PREOPERATIVE MAPPING IN THYROID CANCER: A STANDARDIZED METHOD FOR IMPROVING SURGICAL PLANNING PERFORMANCE OF LYMPH-NODE DISSECTION

Pre-surgical planning is a critical time for succesfull endocrine surgery: it's essential to provide patients with a personalized plan to minimize operative and postoperative risks. Preoperative mapping is a structured high-resolution echotomographic examination performed in the simultaneous presence of two endocrinologist and the surgeon to produce a reliable "anatomical guide" before surgery. The aim of this study is to evaluate preoperative mapping as a standardized method in the diagnostic pathway of thyroid neoplasia. This study involved 105 patients who underwent thyroidectomy and neck lymph node (LN) dissection between 2015 and June 2023 for thyroid cancer. The performance of diagnostic mapping was evalueted dividing the sample according to age, sex and BMI. Preoperative data were collected and their usefulness as a predictor of LN malignancy was calculated using multivariate analyses (MVA). A model including all preoperative data was constructed; their diagnostic performances were calculated and compared to the mapping ones. The diagnostic performances of the mapping obtained are: latero- cervical LN (LC-LN) (Sensitivity 100%, Specificity 88.8%, PPV 71.9%, NPV 100%); central LN (CC-LN) (Sensitivity 45.7%, Specificity 95.6%, PPV 84.2%, NPV 77.4%). For each of the preoperative data studied by MVA, the p is always >0.05. The diagnostic performances of the obtained model are: LC-LN (Sensitivity 33.3%, Specificity 95.4%, PPV 62.5%); CC-LN (Sensitivity 56%, Specificity 87.3%, PPV 66.7%) Mapping turns out to be an excellent tool for studying LC-LN. None of the preoperative data considered has proven to be a valid tool to predict LN malignancy. The performance of the diagnostic model didn't exceed the mapping' performance.