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Eun NL, Kim JA, Lee Y, Youk JH, Yun HJ, Chang H, Kim SM, Lee YS, Chang HS, Yang H, Jeon S, Son EJ. Preoperative Ultrasonography Predicts Level II Lymph Node Metastasis in N1b Papillary Thyroid Carcinoma: Implications for Surgical Planning. Biomedicines 2024; 12:1588. [PMID: 39062161 PMCID: PMC11274539 DOI: 10.3390/biomedicines12071588] [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: 05/28/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE To investigate whether preoperative ultrasonographic (US) features of the index cancer and metastatic lymph nodes (LNs) are associated with level II LN metastasis in N1b papillary rmfthyroid carcinoma (PTC) patients. MATERIALS AND METHODS We enrolled 517 patients (mean age, 42 [range, 6-80] years) who underwent total thyroidectomy and lateral compartment LN dissection between January 2009 and December 2015. We reviewed the clinicopathologic and US features of the index cancer and metastatic LNs in the lateral neck. Logistic regression analysis was performed to analyze features associated with level II LN metastasis. RESULTS Among the patients, 196 (37.9%) had level II metastasis on final pathology. In the preoperative model, larger tumor size (odds ratios [ORs], 1.031; 95% confidence interval [CI]: 1.011-1.051, p = 0.002), nonparallel tumor shape (OR, 1.963; 95% CI: 1.322-2.915, p = 0.001), multilevel LN involvement (OR, 1.906; 95% CI: 1.242-2.925, p = 0.003), and level III involvement (OR, 1.867; 95% CI: 1.223-2.850, p = 0.004), were independently associated with level II LN metastasis. In the postoperative model, non-conventional pathology remained a significant predictor for level II LN metastasis (OR, 1.951; 95% CI: 1.121-3.396; p = 0.018), alongside the presence of extrathyroidal extension (OR, 1.867; 95% CI: 1.060-3.331; p = 0.031), and higher LN ratio (OR, 1.057; 95% CI: 1.039-1.076; p < 0.001). CONCLUSIONS Preoperative US features of the index tumor and LN may be helpful in guiding surgery in N1b PTC. These findings could enhance preoperative planning and decision-making, potentially reducing surgical morbidities by identifying those at higher risk of level II LN metastasis and tailoring surgical approaches accordingly.
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Affiliation(s)
- Na Lae Eun
- Department of Radiology, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea; (N.L.E.)
| | - Jeong-Ah Kim
- Department of Radiology, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea; (N.L.E.)
| | - Yangkyu Lee
- Department of Pathology, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Ji Hyun Youk
- Department of Radiology, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea; (N.L.E.)
| | - Hyeok Jun Yun
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Hojin Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Seok-Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Hyejin Yang
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Soyoung Jeon
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Eun Ju Son
- Department of Radiology, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea; (N.L.E.)
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Xu CY, Yu J, Cui YY, Huang YJ, Fu C, Cui KF. A combination of risk stratification systems for thyroid nodules and cervical lymph nodes may improve the diagnosis and management of thyroid nodules. Front Oncol 2024; 14:1393414. [PMID: 38993646 PMCID: PMC11237952 DOI: 10.3389/fonc.2024.1393414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/12/2024] [Indexed: 07/13/2024] Open
Abstract
Introduction To assess the performance of the European Thyroid Association Thyroid Imaging and Reporting Data System (EU-TIRADS) and the Korean Thyroid Imaging Reporting and Data System (K-TIRADS), which combine risk stratification systems for thyroid nodules (TN-RSS) and cervical lymph nodes (LN-RSS) in diagnosing malignant and metastatic thyroid cancer in a single referral center. Methods We retrospectively analyzed 2,055 consecutive patients who underwent thyroidectomy or fine-needle aspiration (FNA) from January 2021 to December 2022. TNs and LNs were categorized according to the ultrasonography (US) features of EU-TIRADS and K-TIRADS, respectively. The diagnostic performance and postponed malignancy rate (PMR) were compared with those of EU-TIRADS and K-TIRADS. PMR was defined as the number of patients with malignant nodules not recommended for biopsy among patients with cervical LN metastasis. Results According to the EU-TIRADS and K-TIRADS, for TN-RSS alone, there were no significant differences in sensitivity, specificity, accuracy, unnecessary FNA rate (UFR), missed malignancy rate (MMR), and PMR between the two TIRADSs (29.0% vs. 28.8%, 50.5% vs. 51.1%, 32.3% vs. 32.2%, 23.6% vs. 23.5%, 88.6% vs. 88.5%, and 54.2% vs. 54.5%, P > 0.05 for all). Combining the LN-RSS increased the diagnostic accuracy (42.7% vs. 32.3% in EU-TIRADS; 38.8% vs. 32.2% in K-TIRADS) and decreased the PMR (54.2% vs. 33.9% in EU-TIRADS; 54.5% vs. 39.3% in K-TIRADS). EU-TIRADS had higher sensitivity and accuracy and lower PMR than K-TIRADS (41.3% vs. 36.7%, 42.7% vs. 38.8%,33.9% vs. 39.3%, P < 0.05 for all). Conclusions A combination of TN-RSS and LN-RSS for the management of thyroid nodules may be associated with a reduction in PMR, with enhanced sensitivity and accuracy for thyroid cancers in EU-TIRADS and K-TIRADS. These results may offer a new direction for the detection of aggressive thyroid cancers.
