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Park JH, Yi KS, Choi CH, Kim Y, Lee J, Park Y, Lee OJ. Post-surgical thyroid bed myofibroma simulating a recurrent papillary thyroid carcinoma: A case report and review of the literature. Medicine (Baltimore) 2024; 103:e36945. [PMID: 38215099 PMCID: PMC10783218 DOI: 10.1097/md.0000000000036945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/27/2023] [Indexed: 01/14/2024] Open
Abstract
RATIONALE Myofibromas are rare benign spindle cell tumors of the soft tissue, bone, or internal organs that occur at any age. Here, we report a post-surgical thyroid bed myofibroma that mimicked a papillary thyroid carcinoma. PATIENT CONCERNS A 56-year-old male presented with a mass in the thyroid surgical bed, detected 3 years post thyroidectomy following papillary carcinoma. DIAGNOSIS Thyroid ultrasonography revealed a well-defined, lobulated, hypoechoic, solid nodule, with large rod-like echogenic foci in the thyroid surgical bed. The development of a postoperative suture granuloma was considered. However, ultrasonography performed 12 months later showed a marked increase in the lesion size. Two fine needle aspiration cytology yielded nondiagnostic results. INTERVENTION Considering the possibility of local tumor recurrence, surgical resection was performed. OUTCOME The diagnosis of a myofibroma was confirmed, and no additional treatment was administered. LESSONS It is challenging to differentiate lesions occurring on the thyroid surgical bed after surgery, from recurrent thyroid cancer. A lesion measuring 6 mm, with a degree of punctate echogenicity, suggests tumor recurrence. Moreover, myofibromas are extremely rare. This case highlights that it is advisable to perform a core needle biopsy in cases of nondiagnostic fine needle aspiration results.
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Affiliation(s)
- Jun Hyeon Park
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Kyung Sik Yi
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
| | - Chi-Hoon Choi
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
| | - Yook Kim
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
| | - Jisun Lee
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
| | - Yeongtae Park
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Ok-Jun Lee
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Republic of Korea
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Wang J, Dong C, Zhang YZ, Wang L, Yuan X, He M, Xu S, Zhou Q, Jiang J. A novel approach to quantify calcifications of thyroid nodules in US images based on deep learning: predicting the risk of cervical lymph node metastasis in papillary thyroid cancer patients. Eur Radiol 2023; 33:9347-9356. [PMID: 37436509 DOI: 10.1007/s00330-023-09909-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 04/23/2023] [Accepted: 05/15/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE Based on ultrasound (US) images, this study aimed to detect and quantify calcifications of thyroid nodules, which are regarded as one of the most important features in US diagnosis of thyroid cancer, and to further investigate the value of US calcifications in predicting the risk of lymph node metastasis (LNM) in papillary thyroid cancer (PTC). METHODS Based on the DeepLabv3+ networks, 2992 thyroid nodules in US images were used to train a model to detect thyroid nodules, of which 998 were used to train a model to detect and quantify calcifications. A total of 225 and 146 thyroid nodules obtained from two centers, respectively, were used to test the performance of these models. A logistic regression method was used to construct the predictive models for LNM in PTCs. RESULTS Calcifications detected by the network model and experienced radiologists had an agreement degree of above 90%. The novel quantitative parameters of US calcification defined in this study showed a significant difference between PTC patients with and without cervical LNM (p < 0.05). The calcification parameters were beneficial to predicting the LNM risk in PTC patients. The LNM prediction model using these calcification parameters combined with patient age and other US nodular features showed a higher specificity and accuracy than the calcification parameters alone. CONCLUSIONS Our models not only detect the calcifications automatically, but also have value in predicting cervical LNM risk of PTC patients, thereby making it possible to investigate the relationship between calcifications and highly invasive PTC in detail. CLINICAL RELEVANCE STATEMENT Due to the high association of US microcalcifications with thyroid cancers, our model will contribute to the differential diagnosis of thyroid nodules in daily practice. KEY POINTS • We developed an ML-based network model for automatically detecting and quantifying calcifications within thyroid nodules in US images. • Three novel parameters for quantifying US calcifications were defined and verified. • These US calcification parameters showed value in predicting the risk of cervical LNM in PTC patients.
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Affiliation(s)
- Juan Wang
- Department of Ultrasound, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Caixia Dong
- Institute of Artificial Intelligence, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Yao-Zhong Zhang
- The Institute of Medical Science, The University of Tokyo, Shirokanedai 4-6-1, Minato-ku, Tokyo, 108-8639, Japan
| | - Lirong Wang
- Department of Ultrasound, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Xin Yuan
- Department of Ultrasound, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Meiqing He
- Department of Ultrasound, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Songhua Xu
- Institute of Artificial Intelligence, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710004, China.
| | - Qi Zhou
- Department of Ultrasound, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710004, China.
| | - Jue Jiang
- Department of Ultrasound, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710004, China.
