Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2
Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2
Chapter 8Ultrasound in the Managementof Thyroid CancerH. Jack BaskinINTRODUCTIONThe strategic value of ultrasound in the postoperative surveillance of Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2f patients with thyroid cancer and in the preoperative surgical planning of patients undergoing thyroid cancer surgery has become increasingly appreciated over the past decade. In this chapter we will focus on how to recognize and differentiate malignant lymph nodes from benign lymphadenopathy. Once Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2 you become familiar with the appearance of metastatic lymph nodes in thyroid cancer, you will find that ultrasound is a more specific tool for separaEbook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2
ting benign from malignant lymph nodes than it is for separating benign and malignant thyroid nodules. However, we still must rely on ultrasound-guideChapter 8Ultrasound in the Managementof Thyroid CancerH. Jack BaskinINTRODUCTIONThe strategic value of ultrasound in the postoperative surveillance of Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2ve been treated for thyroid cancer. In spite of better surgical techniques, the acceptance of total and near-total thyroidectomy, and the increasing use of radioiodine, the mortality rate from well-differentiated thyroid cancer has changed very little over the past thirty years. Because of its prope Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2nsity to occur at any age, even in the very young, and to recur many years later, thyroid cancer must be monitored for the lifetime of the patient. SuEbook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2
rveillance of these patients in a cost-effective manner has been a challenge. Until the 1990s the only diagnostic tool available was a 1?1I whole bodyChapter 8Ultrasound in the Managementof Thyroid CancerH. Jack BaskinINTRODUCTIONThe strategic value of ultrasound in the postoperative surveillance of Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2in (Tg) but negative diagnostic scans who are treated with 131I and have positive post-treatment scans (1-4). Park et al. have also shown that the doses of 131I used for WBS can stun the uptake of iodine in metastatic lesions and interfere with the subsequent treatment dose of ,3lI (5). The expense, Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2 poor sensitivity, and risk of stunning with a WBS make it an unsatisfactory test with which to follow patients with thyroid cancer.In the last decadeEbook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2
several new probes have been developed that aid in the early detection of recurrent thyroid cancer. These include: (1) sensitive, reliable, reproduciChapter 8Ultrasound in the Managementof Thyroid CancerH. Jack BaskinINTRODUCTIONThe strategic value of ultrasound in the postoperative surveillance of Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2 stimulation without thyroid hormone withdrawal; and (3) high-resolution ultrasound of the postoperative neck to identify early lymph node recurrence. Using these new tools, especially neck ultrasound combined with UG FNA of suspicious lymph nodes, has greatly improved the sensitivity of cancer surv Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2eillance in these patients. Hopefully, their use will result in lower mortality from thyroid cancer.Physical examination of the neck of a patient whoEbook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2
has undergone a thyroidectomy for thyroid cancer is seldom helpful in the early detection of a recurrence. The scar tissue following surgery, combinedChapter 8Ultrasound in the Managementof Thyroid CancerH. Jack BaskinINTRODUCTIONThe strategic value of ultrasound in the postoperative surveillance of Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2in the neck difficult. Even lymph nodes several centimeters in diameter are often not palpable. High-resolution ultrasound has solved this problem by proving to be a very sensitive method to find and locate early recurrent cancer and lymph node metastasis. Frasoldati et al. (6) studied 494 patients Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2with a history of low risk well-differentiated thyroid cancer by a withdrawal WBS, stimulated Tg, and ultrasound, and found by at least one test thatEbook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2
51 had had a recurrence. The WBS was positive in 23 patients (45%), the Tg was positive in 34 patients (67%), and the ultrasound with FNA was positiveChapter 8Ultrasound in the Managementof Thyroid CancerH. Jack BaskinINTRODUCTIONThe strategic value of ultrasound in the postoperative surveillance of Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2Therefore, neck ultrasound has proven to be the most sensitive test available in locating early recurrent disease, even before serum Tg is elevated.ULTRASOUND OF THE POSTOPERATIVE NECKULTRASOUND MANAGEMENT OF THYROID CANCER I 13ultrasound of the neck in a patient who has undergone a thyroidectomy. o Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2ne sees that the carotid artery and jugular vein have migrated medially close to the trachea, and that the thyroid bed has been filled with a varyingEbook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2
