RESUMEN
INTRODUCTION: Lateral lymph node metastasis is common in papillary thyroid microcarcinoma (PTMC). The present study evaluated the clinicopathologic characteristics and ultrasonographic (US) findings in predicting lateral LNM from PTMC in eastern China. MATERIALS AND METHODS: A total of 176 patients with confirmed PTMC by final histological examination who underwent central lymph node dissection (LND) and lateral LND were enrolled in our study. The clinicopathological and US data from the cases were analyzed retrospectively to determine the independent predictive factors for lateral LNM. Then, a scoring system was developed on the basis of independent factors. The sum of the points for individuals was evaluated for the value in predicting lateral LNM. RESULTS: Central LNM, underlying Hashimoto's thyroiditis, upper pole location, no well-defined margin and presence of calcifications were independent predictive factors for lateral LNM on multivariate analysis. Clinicopathological and US index points were statistically significant, with ≤ 2 favoring lateral LNM negativity with a sensitivity of 83.3 %, positive predictive value of 89.6 % and negative predictive value of 72.9 %. CONCLUSIONS: When the evaluation for lateral lymph nodes from a preoperative approach is inadequate or not obvious, our scoring system for prediction of lateral LNM can be another choice. Patients with clinicopathological and US index points ≤ 2 could be considered as lateral LNM negative, so more diagnostic approach is recommended for patients with clinicopathological and US index points >2.
Asunto(s)
Carcinoma Papilar/secundario , Ganglios Linfáticos/patología , Neoplasias de la Tiroides/patología , Adolescente , Adulto , Anciano , Carcinoma Papilar/diagnóstico por imagen , China , Femenino , Enfermedad de Hashimoto/patología , Humanos , Ganglios Linfáticos/cirugía , Metástasis Linfática , Masculino , Persona de Mediana Edad , Curva ROC , Estudios Retrospectivos , Neoplasias de la Tiroides/diagnóstico por imagen , UltrasonografíaRESUMEN
OBJECTIVE: To determine whether a normal technetium-99m-labeled dimercaptosuccinic acid (DMSA) renal scan obviates the need for voiding cystourethrography (VCUG) in evaluating young children after their first urinary tract infection (UTI). STUDY DESIGN: This was a 10-year retrospective review of 142 children (age < or = 2 years, 77 boys and 65 girls) who had their first UTI and were admitted to a tertiary care general hospital. The association between DMSA renal scan results and VCUG results performed 48 hours and 1 month after diagnosis was evaluated. RESULTS: DMSA renal scans and VCUG were performed in 142 patients. Of these, 99 patients (69.7%) had evidence of pyelonephritis, although only 2 (1.4%) had evidence of renal scarring; 42 (29.6%) had vesicoureteral reflux (VUR) on VCUG. The sensitivity, specificity, positive and negative predictive values, and likelihood ratio negative for abnormalities on DMSA renal scans for detecting the the presence of VUR on VCUG were 88% (95% confidence interval [CI] = 73% to 100%), 36% (95% CI = 26% to 46%), 37% (95% CI = 27% to 46%), 88 % (95% CI = 73% to 100%), and 0.33 (95% CI = 0 to 0.88), respectively. CONCLUSIONS: Children with a negative DMSA renal scan during their first UTI episode rarely have VUR and may never have high-grade VUR. Avoiding VCUGs in children with negative DMSA renal scans could significantly reduce the use of this potentially traumatic test.