Ultrasound features of medullary thyroid carcinoma correlate with cancer aggressiveness: a retrospective multicenter study

Trimboli, Pierpaolo; Giovanella, Luca; Valabrega, Stefano; Andrioli, Massimiliano; Baldelli, Roberto; Cremonini, Nadia; Rossi, Fábio Henrique; Guidobaldi, Leo; Barnabei, Agnese; Rota, Francesca Silvia; Paoloni, Antonella; Rizzà, Laura; Fattorini, Giorgio; Latini, M.; Ventura, Claudio; Falasca, P.; Orlandi, Fabio; Crescenzi, Anna; Dambrosio, F; Cantisani, Vito; Romanelli, Francesco; Negro, Roberto; Saggiorato, Enrico; Appetecchia, Marialuisa

doi:10.1186/preaccept-2074894621401138

Cited by 11 publications

(13 citation statements)

References 22 publications

(51 reference statements)

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“…Calcifications in medullary carcinomas are hypothesized to be derived from amyloid deposits 24 25 26 . Medullary carcinomas have a wide range of calcification types on ultrasonography ( Table 1(g) ).…”

Section: Discussionmentioning

confidence: 99%

Calcifications in Thyroid Tumors on Ultrasonography: Calcification Types and Relationship with Histopathological Type

Kobayashi

Fujimoto

Ota

et al. 2018

Ultrasound Int Open

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PurposeThe purpose of the study is to clarify the prevalence of calcifications within thyroid tumors on ultrasonography as well as the relationship between the calcification and histopathological types.Materials and MethodsCalcifications were classified into 6 (or 8) types according to their shape, size, and region. The prevalence of calcifications and types were investigated in new outpatients and patients who underwent thyroid surgery.ResultsAmong 2,902 nodules in 2,678 new outpatients, 747 nodules (26%) had calcifications. The types showed a wide distribution. Among 941 patients with papillary carcinoma (PC), 725 patients (77%) had calcifications, and the types showed a wide distribution. 18 patients with the diffuse sclerosing variant of PC only showed punctate microcalcifications in the parenchyma (100%), 32 patients with the cyst-forming type of PC mostly fragmentary and massive types (100%), and 161 metastatic lymph nodes from PC mostly punctate microcalcifications and fragmentary types (48%). Among 337 patients with follicular carcinoma, 79 patients (23%) had calcifications, and the types were mostly fragmentary, massive, and egg-shell types. Among 41 patients with undifferentiated carcinoma, 33 patients (80%) presented with calcifications, which were mostly the massive and egg-shell types. Among 137 patients with medullary carcinoma, 99 patients (72%) had calcification, and the types showed a wide distribution. None of 173 patients with primary thyroid lymphoma had calcifications (0%).ConclusionCalcifications on ultrasonography can be one of the characteristic findings and a full understanding of the prevalence of calcifications and types will markedly contribute to the ultrasonic diagnosis of thyroid tumors.

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Section: Discussionmentioning

confidence: 99%

Calcifications in Thyroid Tumors on Ultrasonography: Calcification Types and Relationship with Histopathological Type

Kobayashi

Fujimoto

Ota

et al. 2018

Ultrasound Int Open

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“…Although ultrasound-guided FNAB of the focal lesion is a method of choice in the diagnostics of thyroid focal lesions, a definite diagnosis of MTC is not always possible ( 3 ) . Medullary carcinomas are usually shown in the ultrasound image as solid, highly hypoechogenic focal lesions with calcifications due to high amounts of amyloid.…”

Section: Introductionmentioning

confidence: 99%

“…Current knowledge does not allow to determine ultrasonographic characteristics that clearly identify MTCs. The available literature reports show that even one in three lesions may not show the characteristics suspicious of malignancy in an ultrasound image ( 3 ) . Ultrasound sonoelastography is a promising technique for the assessment of the hardness of the thyroid focal lesions.…”