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Affiliation(s)
| | | | | | | | - Chao Fu
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ke-Fei Cui
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Fan F, Li F, Wang Y, Dai Z, Lin Y, Liao L, Wang B, Sun H. Integration of ultrasound-based radiomics with clinical features for predicting cervical lymph node metastasis in postoperative patients with differentiated thyroid carcinoma. Endocrine 2024; 84:999-1012. [PMID: 38129723 PMCID: PMC11208252 DOI: 10.1007/s12020-023-03644-9] [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: 09/20/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The primary objective was to establish a radiomics model utilizing longitudinal +cross-sectional ultrasound (US) images of lymph nodes (LNs) to predict cervical lymph node metastasis (CLNM) following differentiated thyroid carcinoma (DTC) surgery. METHODS A retrospective collection of 211 LNs from 211 postoperative DTC patients who underwent neck US with suspicious LN fine needle aspiration cytopathology findings at our institution was conducted between June 2021 and April 2023. Conventional US and clinicopathological information of patients were gathered. Based on the pathological results, patients were categorized into CLNM and non-CLNM groups. The database was randomly divided into a training cohort (n = 147) and a test cohort (n = 64) at a 7:3 ratio. The least absolute shrinkage and selection operator algorithm was applied to screen the most relevant radiomic features from the longitudinal + cross-sectional US images, and a radiomics model was constructed. Univariate and multivariate analyses were used to assess US and clinicopathological significance features. Subsequently, a combined model for predicting CLNM was constructed by integrating radiomics, conventional US, and clinicopathological features and presented as a nomogram. RESULTS The area under the curves (AUCs) of the longitudinal + cross-sectional radiomics models were 0.846 and 0.801 in the training and test sets, respectively, outperforming the single longitudinal and cross-sectional models (p < 0.05). In the testing cohort, the AUC of the combined model in predicting CLNM was 0.901, surpassing that of the single US model (AUC, 0.731) and radiomics model (AUC, 0.801). CONCLUSIONS The US-based radiomics model exhibits the potential to accurately predict CLNM following DTC surgery, thereby enhancing diagnostic accuracy.
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Affiliation(s)
- Fengjing Fan
- Department of Medical Ultrasound, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Fei Li
- Department of Medical Ultrasound, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yixuan Wang
- Department of Medical Ultrasound, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhengjun Dai
- Scientific Research Department, Huiying Medical Technology Co., Ltd, Beijing, China
| | - Yuyang Lin
- Department of Medical Ultrasound, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Lin Liao
- Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Bei Wang
- Department of Medical Ultrasound, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.
| | - Hongjun Sun
- Department of Medical Ultrasound, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
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Chakrabarty N, Mahajan A, Basu S, D’Cruz AK. Comprehensive Review of the Imaging Recommendations for Diagnosis, Staging, and Management of Thyroid Carcinoma. J Clin Med 2024; 13:2904. [PMID: 38792444 PMCID: PMC11122658 DOI: 10.3390/jcm13102904] [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: 04/18/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Thyroid cancer is the most common head and neck cancer (HNC) in the world. In this article, we comprehensively cover baseline, posttreatment, and follow-up imaging recommendations for thyroid carcinomas along with the eighth edition of the tumor, node, metastasis (TNM) staging system proposed by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). We include characterization and risk stratification of thyroid nodules on ultrasound (US) proposed by various international bodies. Management guidelines (depending upon the type of thyroid carcinoma) based on the international consensus recommendations (mainly by the American Thyroid Association) are also extensively covered in this article, including the role of a radioiodine scan. The management of recurrent disease is also briefly elucidated in this article. In addition, we cover the risk factors and etiopathogenesis of thyroid carcinoma along with the non-imaging diagnostic workup essential for thyroid carcinoma management, including the significance of genetic mutations. US is the diagnostic imaging modality of choice, with US-guided fine needle aspiration (FNA) being the procedure of choice for tissue diagnosis. The roles of computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) in thyroid carcinoma staging are also specified. Through this article, we aim to provide a comprehensive reference guide for the radiologists and the clinicians in the pursuit of optimal care for patients with thyroid carcinoma.