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Correlation between Sonographic Features and Central Neck Lymph Node Metastasis in Solitary Solid Papillary Thyroid Microcarcinoma with a Taller-Than-Wide Shape. Diagnostics (Basel) 2023; 13:diagnostics13050949. [PMID: 36900093 PMCID: PMC10001029 DOI: 10.3390/diagnostics13050949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose: This study aimed to investigate the correlation between sonographic features and central neck lymph node metastasis (CNLM) in solitary solid papillary thyroid microcarcinoma (PTMC) with a taller-than-wide shape. Methods: A total of 103 patients with solitary solid PTMC with a taller-than-wide shape on ultrasonography who underwent surgical histopathological examination were retrospectively selected. Based on the presence or absence of CNLM, patients with PTMC were divided into a CNLM (n = 45) or nonmetastatic (n = 58) group, respectively. Clinical findings and ultrasonographic features, including a suspicious thyroid capsule involvement sign (STCS, which is defined as PTMC abutment or a disrupted thyroid capsule), were compared between the two groups. Additionally, postoperative ultrasonography was performed to assess patients during the follow-up period. Results: Significant differences were observed in sex and the presence of STCS between the two groups (p < 0.05). The specificity and accuracy of the male sex for predicting CNLM were 86.21% (50/58 patients) and 64.08% (66/103 patients), respectively. The sensitivity, specificity, positive predictive value (PPV), and accuracy of STCS for predicting CNLM were 82.22% (37/45 patients), 70.69% (41/58 patients), 68.52% (37/54 patients), and 75.73% (78/103 patients), respectively. The specificity, PPV, and accuracy of the combination of sex and STCS for predicting CNLM were 96.55% (56/58 patients), 87.50% (14/16 patients), and 67.96% (70/103 patients), respectively. A total of 89 (86.4%) patients were followed up for a median of 4.6 years, with no patient having recurrence as detected on ultrasonography and pathological examination. Conclusions: STCS is a useful ultrasonographic feature for predicting CNLM in patients with solitary solid PTMC with a taller-than-wide shape, especially in male patients. Solitary solid PTMC with a taller-than-wide shape may have a good prognosis.
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Wu J, Hu XY, Ghaznavi S, Kinnear S, Symonds CJ, Grundy P, Parkins VM, Sharma P, Lamb D, Khalil M, Hyrcza M, Chandarana SP, Pasieka JL, Harvey A, Warshawski J, Hart R, Deutschman M, Randall DR, Paschke R. The Prospective Implementation of the 2015 ATA Guidelines and Modified ATA Recurrence Risk Stratification System for Treatment of Differentiated Thyroid Cancer in a Canadian Tertiary Care Referral Setting. Thyroid 2022; 32:1509-1518. [PMID: 36226405 DOI: 10.1089/thy.2022.0055] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective: To present clinical outcomes of the prospective implementation of the 2015 American Thyroid Association (ATA) guidelines for the management of thyroid nodules and differentiated thyroid cancer (DTC) using the modified ATA recurrence risk (RR) stratification system. Methods: We prospectively analyzed 612 patients with DTC treated between April 2017 and December 2021 in Calgary, Alberta. Each patient was prospectively assigned a modified ATA RR and American Joint Committee Cancer 8th edition stage. Initial risk stratification and consideration of the 2015 ATA guidelines guided surgical management as well as the indication for and dose of radioiodine (RAI) and other adjuvant therapies. Patients were assessed for their response to treatment (RTT) at 2-years postoperatively. Results: There were 479 patients who had 2-year follow-up data and were included in the study. Of these patients, there were 253 (53%) low-, 129 (27%) intermediate-, and 97 (20%) high-RR patients. Of these, 227 patients (47%) underwent total thyroidectomy (TTX) plus RAI, 178 (37%) underwent TTX only, and 74 (16%) underwent lobectomy. The RTT at 2 years was excellent for 89% (66) of patients with lobectomy, 84% (149) for TTX only, and 53% (121) for TTX plus RAI. Among 253 patients who were deemed low RR, 85% (216) had excellent RTT, 13% (32) indeterminate RTT, 2% (4) biochemical incomplete RTT, and 1 patient had structural incomplete RTT. The intermediate RR group had the following RTT outcomes: 64% (83) excellent, 23% (30) indeterminate, 6% (7) biochemical incomplete, and 7% (9) structural incomplete. The high RR group had the worst RTT outcomes, with 38% (37) excellent, 19% (18) indeterminate, 10% (10) biochemical incomplete, and 33% (32) structural incomplete RTT. Conclusions: The 2015 ATA RR stratification system is useful for predicting disease status at 2-year post-treatment in patients with DTC. The 2015 ATA guidelines and modified ATA RR stratification treatment recommendations may reduce thyroid cancer overtreatment by including lobectomy as a definitive treatment option for low-risk thyroid cancers and selective use of RAI for intermediate and high-risk patients.