Section: Introductionmentioning

confidence: 99%

Shear wave elastography in medullary thyroid carcinoma diagnostics

et al. 2015

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Shear wave elastography (SWE) is a modern method for the assessment of tissue stiffness. There has been a growing interest in the use of this technique for characterizing thyroid focal lesions, including preoperative diagnostics.AimThe aim of the study was to assess the clinical usefulness of SWE in medullary thyroid carcinoma (MTC) diagnostics.Materials and methodsA total of 169 focal lesions were identified in the study group (139 patients), including 6 MTCs in 4 patients (mean age: 45 years). B-mode ultrasound and SWE were performed using Aixplorer (SuperSonic, Aix-en-Provence), with a 4–15 MHz linear probe. The ultrasound was performed to assess the echogenicity and echostructure of the lesions, their margin, the halo sign, the height/width ratio (H/W ratio), the presence of calcifications and the vascularization pattern. This was followed by an analysis of maximum and mean Young's (E) modulus values for MTC (EmaxLR, EmeanLR) and the surrounding thyroid tissues (EmaxSR, EmeanSR), as well as mean E-values (EmeanLRz) for 2 mm region of interest in the stiffest zone of the lesion. The lesions were subject to pathological and/or cytological evaluation.ResultsThe B-mode assessment showed that all MTCs were hypoechogenic, with no halo sign, and they contained micro- and/ or macrocalcifications. Ill-defined lesion margin were found in 4 out of 6 cancers; 4 out of 6 cancers had a H/W ratio > 1. Heterogeneous echostructure and type III vascularity were found in 5 out of 6 lesions. In the SWE, the mean value of EmaxLR for all of the MTCs was 89.5 kPa and (the mean value of EmaxSR for all surrounding tissues was) 39.7 kPa Mean values of EmeanLR and EmeanSR were 34.7 kPa and 24.4 kPa, respectively. The mean value of EmeanLRz was 49.2 kPa.ConclusionsSWE showed MTCs as stiffer lesions compared to the surrounding tissues. The lesions were qualified for fine needle aspiration biopsy based on B-mode assessment. However, the diagnostic algorithm for MTC is based on the measurement of serum calcitonin levels, B-mode ultrasound and FNAB.

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“…These suspicious US findings are relatively consistent regardless of histologic type or variant of thyroid cancer [ 18 , 32 – 34 ]. Moreover, several studies demonstrated that US characteristics of thyroid nodules might be highly reliable for predicting clinical outcomes and appropriate management of patients [ 19 , 21 , 35 ]. In this study, compared to PTCs without any mutation, PTCs with the TERT+BRAF mutation were associated with non-parallel orientation, and PTCs with the BRAF mutation alone were related to incidences of non-parallel orientation and hypoechogenicity based on US.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound and clinicopathological features of papillary thyroid carcinomas with BRAF and TERT promoter mutations

Hahn

Kim

et al. 2017

Oncotarget

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This study is to investigate if any relationship exists between the telomerase reverse transcriptase (TERT) promoter or proto-oncogene BRAF mutation and ultrasound (US) and clinicopathological features of papillary thyroid carcinomas (PTCs). The study included 150 patients with surgically confirmed PTC from October 1994 to December 2004. According to the existence of TERT promoter or BRAF mutations, we categorized patients into three groups (no mutation, BRAF mutation alone, or TERT+BRAF mutations) and analyzed the relationships between TERT promoter or BRAF mutation and US and clinicopathological features. The rate of recurrence or death according to mutation analysis was estimated. There were 35 (23.3%) cases with no mutation, 104 (69.3%) with BRAF mutation alone, and 11 (7.3%) with TERT+BRAF mutations. As the number of genetic mutations increased from no mutation to BRAF mutation alone to both BRAF and TERT mutations, the proportions of hypoechogenicity, non-parallel orientation, spiculated/microlobulated margin, microcalcifications, and high suspicion category increased. PTCs with TERT+BRAF mutations recurred more frequently than other groups (odd ratio = 17.921 and 31.468). The intervals to recurrence and overall survival were significantly shorter in the TERT+BRAF mutation group than in the other groups (Ps <.0001). PTCs with no mutation, with BRAF mutation alone, and with both TERT and BRAF mutations linearly increase in the probability of displaying malignant US features. In PTCs, the coexistence of BRAF with TERT mutations is more strongly correlated with recurrence and mortality than BRAF mutation alone.

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Ultrasound features of medullary thyroid carcinoma correlate with cancer aggressiveness: a retrospective multicenter study

Cited by 11 publications

References 22 publications

Calcifications in Thyroid Tumors on Ultrasonography: Calcification Types and Relationship with Histopathological Type

Calcifications in Thyroid Tumors on Ultrasonography: Calcification Types and Relationship with Histopathological Type

Shear wave elastography in medullary thyroid carcinoma diagnostics

Ultrasound and clinicopathological features of papillary thyroid carcinomas with BRAF and TERT promoter mutations

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