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Affiliation(s)
- Nivedita Chakrabarty
- Department of Radiodiagnosis, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India;
| | - Abhishek Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, 65 Pembroke Place, Liverpool L7 8YA, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India;
| | - Anil K. D’Cruz
- Apollo Hospitals, Navi Mumbai 400614, Maharashtra, India;
- Foundation of Head Neck Oncology, Mumbai 400012, Maharashtra, India
- Union International Cancer Control (UICC), 1202 Geneva, Switzerland
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Chen SP, Li P, Pan YF, Jiang X. Case report: Rare presentation of double primary malignancies of the lung and thyroid: a difficult diagnosis. Front Oncol 2024; 13:1251492. [PMID: 38260838 PMCID: PMC10801227 DOI: 10.3389/fonc.2023.1251492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
This report describes a rare case of double primary cancer in a female patient aged 49 years who died 2 years after diagnosis. The patient was diagnosed with BRAFV600E-mutant metastatic papillary thyroid carcinoma (PTC) and ALK fusion-positive metastatic lung adenocarcinoma. She presented with multifocal thyroid lesions and underwent radical thyroidectomy and bilateral cervical lymphadenectomy. Thyroid ultrasound revealed the presence of five hypoechoic nodules with irregular margins and microcalcifications; an irregular inhomogeneous hypoechoic level IV cervical lymph node was also found on the right side. Histological analysis confirmed the presence of metastatic PTC, and the tumor tested positive for the BRAFV600E mutation. Ultrasound of the neck, which was performed 4 months postdischarge, revealed enlargement of the left-sided cervical lymph nodes; a biopsy from these nodes confirmed a diagnosis of metastatic PTC. Positron emission tomography-computed tomography scans revealed the presence of multiple pulmonary hypermetabolic foci scattered across bilateral lung fields. Multiple hypermetabolic foci were also observed in the lymph nodes on both sides of the neck, axillae, and mediastinum; in addition, there was evidence of bone destruction with hypermetabolic foci. Supplementary reports from the histological and immunohistochemical analyses of cervical lymph node tissue obtained during primary surgery confirmed the presence of metastatic PTC and poorly differentiated lung adenocarcinoma. In particular, one enlarged cervical lymph node located on the right side of the neck demonstrated tumor components of both PTC and lung adenocarcinoma. Pathological analysis of axillary lymph node puncture biopsy confirmed the presence of metastatic lung adenocarcinoma, and gene analysis revealed the presence of ALK fusion. The patient received targeted therapy based on a multidisciplinary discussion. However, she had a poor prognosis and died 2 years after the diagnosis. The initial thyroid ultrasound findings were reviewed retrospectively; the findings suggested that the possibility of double primary cancers should be considered in cases where the enlarged cervical lymph nodes are highly suspicious of PTC and present as inhomogeneous hypoechoic masses with irregular morphology.
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Affiliation(s)
- Shun-Ping Chen
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peng Li
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi-Fei Pan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xin Jiang
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Shen Y, Li X, Tao L, Chen Y, Xie R. Clinical Efficacy of Intraoperative Ultrasound for Prophylactic Lymphadenectomy of the Lateral Cervical Neck in Stage CN0 Papillary Thyroid Cancer: A Prospective Study. J INVEST SURG 2023; 36:2154416. [DOI: 10.1080/08941939.2022.2154416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Yi Shen
- Department of General Surgery, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoen Li
- Department of General Surgery, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lingling Tao
- Department of Ultrasound, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yupan Chen
- Department of General Surgery, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Rongli Xie
- Department of General Surgery, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Chen GY, Li T. Submandibular solid-cystic mass as the first and sole manifestation of occult thyroid papillary carcinoma: A case report. World J Clin Cases 2023; 11:7253-7257. [PMID: 37946756 PMCID: PMC10631415 DOI: 10.12998/wjcc.v11.i29.7253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Occult thyroid papillary carcinoma (OTPC) is typically characterized by initial presentation with cervical lymph node metastasis and can be detected through ultrasound. However, the initial and sole manifestation was a submandibular solid-cystic mass. High-frequency ultrasound, enhanced multislice computed tomography (CT) scan, and thyroid function tests revealed no abnormalities, which is relatively uncommon. CASE SUMMARY A 24-year-old Chinese female, who studied at a university in Shandong Province, presented to the clinic in June 2019 with a right submandibular mass that she had noticed 2 mo earlier. Clinical examination revealed a 2-cm, nontender, movable solid-cystic mass in the submandibular region, with no palpable thyroid mass observed. Ultrasonography revealed a 2.0 cm × 1.1 cm solid-cystic mass in the right submandibular region, and the thyroid gland showed no abnormalities. CT scan and 131I whole body follow-up scan showed that there were no abnormalities in the thyroid. However, cytology and pathology showed papillary tumor cell clusters, consistent with papillary thyroid carcinoma. Thus, we performed total thyroidectomy and right neck lymph node dissection. The pathology revealed the thyroid was detected as classical thyroid micropapillary carcinoma, and lymph nodes of levels VI central and levels II, III, IV, V on the right side showed no tumor metastasis. The patient was followed up for 2 years without significant recurrence. CONCLUSION The presentation of a submandibular solid-cystic mass as the primary and solitary indication of OTPC is relatively uncommon. Fine needle aspiration is advised for evaluating neck masses.