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Affiliation(s)
- Jiahui Wu
- Arnie Charbonneau Cancer Institute, Departments of Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Xun Yang Hu
- Arnie Charbonneau Cancer Institute, Departments of Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Section of Endocrinology, University of Calgary, Calgary, Canada
| | - Sana Ghaznavi
- Arnie Charbonneau Cancer Institute, Departments of Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Section of Endocrinology, University of Calgary, Calgary, Canada
| | - Susan Kinnear
- Arnie Charbonneau Cancer Institute, Departments of Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Section of Endocrinology, University of Calgary, Calgary, Canada
| | - Christopher John Symonds
- Arnie Charbonneau Cancer Institute, Departments of Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Section of Endocrinology, University of Calgary, Calgary, Canada
| | - Peter Grundy
- Arnie Charbonneau Cancer Institute, Departments of Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Section of Endocrinology, University of Calgary, Calgary, Canada
| | - Vicky M Parkins
- Arnie Charbonneau Cancer Institute, Departments of Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Section of Endocrinology, University of Calgary, Calgary, Canada
| | - Priyanka Sharma
- Arnie Charbonneau Cancer Institute, Departments of Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Debbie Lamb
- Arnie Charbonneau Cancer Institute, Departments of Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Moosa Khalil
- Pathology and Laboratory Medicine and Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Martin Hyrcza
- Pathology and Laboratory Medicine and Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Shamir P Chandarana
- Arnie Charbonneau Cancer Institute, Departments of Cumming School of Medicine, University of Calgary, Calgary, Canada
- Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Janice L Pasieka
- Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Adrian Harvey
- Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Joseph Warshawski
- Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Robert Hart
- Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Michael Deutschman
- Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Derrick R Randall
- Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ralf Paschke
- Department of Medicine, Section of Endocrinology, Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Jeong SY, Baek JH, Chung SR, Choi YJ, Song DE, Chung KW, Kim WW, Lee JH. Diagnostic Performance of Core Needle Biopsy for Characterizing Thyroidectomy Bed Lesions. Korean J Radiol 2022; 23:1019-1027. [PMID: 36098339 PMCID: PMC9523230 DOI: 10.3348/kjr.2021.0772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Thyroidectomy bed lesions frequently show suspicious ultrasound (US) features after thyroid surgery. Fine-needle aspiration (FNA) may not provide definitive pathological information about the lesions. Although core-needle biopsy (CNB) has excellent diagnostic performance in characterizing suspicious thyroid nodules, no published studies have evaluated the performance of CNB specifically for thyroidectomy bed lesions. Therefore, we aimed to evaluate the diagnostic performance and safety of CNB for characterizing thyroidectomy bed lesions. Materials and Methods A total of 124 thyroidectomy bed lesions in 113 patients (79 female and 34 male; age, 23–85 years) who underwent US-guided CNB between December 2008 and December 2020 were included. We reviewed the US imaging features of the target lesions and the histories of previous biopsies. The pathologic results, diagnostic performance for malignancy, and complications of CNB were analyzed. Results All samples (100%) obtained by CNB were adequate for pathological analysis. Pathological analysis revealed inconclusive results in two lesions (1.6%). According to the reference standard, 50 lesions were ultimately malignant (40.3%), and 72 were benign (58.1%), excluding the two inconclusive lesions. The performance of CNB for diagnosing malignant thyroidectomy bed lesions in the 122 lesions had a sensitivity of 98.0% (49/50), a specificity of 100% (72/72), positive predictive value of 100% (49/49), and negative predictive value of 98.6% (72/73). Eleven lesions were referred for CNB after prior inconclusive FNA results in thyroidectomy bed lesions, for all of which CNB yielded correct conclusive pathologic diagnoses. According to the pathological analysis of CNB, there were various benign lesions (58.9%, 73/124) besides recurrence, including benign postoperative lesions other than suture granuloma (32.3%, 40/124), suture granuloma (15.3%, 19/124), remnant thyroid tissue (5.6%, 7/124), parathyroid lesions (4%, 5/124), and abscesses (1.6%, 2/124). No major or minor complications were associated with the CNB procedure. Conclusion US-guided CNB is accurate and safe for characterizing thyroidectomy bed lesions.
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Affiliation(s)
- So Yeong Jeong
- Department of Radiology, Hanyang University Medical Center, Hanyang University Medical College, Seoul, Korea.,Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Woong Kim
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Grant EG, Malhi H. The Post-Thyroidectomy US Examination: Less May Be More. Radiology 2021; 299:381-382. [PMID: 33656384 DOI: 10.1148/radiol.2021210155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Edward G Grant
- From the Department of Radiology, University of Southern California School of Medicine, 1500 San Pablo St, Los Angeles, CA 90033
| | - Harshawn Malhi
- From the Department of Radiology, University of Southern California School of Medicine, 1500 San Pablo St, Los Angeles, CA 90033
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