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What is Thyroid Cancer Ultrasound Lymph Node Mapping, and why do I need to have one BEFORE my Cancer Surgery?

Posted Jun 24 2009 2:05pm 6 Comments
Prior to the new approach to thyroid cancer, the radio-iodine whole body scan WBS, was the mainstay of diagnostic cancer studies. Along came highly sensitive cancer markers, Thyroglobulin TG, and the TG antibody. The WBS was poor at detecting recurrence. The addition of the newer high frequency ultrasound was better at finding recurrences, than the WBS. With Cancer markers and Ultrasound we can find the cancer that is missed with WBS, and even after a post treatment scan. The lymph node mapping by high frequency ultrasound can find tumor recurrence even when the WBS, TG and PET/CT are negative! Well if it is that good after the surgery, maybe it is good PRIOR to the original surgery. In fact if you have a qualified clinical thyroidologist, and thyroid ultrasonographer map your neck BEFORE the original surgery, it will expand the scope of the first surgery in 20-30% of the patients with a positive needle biopsy confirming cancer or is suspicious of thyroid cancer. The expanded surgery would include the lateral neck nodes on the side of the positive node biopsy. Modern thyroid cancer pre-op should include a lymph node mapping. INSIST on one before the surgery.It will save you another surgery in 1-5 years. The first surgery is the most important. Recurrences will be less likely if positive nodes, which would be still left in the neck were not removed at the original surgery. The use of MR,CT or PET/CT will not be as accurate as Ultrasound in the right operators hands at finding your neck node disease. Ask your endocrinologist or internist to refer you to an endocrine neck ultrasound lab where a clinical thyroidologist, and ultrasonographer can help him. My referral endocrine neck ultrasound lab website is www.endocrineneck.com.

Case Presentation:

56 Y/O female was seen 6 weeks after total thyroidectomy for a needle biopsy proven papillary thyroid cancer. The internist sent her for management of the cancer, after the surgery. The cancer marker on Thyroid hormone was <0.1, and the TSH was 0.09. However the lymph node mapping found cancer nodes in the right neck. The ultrasound guided FNA biopsy was negative for cytology, but was positive for TG in the washings from the largest node. It is common that the cytology will miss the tumor , but the TG will be found in the node. Any TG in the node is abnormal.The patient was shocked that a node study was not done before the first surgery. I told her it was relatively new information,and not well known by non-specialists. The patient was sent back to surgery to do a modified neck dissection. 4/15 nodes were positive for metastatic thyroid cancer in the neck.

The best time to send a patient to the clinical thyroidologist is when the nodule is first found, not after the biopsy, and surely not after the crucial first surgery.

Good Luck,
Dr.G.
Comments (6)
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I have a enlarged ymph on my neck it is not Cancer ... My doc, wants it taken out but the doc, what is the surgery like ??? Is there big resk's with it ??? How long would I have to be out of work ???

4 things needed to be done before the surgery.

A consultation with a clinical thyroidologist or endocrinologist.

Also,

1. second opinion on the FNA  pathology.

2. serum thyroglobulin or calcitonin cancer markers.

3. US lymph node mapping. If it is positive for cancer nodes the original surgery must be  altered to include neck dissection. This will save you recurrences later, by doing both at the original surgery. The mapping changes the original surgery 30% of the time. 

To get the slides from the biopsy copy the records release form on thyroid.com.

Ask for all the slides and the report.

Send them to  an outside thyroid cytology expert. 

I felt a palpable lump on my neck. After an ultrasound, CT scan & biopsy, I was diagnosed with thyroid cancer (well-differentiated papillary carcinoma). Had a total thyroidectomy with limited neck dissection done. Had complications after surgery, was entubated, almost had a tracheostomy done, and ended up with vocal cord immobility. But the palpable node is still there. Can't get radiodine ablation because as per 123 uptake, palpable node wont take that therapy. Therefore, i need a more exensive neck dissection. But no other surgeon will perform till my vocal cord immobility is fixed. Latest news, my vocals are getting better but need augmentation injections. I am just so confused over all this situation. COuld any of these issues been prevented? Why wasnt that lump removed?

Please advise. 

i noticed a lump om my left side of neck.then went for thyroid test anultrasound scan,whose reports show thatCYSTIC CHANGE COLLOID GOITRE.

MICROSCOPIC EXAMINATION:SHOWS THICK AND THIN COLLOID WITH CYST

MACROPHAGES,DEGENERATED EPITHELIAL CELLS AND FEW RBC.NO MALLIGNANT CELLS  SEEN .then i went for thyroid scan which shows the report that

LEFT ENLARGED GLAND WITH COLD AREA IN ISTHUMUS AND LEFT LOWER POLE OF THYROID GLAND

SUGGESTED CLINICAL AND FNAC AND USG CORELATION.

plz advise me further and which dr i shud consult? 

I underwent breast augmentation after I had a sentinel node removed, and I have to warn you that sometimes it’s better to pay a little bit more and go to a more reputable doctor.  I’m not going to list his name because it’s not like a got an infection or was a victim of malpractice or anything – it’s just that he has a poor eye for his work, to put it mildly.  If you really want to see what I mean (and have the constitution for this sort of thing) look at the breast augmentation before and after pictures.  I understand that I am still recovering from the removal of the lymph node, but this is obviously a botched job here.  I guess that’s what I get for getting the operation in Chula Vista. 
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