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Affiliation(s)
- Geng-Yu Chen
- Thyroid and Breast Surgery, The Fourth People’s Hospital of Jinan City, Jinan 250021, Shandong Province, China
| | - Tong Li
- Thyroid and Breast Surgery, The Fourth People’s Hospital of Jinan City, Jinan 250021, Shandong Province, China
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Albuck AL, Issa PP, Hussein M, Aboueisha M, Attia AS, Omar M, Munshi R, Shama M, Toraih E, Randolph GW, Kandil E. A combination of computed tomography scan and ultrasound provides optimal detection of cervical lymph node metastasis in papillary thyroid carcinomas: A systematic review and meta-analysis. Head Neck 2023; 45:2173-2184. [PMID: 37417426 DOI: 10.1002/hed.27451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Lymph node metastasis (LNM) in patients with papillary thyroid carcinoma (PTC) is common. This meta-analysis assesses the diagnostic accuracy of computed tomography (CT), ultrasound (US), and CT + US in detecting central and lateral LNM. METHODS A systematic review and meta-analysis was performed by searching PubMed, Embase, and Cochrane for studies published up to April 2022. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated. The area under the curve (AUC) for summary receiver operating curves (sROC) were compared. RESULTS The study population included 7902 patients with a total of 15 014 lymph nodes. Twenty-four studies analyzed the sensitivity of the overall neck region in which dual CT + US imaging (55.9%) had greater sensitivities (p < 0.001) than either US (48.4%) or CT (50.4%) alone. The specificity of US alone (89.0%) was greater (p < 0.001) than CT alone (88.5%) or dual imaging (86.8%). The DOR for dual CT + US imaging was greatest (p < 0.001) at 11.134, while the AUCs of the three imaging modalities were similar (p > 0.05). Twenty-one studies analyzed the sensitivity of the central neck region in which both CT (45.8%) and CT + US imaging (43.4%) had greater sensitivities (p < 0.001) than US alone (35.3%). The specificity of all three modalities was higher than 85%. The DOR for CT (7.985) was greater than US alone (4.723, p < 0.001) or dual CT + US imaging (4.907, p = 0.015). The AUC of both CT + US (0.785) and CT alone (0.785) were significantly greater (p < 0.001) than US alone (0.685). Of the 19 studies that reported lateral LNM, CT + US imaging sensitivity (84.5%) was higher than CT alone (69.2%, p < 0.001) and US alone (79.7%, p = 0.038). The specificity of all imaging techniques was all greater than 80.0%. CT + US imaging DOR (35.573) was greater than CT (20.959, p = 0.024) and US (15.181, p < 0.001) individually. The AUC of independent imaging was high (CT: 0.863, US: 0.858) and improved significantly when combined (CT + US: 0.919, p = 0.024 and p < 0.001, respectively). CONCLUSIONS We report an up-to-date analysis elucidating the diagnostic accuracy of LNM detection by either CT, US, or in combination. Our work suggests dual CT + US to be the best for overall detection of LNM and CT to be preferable in detecting central LNM. The use of either CT or US alone may detect lateral LNM with acceptable accuracy, yet dual imaging (CT + US) significantly improved detection rates.
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Affiliation(s)
- Aaron L Albuck
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Peter P Issa
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mohammad Hussein
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mohamed Aboueisha
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Abdallah S Attia
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mahmoud Omar
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ruhul Munshi
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mohamed Shama
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Eman Toraih
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Gregory W Randolph
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Liu L, Jia C, Li G, Shi Q, Du L, Wu R. Can pre-operative ultrasound elastography predict aggressive features of solitary papillary thyroid carcinoma? Br J Radiol 2023; 96:20220820. [PMID: 37171910 PMCID: PMC10461290 DOI: 10.1259/bjr.20220820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/16/2023] [Accepted: 04/17/2023] [Indexed: 05/14/2023] Open
Abstract
OBJECTIVE To investigate whether pre-operative ultrasound elastography (USE) can be used to predict aggressive features of solitary papillary thyroid carcinomas (PTCs). METHODS Clinical and USE indices were retrospectively analyzed in 487 patients with surgically confirmed solitary PTCs. The patients were grouped per aggressive features on pathologic testing. Univariate and binary logistic regression analyses were performed to explore independent risk factors of aggressive features. RESULTS Univariate analysis revealed standard deviation (SD) values of the tumor shear-wave velocity (SWV) were associated with capsular invasion (p < 0.05). Further, shear-wave elasticity and SWV ratios correlated with extrathyroidal extension (all p < 0.05). The tumor shear-wave elasticity and SWV SD values were associated with cervical lymph node metastasis (CLNM) (all p < 0.05). Binary logistic regression analysis identified location and capsule contact as independent predictive risk factors for capsular invasion (all p < 0.05); size for extrathyroidal extension (all p < 0.05); and sex, age, margin, and suspected CLNM for CLNM (all p < 0.05). However, pre-operational USE indexes were not independent predictors of aggressive features (all p > 0.05). CONCLUSION Pre-operative USE indices were not independent risk factors of aggressive features of solitary PTCs. Thus, USE may have a limited value for predicting the aggressive features of PTC. ADVANCES IN KNOWLEDGE Pre-operative USE indices may have a limited value for predicting the aggressive features of PTC.
