Thyroid Cancer Preoperative Imaging

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Before removal of thyroid cancer:
    • It is critical to perform a thorough evaluation:
      • To determine the extent of disease
  • Preoperative imaging should include:
    • A comprehensive ultrasound (US) of the neck to examine the contralateral lobe of the thyroid, the central neck compartments, and the lateral neck lymph nodes (LN):
      • Such imaging may change the surgical approach in up to 40% of cases
  • The anterior neck is divided into seven contiguous compartments in which thyroid cancer metastatic LN spread occurs
  • The central neck compartment (level VI) contains the thyroid and poses the greatest challenge to clinicians when deciding the optimal surgery:
    • It is bordered laterally by the carotid arteries, inferiorly by the clavicles, and superiorly by the hyoid bone
    • Level VI is the compartment that is most frequently involved with LN metastases:
      • But sonographic identification of diseased nodes is hampered by poor preoperative sensitivity:
        • The intact thyroid gland obscures visualization of the majority of nodal metastases
  • The lateral neck is further subdivided into four compartments lateral to the carotid:
    • Level IV is bordered laterally by the sternocleidomastoid (SCM), inferiorly by the clavicle, and superiorly by the cricoid cartilage
    • Level III, located immediately cephalad to level IV, extends superiorly to the carotid bifurcation
    • Level II is located below the mandible and extends to the hyoid bone
    • Level V nodes are located in the posterior triangle, lateral to the lateral edge of the SCM.
  • The presence of malignancy in sonographically suspicious nodes:
    • Can be confirmed with FNA for cytologic analysis and measurement of thyroglobulin (Tg) in the needle washout
  • If advanced, bulky nodal disease is identified on US, or the patient has clinical signs or symptoms of advanced disease (hoarseness, hemoptysis, a nonmobile thyroid mass):
    • CT or magnetic resonance imaging (MRI) of the neck may be considered to search for additional metastases in areas that cannot be visualized sonographically, including within the mediastinum, at the skull base, and posterior to the trachea
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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