The inferior deep cervical lymph nodes, the juguloomohyoid nodes, and the supraclavicular, or scalene, nodes are considered deep jugular nodes. They are known as the lateral jugular, anterior jugular, and jugulo-digastric lymph nodes. Posterior lymph nodes are located along the back of the neck.ĭeep cervical lymph nodes are associated with their positions adjacent to the internal jugular vein, which runs near the sides of the neck. Paratracheal nodes are located near the sides of the trachea. Pretracheal nodes are positioned in front of the trachea, or windpipe, at the bottom center of the neck. If a palpable node is located, describe it with detail (painful, hard, indurated). For the anterior cervical lymph node exam, palpate the lymph nodes in the neck using circular motion over the underlying tissues in each area. Thyroid lymph nodes lie near the thyroid gland, just above the center of the collarbone. The lymph node examination is performed with circular motion, identifying pain, and swollen ganglia or induration. Prelaryngeal lymph nodes are located in front of the larynx, or voice box, near the middle and center of the neck. The anterior cervical lymph nodes are further down the front of the neck, divided into prelaryngeal, thyroid, pretracheal, and paratracheal, based on their position near structures of the throat. The risk of malignancy in thyroid nodules increases with the presence of suspicious ultrasonographic features on cervical lymph nodes.Anterior superficial and deep nodes include submental and submaxillary (tonsillar) nodes located under the chin and jawline, respectively. Superficial Cervical: The superficial cervical lymph nodes can be divided into the superficial anterior cervical nodes and the posterior lateral superficial. Lymph nodes, situated all over the body, are part of the lymphatic. While as opposed to benign looking ECLN, ECLN with only one suspicious feature had a PPV of 70.97%, NPV of 50.00%, sensitivity of 33.33%, and specificity of 83.02%, and ECLN with two or more suspicious feature had a PPV of 73.91%, NPV of 48.96%, sensitivity of 25.76%, and specificity of 88.68%.ĮCLN are associated with an increased likelihood of thyroid malignancy in the patients undergoing evaluation of a suspicious nodule. Cervical lymphadenopathy refers to the swelling of lymph nodes located in the neck. Benign appearing ECLN had a positive predictive value (PPV) of 41.54%, negative predictive value (NPV) of 59.02%, sensitivity of 51.92%, and specificity of 48.65% in predicting malignancy as opposed to the absence of ECLN. Of the 119 patients with ECLN, 54.6% had benign appearing ECLN with no suspicious features, 26.1% had one suspicious feature, and 19.3% had more than one suspicious features. ECLN (>1 cm) were found in 66 (46.5%) patient with PTC compared to only 53 (17.8%) patients with benign nodules (P < 0.001). On final pathology, PTC was found in 142 patients (32.3%), the remaining 298 (67.7%) exhibited benign findings. Patients with malignancy other than papillary thyroid cancer (PTC) were excluded.
Ultrasonographic features of the identified cervical lymph nodes were correlated with the final pathology report. Radiological and surgical reports were retrospectively reviewed for the patients with suspicious thyroid nodules who underwent thyroidectomy and preoperative comprehensive neck US. We aim to investigate the significance of enlarged cervical lymph nodes (ECLN) identified by initial surgeon-performed ultrasound (US) as a tool for determining the risk of malignancy in the patients presenting with suspicious thyroid nodules.
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