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Affiliation(s)
| | - Chao Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiusheng Shi
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Masuoka S, Hiyama T, Kuno H, Sekiya K, Sakashita S, Kobayashi T. Imaging Approach for Cervical Lymph Node Metastases from Unknown Primary Tumor. Radiographics 2023; 43:e220071. [PMID: 36795593 DOI: 10.1148/rg.220071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Neck swelling due to lymph node (LN) metastasis is one of the initial symptoms of head and neck cancer, and in some cases, the primary tumor is not clinically evident. The purpose of imaging for LN metastasis from an unknown primary site is to identify the primary tumor or detect its absence, which leads to the correct diagnosis and optimal treatment. The authors discuss diagnostic imaging approaches for identifying the primary tumor in cases of unknown primary cervical LN metastases. The distribution and characteristics of LN metastases may help locate the primary site. Unknown primary LN metastasis often occurs at nodal levels II and III, and in recent reports, these were mostly related to human papillomavirus (HPV)-positive squamous cell carcinoma of the oropharynx. Another characteristic imaging finding suggestive of metastasis from HPV-associated oropharyngeal cancer is a cystic change in LN metastases. Other characteristic imaging findings such as calcification may help predict the histologic type and locate the primary site. In cases of LN metastases at nodal levels IV and VB, a primary lesion located outside the head and neck region must also be considered. One clue for detecting the primary lesion at imaging is the disruption of anatomic structures, which can help in identifying small mucosal lesions or submucosal tumors at each subsite. Additionally, fluorine 18 fluorodeoxyglucose PET/CT may help identify a primary tumor. These imaging approaches for identifying primary tumors enable prompt identification of the primary site and assist clinicians in making the correct diagnosis. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Sota Masuoka
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Takashi Hiyama
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Hirofumi Kuno
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Kotaro Sekiya
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Shingo Sakashita
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Tatsushi Kobayashi
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
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Lee MK, Na DG, Joo L, Lee JY, Ha EJ, Kim JH, Jung SL, Baek JH. Standardized Imaging and Reporting for Thyroid Ultrasound: Korean Society of Thyroid Radiology Consensus Statement and Recommendation. Korean J Radiol 2023; 24:22-30. [PMID: 36606617 PMCID: PMC9830140 DOI: 10.3348/kjr.2022.0894] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 01/03/2023] Open
Abstract
Ultrasonography (US) is a primary imaging modality for diagnosing nodular thyroid disease and has an essential role in identifying the most appropriate management strategy for patients with nodular thyroid disease. Standardized imaging techniques and reporting formats for thyroid US are necessary. For this purpose, the Korean Society of Thyroid Radiology (KSThR) organized a task force in June 2021 and developed recommendations for standardized imaging technique and reporting format, based on the 2021 KSThR consensus statement and recommendations for US-based diagnosis and management of thyroid nodules. The goal was to achieve an expert consensus applicable to clinical practice.
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Affiliation(s)
- Min Kyoung Lee
- Department of Radiology, Yeoido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea.
| | - Leehi Joo
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeoido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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12
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Huang C, Hu D, Zhuang Y, Su X. Risk factors and prediction model of level II lymph node metastasis in papillary thyroid carcinoma. Front Oncol 2022; 12:984038. [PMID: 36605444 PMCID: PMC9807902 DOI: 10.3389/fonc.2022.984038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Surgical management of lateral lymph nodes in papillary thyroid carcinoma, especially at level II, remains controversial. This study aimed to investigate the risk factors for level II lymph node metastasis in patients with papillary thyroid carcinoma and establish a prediction model to estimate the metastatic risk. Materials and methods A total of 768 patients with papillary thyroid carcinoma underwent thyroidectomy and central plus lateral lymph node dissection, including levels VI, II, III, and IV, at the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2018. Data on the clinicopathological characteristics were collected and analyzed. Univariate and multivariate analyses were performed to identify risk factors for level II lymph node metastasis. Subsequently, a predictive model was established based on the results of the multivariate analyses. Results The level II lymph node metastatic rate was 34.11% with the following features: largest tumor diameter >20 mm (Odds ratio=1.629, P=0.026), located in the upper pole (Odds ratio=4.970, P<0.001), clinical lymph node-positive (clinical central lymph node-positive: Odds ratio=1.797; clinical lateral lymph node-positive: Odds ratio=1.805, P=0.008), vascular invasion (Odds ratio=6.759, P=0.012), and rate of central lymph node metastasis (Odds ratio=2.498, P<0.001). Level III lymph node metastasis (Odds ratio=2.749, P<0.001) and level IV lymph node metastasis (Odds ratio=1.732, P=0.007) were independent of level II lymph node metastasis predictors. The prediction model's areas under the receiver operating characteristic curve were 0.815 and 0.804, based on bootstrapping validation. Level II lymph node metastasis was associated with the tumor-free survival rate of patients with papillary thyroid carcinoma (P<0.001). Conclusions Largest tumor diameter >20 mm, located in the upper pole, clinical lymph node-positive, vascular invasion, rate of central lymph node metastasis, and levels III and IV lymph node metastases were independent level II lymph node metastasis predictors. We developed a prediction model for level II lymph node metastasis. Overall, level II lymph node metastasis dissection should be individualized according to clinicopathological data both preoperatively and intraoperatively.
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Affiliation(s)
- Chun Huang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuchen Zhuang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinliang Su
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Xinliang Su,
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13
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Chung SR, Baek JH, Rho YH, Choi YJ, Sung TY, Song DE, Kim TY, Lee JH. Sonographic Diagnosis of Cervical Lymph Node Metastasis in Patients with Thyroid Cancer and Comparison of European and Korean Guidelines for Stratifying the Risk of Malignant Lymph Node. Korean J Radiol 2022; 23:1102-1111. [PMID: 36126955 PMCID: PMC9614289 DOI: 10.3348/kjr.2022.0358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate the ultrasonography (US) features for diagnosing metastasis in cervical lymph nodes (LNs) in patients with thyroid cancer and compare the US classification of risk of LN metastasis between European and Korean guidelines. MATERIALS AND METHODS From January 2014 to December 2018, US-guided fine-needle aspiration was performed on 836 LNs from 714 patients for the preoperative nodal staging of thyroid cancer. The US features of LNs were retrospectively reviewed for the following features: size, presence of hilum, margin, orientation, cystic change, punctate echogenic foci (PEF), large echogenic foci, eccentric cortical thickening, abnormal vascularity, and cortical hyperechogenicity. A multiple logistic regression analysis was performed to identify the independent US features for the diagnosis of metastatic LNs. The diagnostic performance of independent US features was subsequently evaluated. LNs were categorized according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and European Thyroid Association (ETA) guidelines, and the correlation between the two sets of classifications was assessed. RESULTS Absence of the hilum, presence of cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features of metastatic LNs. Cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity showed high specificity (86.8%-99.6%). The absence of the hilum had the highest sensitivity yet low specificity (66.4%). When LNs were classified according to the ETA guidelines and K-TIRADS, they yielded similar categorizations of malignancy risks and were strongly correlated (Spearman coefficient, 0.9766 [95% confidence interval, 0.973-0.979]). According to the ETA guidelines, 9.8% (82/836) of LNs were classified as "not specified." CONCLUSION Absence of hilum, cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features suggestive of metastatic LNs in thyroid cancer. Both K-TIRADS and the ETA guidelines provided similar risk stratification for metastatic LNs with a high correlation; however, the ETA guidelines failed to classify 9.8% of LNs into a specific risk stratum. These results may provide a basis for revising LN classification in future guidelines.
