented at: the 88th Annual Meeting of the American Thyroid Association; Washington, D.C.: October 3-7, 2018. Abstract clinical oral 19.

This article originally appeared on Cancer Therapy Advisor