Preoperative Ultrasonographic Staging of Papillary Thyroid Carcinoma With the Eighth American Joint Committee on Cancer Tumor-Node-Metastasis Staging System

Abstract

Objective The purpose of this study was to evaluate the performance of preoperative ultrasonography (US) in the staging of papillary thyroid carcinoma (PTC) according to the eighth AJCC TNM classification system, to determine the effect of the preoperative US staging in the management of PTC. Patients and Methods Preoperative US was performed by 2 highly trained sonographers in 665 consecutive patients with PTC, and the T and N categories were determined preoperatively. The accuracy of preoperative US in clinical staging was evaluated based on the histopathological specimens according to the eighth AJCC TNM classification. Further analysis was performed to identify the high-risk factors of N1b stage. Results Overall accuracy of preoperative US for T stage was 92.5% (615/665). The accuracy of sonographic evaluation for T was high except for the T4a. Overall accuracy of preoperative US for N stage was 59% (426/655). The accuracies of sonographic evaluation for N0, N1a, and N1b were 81.8% (274/335), 33.3% (70/250), and 87.5% (70/80), respectively. Of 250 N1a patients, 164 (65.6%) were underestimated by US. Univariate and multivariate analyses showed that larger tumor diameter, multifocality, and higher T stage significantly increase the risk of N1b stage (P < 0.01). Conclusions Preoperative US was useful for the evaluation in staging of PTC, but some limitations still existed. For higher-risk patients of N1b (larger tumor size, multifocality, and higher T stage), preoperative US examination for lateral neck region should be further emphasized, and prophylactic lateral nodal dissection should be determined based on both preoperative imaging results and intraoperative evaluation.

Diagnostic Test Accuracy of Ultrasonography vs Computed Tomography for Papillary Thyroid Cancer Cervical Lymph Node Metastasis

“…A total of 47 studies were included, with 31 942 observations of individuals with thyroid cancer . A summary study flow diagram is shown in Figure 1.…”

Radiologist versus Non-Radiologist Detection of Lymph Node Metastasis in Papillary Thyroid Carcinoma by Ultrasound: A Meta-Analysis

“…A total of 25 studies were included in our meta-analysis. All studies were published between 2007 and 2022 and include works from Korea (11 studies), China (7 studies), the United States (5 studies), and Chile (1 study) [ 13 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Four works were published within the last two years (2020 and beyond), suggesting heightened interest in determining the accuracy of diagnostic imaging.…”

“… Diagnostic parameters of ultrasound performed by non-radiologists [ 13 , 19 , 21 , 22 , 31 , 33 , 41 ]. The ( A ) sensitivity, ( B ) specificity, ( C ) positive likelihood ratio, and ( D ) negative likelihood ratio are presented.…”

“… Comparison of diagnostic parameters of ultrasound performed by radiologists with those performed by non-radiologists. The ( A ) diagnostic odds ratio of radiologists [ 18 , 20 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 32 , 34 , 35 , 36 , 37 , 38 , 39 ], ( B ) diagnostic odds ratio of non-radiologists [ 13 , 19 , 21 , 22 , 31 , 33 , 41 ], and ( C ) summary receiver operating curve are presented. Summary receiver operating curve is presented as an area under the curve and standard error.…”

Construction and Validation of a Predictive Nomogram Based on Ultrasound for Lymph Node Metastasis of Papillary Thyroid Carcinoma in the Cervical Central Region

“…Ultrasonography (US) is regarded as the preferred technology for detecting thyroid lesions and evaluating the metastatic status of cervical lymph nodes (CLNs). [5][6][7] However, direct preoperative identification of CLNM remains a challenge, especially for lymph nodes located in the central region, i.e., cervical region VI. 8 Therefore, clinicians are often inclined to perform lymph nodes dissection at the same time as thyroidectomy to avoid missing lymph node metastasis.…”