Papillary Thyroid Cancer Prognosis: An Evolving Field

Reconceptualize tall-cell variant papillary thyroid microcarcinoma: From a "sonographic histology" perspective

OBJECTIVE

This study aimed to examine the relationship between sonographic features and histological manifestations in the tall-cell variant of papillary thyroid microcarcinoma (TCV-PTMC), thus proposing the concept of "sonographic histology" and examine its value in the clinical management of the aggressive tall-cell variant.

METHODS

This study retrospectively included 104 participants who were admitted to Peking University Third Hospital from 2015 to 2022 and were histopathologically confirmed as having TCV-PTMC or classical PTMC. We mainly compared the general characteristics, sonographic characteristics, and pathological specimens between the two cohorts.

RESULTS

Hypoechoic nodules with a localized central isoechoic lesion and hypoechoic halo around nodules were most often observed in TCV-PTMC, which correlated with circumferentially distributed tumor epithelium and densely distributed tumor stroma histopathologically. Additionally, TCV-PTMC showed nodules with a more regular margin and less microcalcification than classical PTMC, which led to an underestimation of the risk of TCV-PTMC.

CONCLUSION

The good association between the ultrasound echo pattern and tissue cell arrangement was defined as sonographic histology in this study and can be applied in the preoperative identification of TCV-PTMC. This concept may provide novel insight for the identification of special subtypes of thyroid tumors and may modify pitfalls of the Thyroid Imaging Reporting and Data System in aggressive variants of microcarcinoma.

Contrast-Enhanced Ultrasound: An Effective Method for Noninvasive Diagnosis of Mummified Thyroid Nodules

Mummified thyroid nodules are a special type of thyroid nodule, which is benign, but is often diagnosed as malignant by ultrasound. This study investigated the usefulness of contrast-enhanced ultrasound (CEUS) in the diagnosis of mummified nodules. 66 patients with mummified nodules were divided into two groups: a no-enhancement group and a low-enhancement group. 32 patients with papillary thyroid carcinoma (PTC) were recruited in control group. In the no-enhancement group, CEUS showed that there was no contrast agent entering the nodules, with or without a little dot enhancement or regular ring enhancement around the nodules. The low-enhancement group showed low enhancement inside nodules, which was similar to that in the PTC group. In semiquantitative time-intensity curve analyses, intensity maximum of the central area of nodules in the low-enhancement group was lower than that in the PTC group (P < 0.05) and time to peak of the central area of nodules in the low-enhancement group was lower than that in the PTC group (P < 0.05). The results demonstrate that CEUS could be used to effectively diagnose mummified nodules, obviating the need for patients to undergo invasive examination such as biopsy or even surgery.