Predictive Factors for Extrathyroidal Extension of Papillary Thyroid Carcinoma Based on Preoperative Sonography

Lee, Chang Yoon; Kim, Soo Jin; Ko, Kyung Ran; Chung, Ki-Wook; Lee, Joo-Hyuk

doi:10.7863/ultra.33.2.231

Cited by 55 publications

(49 citation statements)

References 32 publications

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“…However, a subcapsular location, defined as thyroid nodules abutting on the thyroid capsule on US imaging, may be a pre-operative imaging biomarker indicative of ETE. 28 A subcapsular location was significantly associated with risk of LCLN metastasis in this study. This imaging biomarker has an advantage over ETE in that it can be easily identified during the pre-operative examination.…”

Section: Discussionsupporting

confidence: 53%

“…In this study, we focused only on the pre‐operative features of PTMCs and did not evaluate any potential association between ETE and the risk of LCLN metastasis. However, a subcapsular location, defined as thyroid nodules abutting on the thyroid capsule on US imaging, may be a pre‐operative imaging biomarker indicative of ETE . A subcapsular location was significantly associated with risk of LCLN metastasis in this study.…”

Section: Discussionmentioning

confidence: 57%

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Features of papillary thyroid microcarcinoma associated with lateral cervical lymph node metastasis

Jeon

Chung

Kwon

et al. 2017

Clinical Endocrinology

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 57%

Features of papillary thyroid microcarcinoma associated with lateral cervical lymph node metastasis

Jeon

Chung

Kwon

et al. 2017

Clinical Endocrinology

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“…This study included 76 patients with ETE and/or nodal metastasis and six patients without clinical ETE or nodal metastasis. The former may have more aggressive biological behavior compared to the latter, low risk patients (Pacini et al 2006, Cooper et al 2009, Park et al 2009, Lee et al 2014. Therefore, the rate of multifocal PTC may be different in all solitary PTC.…”

Section: Discussionmentioning

confidence: 99%

“…A single thyroid nodule was defined as a cytologically suspicious nodule identified by ultrasound without coexisting indeterminate nodules, not including pure cystic nodules and colloid cysts, which cannot become malignant. The definition of the clinical T3, N1, and heterogenecity in ultrasound was described in our previous study (Lee et al 2014). Briefly, if the echogenicity of the thyroid tissue was moderately heterogeneous with reduced echogenicity compared to the adjacent strap muscles, we defined it as 'heterogeneous' echogenicity.…”

Section: Ultrasonographic Examinationmentioning

confidence: 99%

Identification of occult tumors by whole-specimen mapping in solitary papillary thyroid carcinoma

Park¹,

Jung²,

Ryu³

et al. 2015

Endocrine-Related Cancer

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We undertook this study to estimate an accurate incidence and spread patterns of occult papillary thyroid carcinoma (PTC) in patients with a preoperative diagnosis of solitary PTC by using whole-specimen mapping of all specimens after a total thyroidectomy. Enrolled prospectively in this whole-thyroid mapping study are 82 consecutive patients who underwent a total thyroidectomy under a preoperative diagnosis of solitary PTC. All thyroidectomy specimens were serially sectioned in 2 mm thickness and whole-thyroid mapping was carried out for additional foci of occult PTC. The frequencies of occult lesions detected in the whole and contralateral lobe were determined, and clinicopathologic factors associated with multifocality were assessed. Whole-thyroid mapping revealed 66 occult PTC lesions missed by preoperative ultrasound in 37 (45.1%) of the 82 patients. The great majority (92.5%) of the occult PTC was smaller than 3 mm in size and 25 patients (30.5%) had contralateral lesions. We found that the male sex was an independent predictor of multifocality (odds ratio (OR), 3.00; 95% CI, 1.11-8.14), adjusting for preoperative findings. Analysis with pathologic parameters showed that the male sex (OR, 5.03; 95% CI, 1.68-15.08) and extrathyroidal extensions (OR, 3.03; 95% CI,) were associated with multifocal PTC. However, none of the clinicopathologic factors evaluated predicted contralateral PTC. Our study demonstrates the diagnostic limitations of ultrasound for the detection of multifocal PTC and the need to consider the possibility of occult lesions in the management of solitary PTC, especially in male patients.

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“…Currently, tumor aggressiveness is based on surgical histological analysis, which is only available after surgical resection of the thyroid gland (10). While commonly used as the primary imaging modality for thyroid, thyroid nodules, and cervical lymph nodes, routine neck ultrasonography cannot reliably exclude minor extrathyroidal extension (11,12). This has significant clinical implications since the presence of extrathyroidal extension is a marker of a potentially more aggressive tumor behavior that would lead to more aggressive initial therapy (likely total thyroidectomy and perhaps radioactive iodine ablation).…”

mentioning

confidence: 99%

Using Diffusion-Weighted MRI to Predict Aggressive Histological Features in Papillary Thyroid Carcinoma: A Novel Tool for Pre-Operative Risk Stratification in Thyroid Cancer

Moreira

Hatzoglou

et al. 2015

Thyroid

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Background: Initial management recommendations of papillary thyroid carcinoma (PTC) are very dependent on preoperative studies designed to evaluate the presence of PTC with aggressive features. The purpose of this study was to evaluate whether diffusion-weighted magnetic resonance imaging (DW-MRI) before surgery can be used as a tool to stratify tumor aggressiveness in patients with PTC. Methods: In this prospective study, 28 patients with PTC underwent DW-MRI studies on a three Tesla MR scanner prior to thyroidectomy. Due to image quality, 21 patients were finally suitable for further analysis. Apparent diffusion coefficients (ADCs) of normal thyroid tissues and PTCs for 21 patients were calculated. Tumor aggressiveness was defined by surgical histopathology. The Mann-Whitney U test was used to compare the difference in ADCs among groups of normal thyroid tissues and PTCs with and without features of tumor aggressiveness. Receiver operating characteristic (ROC) analysis was performed to assess the discriminative specificity, sensitivity, and accuracy of and determine the cutoff value for the ADC in stratifying PTCs with tumor aggressiveness. Results: There was no significant difference in ADC values between normal thyroid tissues and PTCs. However, ADC values of PTCs with extrathyroidal extension (ETE; 1.53 -0.25 · 10 -3 mm 2 /s) were significantly lower than corresponding values from PTCs without ETE (2.37 -0.67 · 10 -3 mm 2 /s; p < 0.005). ADC values identified 3 papillary carcinoma patients with extrathyroidal extension that would have otherwise been candidates for observation based on ultrasound evaluations. The cutoff value of ADC to discriminate PTCs with and without ETE was determined at 1.85 · 10 -3 mm 2 /s with a sensitivity of 85%, specificity of 85%, and ROC curve area of 0.85. Conclusion: ADC value derived from DW-MRI before surgery has the potential to stratify ETE in patients with PTCs.

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Predictive Factors for Extrathyroidal Extension of Papillary Thyroid Carcinoma Based on Preoperative Sonography

Cited by 55 publications

References 32 publications

Features of papillary thyroid microcarcinoma associated with lateral cervical lymph node metastasis

Features of papillary thyroid microcarcinoma associated with lateral cervical lymph node metastasis

Identification of occult tumors by whole-specimen mapping in solitary papillary thyroid carcinoma

Using Diffusion-Weighted MRI to Predict Aggressive Histological Features in Papillary Thyroid Carcinoma: A Novel Tool for Pre-Operative Risk Stratification in Thyroid Cancer

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