amount of hyperechoic connective tissue that appears white (dense) on ultrasound. This serves well in demarcating a recurrence of cancer or a metastatChapter 8Ultrasound in the Managementof Thyroid CancerH. Jack BaskinINTRODUCTIONThe strategic value of ultrasound in the postoperative surveillance of Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2amining the neck of someone who underwent a thyroidectomy or hemithyroidectomy for benign disease. This allows one to become accustomed to the neck structures and the altered anatomy of the postoperative neck without worrying about recurrent thyroid cancer.The commonest areas for detecting cancer ar Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2e the thyroid bed and the jugular chain of lymph nodes, but metastatic lymph nodes may occur anywhere in the neck. In performing ultrasound looking foEbook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2
r metastatic lymph nodes, the entire length of the internal jugular vein from the head of the clavicle up to the mandible is searched, paying close atChapter 8Ultrasound in the Managementof Thyroid CancerH. Jack BaskinINTRODUCTIONThe strategic value of ultrasound in the postoperative surveillance of Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2medial to the common carotid artery. Malignant paratrachael lymph nodes in this area are likely to metastasize more quickly to the mediastinum and lungs.Fig. 8.1. Normal postoperative left neck. Note that the common114 H.J. BASKINFig. 8.2. Normal postoperative right neck. In this patient the vein re Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2mains lateral to the artery, but still lies adjacent to it. The strap muscles (sm) have helped fill in the space left by removal of the thyroid.The noEbook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2
rmal neck contains approximately 300 lymph nodes. Except for the pharyngeal area, they are usually less than 0.5 cm in their short axis and flattened Chapter 8Ultrasound in the Managementof Thyroid CancerH. Jack BaskinINTRODUCTIONThe strategic value of ultrasound in the postoperative surveillance of Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2ut generally maintain this flattened or oval shape. High-resolution ultrasound often shows a white line of fat and intranodal blood vessels running through the center of the lymph node referred to as a hilar line. The hilar line is present in most benign lymph nodes greater than 0.5cm and is also mo Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2re prominent in older patients. A hilar line is seldom seen in malignant lymph nodes. Because lymph node hyperplasia is so common in the neck, only thEbook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2
ose lymph nodes >0.5cm in the short axis are usually biopsied. Those with a short axis 0.5cm (0.8cm in the pharyngeal area) or less should have their Chapter 8Ultrasound in the Managementof Thyroid CancerH. Jack BaskinINTRODUCTIONThe strategic value of ultrasound in the postoperative surveillance of Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2 a short/long axis ratio >0.5. Postoperative ultrasound surveillance for cancer is done in the transverse view, since all lymph nodes may appear elongated in the longitudinal view.In addition to a rounded shape and the absence of a hilarULTRASOUND MANAGEMENT OF THYROID CANCER I 15Table 8.1. Neck lym Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2ph node characteristicsBenignMalignantShort,'Long Axis<0.5>0.5Hilar linePresentAbsentJugular Deviation or CompressionAbsentPresentMicrocalcificationsAEbook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2
bsentPresentCystic NecrosisAbsentPresentVascularityCentralChaotic/peripheralFig. 8.3. Benign lymph node. The normal neck contains scores of lymph nodeChapter 8Ultrasound in the Managementof Thyroid CancerH. Jack BaskinINTRODUCTIONThe strategic value of ultrasound in the postoperative surveillance of Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2ins lateral or migrates anterior next to the carotid artery in the postoperative neck. Since metastatic nodes commonly occur in proximity to the jugular vein or in the carotid sheath, any deviation of the jugular vein away from the carotid artery strongly suggests malignancy. The entire length of th Ebook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2e vessels should be surveyed closely with particular attention given to any area where the artery and vein diverge.In addition to causing deviation ofEbook Thyroid ultrasound and ultrasound guided FNA (2nd edition): Part 2
the internal jugular vein, malignant lymph nodes tend to compress the vein and cause a partial obstruction to blood flow. Benign lymph nodes rarely dChapter 8Ultrasound in the Managementof Thyroid CancerH. Jack BaskinINTRODUCTIONThe strategic value of ultrasound in the postoperative surveillance ofGọi ngay
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