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Affiliation(s)
- Sae Rom Chung
- 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
| | - Yun Hwa Rho
- 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
| | - Tae-Yon Sung
- Department of Surgery, 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
| | - Tae Yong Kim
- Department of Internal Medicine, 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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Liu N, Tang L, Chen Y, Wang Y, Huang W, Du Z, Shen Y, Wu Z, He T, Su G, Xie W, Chen Y. A Combination of Contrast-Enhanced Ultrasound and Thyroglobulin Level in Fine-Needle Aspirates Improves Diagnostic Accuracy for Metastatic Lymph Nodes of Papillary Thyroid Carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2431-2443. [PMID: 34971466 DOI: 10.1002/jum.15926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/17/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) combined with thyroglobulin (Tg) levels in fine-needle aspirates (FNA) washout fluid (FNA-Tg) in diagnosing cervical lymph node (LN) metastasis in papillary thyroid cancer (PTC) patients. METHODS Data from 190 LNs in 167 patients suspected of metastasis from the US between November 2018 and September 2020 were included. All subjects underwent FNA, CEUS, and FNA-Tg examinations. The final outcomes were confirmed by histopathological or cytological examination or follow-up imaging. Data were analyzed using the Wilcoxon rank-sum or chi-squared test. The diagnostic efficacy of FNA, CEUS, and FNA-Tg in diagnosing LNs was compared. RESULTS A cutoff value of 6.15 ng/ml (AUC 0.925, 95% confidence interval (CI) 0.885-0.966) successfully identified metastatic LNs. FNA missed 58 LN metastases, of these, 94.8% (55/58) were correctly diagnosed using the combination of CEUS and FNA-Tg. FNA-Tg showed higher sensitivity (90.2%), NPV (86.1%) and accuracy (88.9%) than either FNA (48.2, 57.4 and 69.5%, respectively) or CEUS (82.1, 67.7 and 70.5%, respectively) alone. The combination of CEUS, FNA and FNA-Tg resulted in maximal sensitivity (100%) and NPV (100%) but reduced specificity (51.3%) and overall diagnostic accuracy (80.0%). After adding FNA-Tg to discordant samples between CEUS and FNA, 81.9% of LNs (77/94) were correctly diagnosed. CONCLUSIONS The combination of FNA, FNA-Tg and CEUS was found to be a promising imaging tool in detecting metastatic LNs in PTC patients.
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Affiliation(s)
- Naxiang Liu
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Lina Tang
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yijie Chen
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yaoqin Wang
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Weiqin Huang
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Zhongshi Du
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Youhong Shen
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Zhougui Wu
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Tongmei He
- Department of Pathology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Guangjian Su
- Department of Clinical Laboratory, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Wenting Xie
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yunchao Chen
- Department of Ultrasound, Xiang'an Hospital of Xiamen University, Xiamen, China
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15
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Rosario PW, Mourão GF. Natural history, predictive factors of apparent disease (structural or biochemical) and spontaneous excellent response in patients with papillary thyroid carcinoma and indeterminate response to initial therapy with radioiodine. Endocrine 2022; 76:671-676. [PMID: 35347578 DOI: 10.1007/s12020-022-03040-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND About 20% of patients with papillary thyroid carcinoma (PTC) submitted to total thyroidectomy followed by radioactive iodine (RAI) exhibit an indeterminate response to therapy. The aim was to evaluate the natural history, predictive factors of apparent disease (structural or biochemical), and spontaneous excellent response in patients with PTC and an initial indeterminate response to RAI therapy defined based on unstimulated Tg (u-Tg). METHODS We evaluated 164 patients who were initially treated with total thyroidectomy and RAI and who had an indeterminate response to therapy (u-Tg between 0.2 and 1 ng/ml, undetectable anti-Tg antibodies [TgAb], and neck ultrasonography [US] without anomalies). None of the patients received empirical therapy with RAI. The patients were followed up for 24 to 144 months (median 72 months). RESULTS Apparent disease occurred in 16 patients (9.7%), including 13 with structural disease and 3 with u-Tg elevation > 1 ng/ml, but no tumor was detected by the imaging methods (biochemical disease). A higher frequency of disease was observed in patients with >3 lymph node metastases (LNM) and initial u-Tg >0.35 ng/ml. The frequency was only 2% among patients with ≤3 LNM and u-Tg ≤0.35 ng/ml and 9.7% among patients with > 3 LNM or u-Tg >0.35 ng/ml, while the frequency was 27% in patients with >3 LNM and u-Tg >0.35 ng/ml. In the absence of any additional therapy, u-Tg was <0.2 ng/ml (excellent response) in the last assessment in 70 patients (42.7%). Only initial u-Tg was associated with a higher probability of spontaneously achieving an excellent response: 40/72 patients (55.5%) with u-Tg ≤0.35 ng/ml versus 30/92 patients (32.6%) with u-Tg >0.35 ng/ml. CONCLUSIONS A minority of patients with PTC and an initial indeterminate response to RAI defined based on u-Tg develop apparent disease (structural or biochemical) and many spontaneously achieve an excellent response. The risk of disease can be refined based on parameters such as the extent of lymph node involvement and initial Tg concentration.
