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Best of Scientific Oral Presentations

Pediatric Otolaryngology

Lymph Node Metastasis Undetected by Ultrasound in Pediatric Thyroid Malignancies

Sunday, October 18, 2026
4:54 PM - 5:00 PM PT
Location: West Exhibit Hall A, Learning Zone 6

    Presenting Author(s)

  • Brooke B. Swain, BS

    Medical Student
    Vanderbilt University School of Medicine
    Mobile, AL, United States

    • Co-Author(s)

  • Kalpnaben R. Patel, MD,CCRP

    Pediatric Otolaryngology Research Coordinator
    Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
    Franklin, TN, United States

  • LD

    Liping Du, PhD

    Research Assistant Professor of Biostatistics
    Vanderbilt University Department of Biostatistics, United States

    • Senior Author(s)

  • Ryan H. Belcher, MD, MPH

    Associate Professor
    Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
    Nashville, Tennessee, United States

Disclosure(s):
Brooke B. Swain, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Kalpnaben R. Patel, MD,CCRP:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Ryan H. Belcher, MD, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Pediatric PTC can often metastasize to cervical or central neck lymph nodes. Metastatic lymph nodes may appear benign on preoperative ultrasound or not be detectable at all, only to be identified on final pathology after selective neck dissection. This study characterizes the rates and risk factors of undetected nodal metastasis.

Methods: Pediatric patients ( < 18 years) who underwent total or completion thyroidectomy for PTC from 2010-2025 were included. Level-specific cervical lymph node findings on ultrasound were compared with surgical pathology. The primary outcome was lymph node metastasis undetected by ultrasound. Risk factors were evaluated using univariate logistic regression, with covariates including age, BMI, tumor size, multifocality, extrathyroidal extension, angioinvasion, extranodal extension, and positive lymph node ratio.

Results: Twenty-five patients (mean age 14.1 years) met inclusion criteria, including 22 central neck dissections and 12 lateral neck dissections (3 bilateral). No dissections had undetected metastasis at level II. Undetected nodal metastasis occurred in 3 neck dissections (25.0%) at level III, 4 dissections (40.0%) at level IV, and 16 dissections (94.1%) at level VI. On univariate analysis, the presence of extrathyroidal extension was associated with a higher odds of undetected lymph node metastasis (OR 0.06, 95% CI 0.01-0.52, p=0.011), and higher positive lymph node ratio trended towards a greater likelihood of undetected nodal metastasis (OR 0.1, 95% CI 0.01-1.06, p=0.056). Tumors 2-4 cm were more likely to detect nodal metastasis on ultrasound imaging (OR 6.11, 95% CI 1.06-35.35, p=0.043).

Conclusions: Ultrasound underestimates nodal disease in pediatric PTC, particularly in the central neck. Higher nodal burden, extrathyroidal extension, and smaller tumor size ( < 2cm) may contribute to undetected metastasis, demonstrating potential limitations of ultrasound-based staging and post-operative treatment if lymph nodes not detect preoperatively.