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Cystic lymph node metastases in papillary thyroid carcinoma
Patrick Wunderbaldinger1, Mukesh G Harisinghani, Peter F Hahn
1Department of Radiology, University of Vienna, Waehringer Guertel 18-20, A-1030 Vienna, Austria.
AJR. American Journal of Roentgenology
|February 22, 2002
Summary
Cystic lymph node metastases from papillary thyroid carcinoma often show complex sonographic features like thickened walls and internal structures. Younger patients may present with purely cystic nodes, mimicking benign lesions and necessitating biopsy for accurate diagnosis.
Area of Science:
- Radiology
- Oncology
- Pathology
Background:
- Papillary thyroid carcinoma (PTC) commonly metastasizes to cervical lymph nodes.
- Cystic transformation of lymph node metastases can complicate diagnosis.
- Differentiating cystic nodal metastases from benign neck cysts is clinically important.
Purpose of the Study:
- To describe the sonographic characteristics of cystic nodal metastases from PTC.
- To correlate sonographic findings with pathology for diagnostic clues.
- To aid in distinguishing these metastases from benign cystic lesions like branchial cysts.
Main Methods:
- Retrospective analysis of sonographic findings in 74 patients with 97 histologically confirmed cystic nodal metastases from PTC.
- Categorization of cystic nodes as simple (purely cystic) or complex based on sonographic features.
- Comparison of sonographic findings with gross pathology and histology.
Main Results:
- Most cystic metastases were ipsilateral and located in the jugular chain.
- Cystic nodal metastases were the initial presentation in 14.9% of patients.
- Purely cystic nodes (<6.2%) were observed primarily in patients under 35, mimicking branchial cysts. Complex nodes often had thickened walls, internal nodules, or septations.
Conclusions:
- Sonographic features of thickened outer wall, internal echoes, nodularity, and septations are common in cystic PTC nodal metastases.
- Purely cystic appearance in younger patients can mimic benign cysts, underscoring the need for biopsy.
- Accurate sonographic assessment aids in differentiating malignant cystic nodes from benign conditions.