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16
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do Prado Padovani R, Chablani SV, Tuttle RM. Radioactive iodine therapy: multiple faces of the same polyhedron. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:2359-3997000000461. [PMID: 35551676 PMCID: PMC9832850 DOI: 10.20945/2359-3997000000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022]
Abstract
The incidence of differentiated thyroid carcinoma (DTC) has increased in recent decades with early stage, low risk papillary thyroid cancer (PTC) being detected and diagnosed. As a result, the psychological, financial, and clinical ramifications of overdiagnosis and excessively aggressive therapy are being increasingly recognized with many authorities calling for a re-evaluation of the traditional "one size fits all" management approaches. To address these critical issues, most thyroid cancer guidelines endorse a more risk adapted management strategy where the intensity of therapy and follow up is matched to the anticipated risk of recurrence and death from DTC for each patient. This "less is more" strategy provides for a minimalistic management approach for properly selected patients with low-risk DTC. This has re-kindled the long-standing debate regarding the routine use of radioactive iodine therapy (RIT) in DTC. Although recent guidelines have moved toward a more selective use of RIT, particular in patients with low-intermediate risk DTC, the proper selection of patients, the expected benefit, and the potential risks continue to be a source of ongoing controversy and debate. In this manuscript, we will review the wide range of clinical, imaging, medical team, and patient factors that must be considered when evaluating individual patients for RIT. Through a review of the current literature evaluating the potential benefits and risks of RIT, we will present a risk adapted approach to proper patient selection for RIT which emphasizes peri-operative risk stratification as the primary tool that clinicians should use to guide initial RIT management recommendations.
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17
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Lee JY, Yoo RE, Rhim JH, Lee KH, Choi KS, Hwang I, Kang KM, Kim JH. Validation of Ultrasound Risk Stratification Systems for Cervical Lymph Node Metastasis in Patients with Thyroid Cancer. Cancers (Basel) 2022; 14:cancers14092106. [PMID: 35565235 PMCID: PMC9105025 DOI: 10.3390/cancers14092106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Ultrasound (US) malignancy risk stratification systems (RSS) for cervical lymph nodes (LNs) have not been fully established in patients with thyroid cancer. In this study, we assessed the malignancy risks of each US feature and risk category from the Korean Society of Thyroid Radiology (KSThR) and the European Thyroid Association (ETA). Both systems effectively classified malignancy risks; however, 15.1% of LNs were unclassifiable in ETA RSS. Suspicious US features of hyperechogenicity, cystic change, echogenic foci, and abnormal vascularity were independently associated with metastasis. When the primary tumor characteristics were assessed, tumor multiplicity was associated with metastasis in the indeterminate LN group. We refined this system and proposed an RSS based on the KSThR system for cervical LNs in patients with thyroid cancer. Abstract A malignancy risk stratification system (RSS) for cervical lymph nodes (LNs) has not been fully established. This study aimed to validate the current RSS for the diagnosis of cervical LN metastasis in thyroid cancer. In total, 346 LNs from 282 consecutive patients between December 2006 and June 2015 were included. We determined the malignancy risk of each ultrasound (US) feature and performed univariable and multivariable logistic regression analyses. Each risk category from the Korean Society of Thyroid Radiology (KSThR) and the European Thyroid Association (ETA) was applied to calculate malignancy risks. The effects of size, number of suspicious features, and primary tumor characteristics were analyzed to refine the current RSS. Suspicious features including echogenic foci, cystic change, hyperechogenicity, and abnormal vascularity were independently predictive of malignancy (p ≤ 0.045). The malignancy risks of probably benign, indeterminate, and suspicious categories were 2.2–2.5%, 26.8–29.0%, and 85.8–87.4%, respectively, according to the KSThR and ETA criteria. According to the ETA criteria, 15.1% of LNs were unclassifiable. In indeterminate LNs, multiplicity of the primary tumor was significantly associated with malignancy (odds ratio, 6.53; p = 0.004). We refined the KSThR system and proposed a US RSS for LNs in patients with thyroid cancer.
