Preoperative Visualized Ultrasound Assessment of the Recurrent Laryngeal Nerve in Thyroid Cancer Surgery: Reliability and Risk Features by Imaging

Abstract

Background

Preoperative identification and visualization of tumor infiltration of the recurrent laryngeal nerve (RLN) in patients with thyroid cancer is important. The purpose of our study was to evaluate the reliability and feasibility of preoperative assessment by ultrasound and to identify ultrasound imaging features potentially associated with tumor infiltration of the RLN.

Methods

In this prospective study, patients undergoing thyroid cancer surgery at our institution between August 2020 and January 2021 were included, and preoperative ultrasound visualization of the RLN and thyroid lesions was performed. RLN infiltration was also confirmed surgically in all cases. Five patients with enlarged lymph nodes were selected to undergo injection of carbon nanoparticles to confirm the correctness of RLN identification by preoperative ultrasound. The repeatability of RLN assessment by ultrasound was evaluated by comparing the correlation between pre- and intraoperative, intra- and inter-group assessments. Parameters of normal RLNs according to age, sex, and body mass index were established. Finally, ultrasound imaging features of patients with RLN tumor infiltration were analyzed to identify potential risk predictors.

Results

According to the ultrasonic assessment, RLNs of 70 patients appeared normal, while 14 of those patients appeared to be infiltrated by tumors. During surgery, the 70 cases of normal RLNs were confirmed, but only 8 of the 14 suspected cases of infiltration were confirmed. In all five patients injected with carbon nanoparticles, the location of RLNs adjacent to the marked lymph nodes observed by surgeons corresponded to the RLN location identified by preoperative ultrasound. The repeatability of RLN estimation varied from moderate to excellent. There were no significant differences in cross-sectional area, width, or thickness of normal RLNs according to age, sex, or body mass index. Indistinct margin with tumor, incontinuous shape as ultrasound features by the analysis of patients with surgically confirmed RLN infiltration were associated with tumor invasion.

Conclusion

We show that preoperative ultrasound can be applied to visualize the RLN and may help predict tumor infiltration of the RLN.

Keywords:

• recurrent laryngeal nerve
• ultrasound
• visualization
• reliability

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethical Approval Statement

The study was approved by the Medical Ethics Committee of West China Hospital, Sichuan University, and it was conducted in strict accordance with the principles of the Declaration of Helsinki (as revised in 2013). Before enrollment, patients were informed about the procedures, and written informed consent was obtained. A statement covering patient data confidentiality was fully respected during data collection and the preparation of the manuscript.

Disclosure

The authors report no conflicts of interest related to this work.