Ultrasound-guided Fine-needle Aspiration of Cervical
Lymph Nodes
Î Ultrasound evaluation (''mapping'') of bilateral lymph node compartments
1–6 should be performed routinely in the preoperative evaluation of patients
with definitive cytologic evidence of carcinoma (positive FNA).
Î Screening for distant metastasis is generally not performed prior to initial
surgery for differentiated thyroid cancers.
Î It is mandatory that the needle tip is visualized within the target lymph node
during the FNA to assure specimen accuracy.
• For a description of technique please see full text article.
(http://online.liebertpub.com/doi/full/10.1089/thy.2014.0096)
Table 1. Preoperative Ultrasound Scanning Technique
Equipment: High-frequency linear array probe.
Positioning: Hyperextension of neck.
Primary lesion: Assess size, multiplicity, margin, invasion of deep structures.
Central compartment lymph nodes (level 6): Scan from submental area to sternal notch. Scan
three distinct areas: pretracheal, right paratracheal, and le paratracheal. Turn head away from
side of interest to image tracheoesophageal groove. Angle transducer inferiorly to examine
mediastinum.
Lateral compartment lymph nodes (levels 2, 3, and 4): Scan from mandible to clavicle. Angle
transducer inferiorly at clavicle to image infraclavicular nodes at base of level 4.
Posterior compartment lymph nodes (level 5): Sweep laterally along clavicle to posterior border
of sternocleidomastoid muscle, then trace posterior border superiorly to mastoid process.
Table 2. Ultrasound Features Predictive of Malignant Lymph
Node Involvement
Criterion Sensitivity Specificity
Size >1 cm 68% 75%
Shape (ratio of long axis to short axis <2.0) 46% 64%
Punctate calcifications 46% 100%
Peripheral hypervascularity 86% 82%
Adapted from Leboulleux et al. Neuroimaging Clin N Am 18:479–489, vii–viii.
Diagnosis