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Affiliation(s)
- Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Jung Hyo Rhim
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 156707, Korea;
| | - Kyung Hoon Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Kyu Sung Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
- Correspondence: ; Tel.: +82-2-2072-3280
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Russell MD, Orloff LA. Ultrasonography of the thyroid, parathyroids, and beyond. HNO 2022; 70:333-344. [PMID: 35364686 PMCID: PMC8974803 DOI: 10.1007/s00106-022-01162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/29/2022]
Abstract
Background Ultrasonography has become an essential tool for the evaluation and management of thyroid and parathyroid diseases. Its applications extend beyond neck endocrine conditions to a multitude of pathologies within the head and neck region. Objectives Our study aimed to: (1) provide a broad review of neck ultrasonography and key findings in neck endocrine diseases; (2) support skilled performance office-based diagnostic ultrasonography and its varied applications. Materials and methods A review of the current literature was supplemented with clinical examples of key ultrasonographic findings. Results Current applications and key findings of ultrasonography in the diagnosis and management of neck endocrine conditions are reviewed. Conclusion Ultrasonography is a fundamental component in the evaluation and management of neck endocrine diseases. The reader is encouraged to use this review to enhance office-based performance and application of ultrasonography. Video online The online version of this article contains 11 additional videos. They are provided to illustrate some of the dynamic aspects of US performance. The article and the videos are available online (10.1007/s00106-022-01162-0). The videos can be found in the article back matter as “Electronic Supplementary Material”.
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Affiliation(s)
- Marika D Russell
- Department of Otolaryngology-Head and Neck Surgery, University of California, 2233 Post Street, 3rd Floor, San Francisco, CA, USA.
| | - Lisa A Orloff
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Shao G, Sun B, Shi M, Song Y, Sun Z, Hao X, Li L, Fu Z. Preoperative comprehensive malignancy risk estimation for thyroid nodules: Development and verification of a network-based prediction model. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1264-1271. [DOI: 10.1016/j.ejso.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/19/2022] [Accepted: 03/18/2022] [Indexed: 12/07/2022]
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20
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Eun NL, Kim JA, Gweon HM, Youk JH, Son EJ. Preoperative Nodal US Features for Predicting Recurrence in N1b Papillary Thyroid Carcinoma. Cancers (Basel) 2021; 14:cancers14010174. [PMID: 35008339 PMCID: PMC8750311 DOI: 10.3390/cancers14010174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/13/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022] Open
Abstract
Simple Summary The presence of lateral neck lymph node (LN) metastasis (N1b) is a known prognostic factor for poor prognosis and high morbidity after surgery in papillary thyroid carcinoma (PTC). Previous studies have suggested that tumor size and metastatic LN characteristics, including LN size, number, ratio, and extranodal extension, are associated with recurrence; however, the prognostic role of imaging features of LNs in the lateral neck have rarely been reported. In this study, we investigated whether ultrasound imaging features of lateral neck LN metastases can be prognostic markers for predicting recurrence and thereby guide surgical extent and posttreatment surveillance in N1b PTC. Abstract This study aimed to investigate whether preoperative ultrasonographic (US) features of metastatic lymph nodes (LNs) are associated with tumor recurrence in patients with N1b papillary thyroid carcinoma (PTC). We enrolled 692 patients (mean age, 41.9 years; range, 6–80 years) who underwent total thyroidectomy and lateral compartment LN dissection between January 2009 and December 2015 and were followed-up for 12 months or longer. Clinicopathologic findings and US features of the index tumor and metastatic LNs in the lateral neck were reviewed. A Kaplan-Meier analysis and Cox proportion hazard model were used to analyze the recurrence-free survival rates and features associated with postoperative recurrence. Thirty-seven (5.3%) patients had developed recurrence at a median follow-up of 66.5 months. On multivariate Cox proportional hazard analysis, male sex (hazard ratio [HR], 2.277; 95% confidence interval [CI]: 1.131, 4.586; p = 0.021), age ≥55 years (HR, 3.216; 95% CI: 1.529, 6.766; p = 0.002), LN size (HR, 1.054; 95% CI: 1.024, 1.085; p < 0.001), and hyperechogenicity of LN (HR, 8.223; 95% CI: 1.689, 40.046; p = 0.009) on US were independently associated with recurrence. Preoperative US features of LNs, including size and hyperechogenicity, may be valuable for predicting recurrence in patients with N1b PTC.
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Affiliation(s)
| | | | | | | | - Eun Ju Son
- Correspondence: ; Tel.: +82-2-2019-3510; Fax: +82-2-3462-5472
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21
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Segmentation of Lymph Nodes in Ultrasound Images Using U-Net Convolutional Neural Networks and Gabor-Based Anisotropic Diffusion. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00670-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Ha EJ, Chung SR, Na DG, Ahn HS, Chung J, Lee JY, Park JS, Yoo RE, Baek JH, Baek SM, Cho SW, Choi YJ, Hahn SY, Jung SL, Kim JH, Kim SK, Kim SJ, Lee CY, Lee HK, Lee JH, Lee YH, Lim HK, Shin JH, Sim JS, Sung JY, Yoon JH, Choi M. 2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol 2021; 22:2094-2123. [PMID: 34719893 PMCID: PMC8628155 DOI: 10.3348/kjr.2021.0713] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1-2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.
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Affiliation(s)
- Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Chung
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Korea
| | - Seong Whi Cho
- Department of Radiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seul Kee Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Soo Jin Kim
- Department of Radiology, New Korea Hospital, Gimpo, Korea
| | - Chang Yoon Lee
- Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Ho Kyu Lee
- Department of Radiology, Jeju National University, Jeju, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
| | - Jin Young Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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Zhang X, Wang L, Feng N, Ni T, Tang W. Reassessing the Value of Contrast-Enhanced Ultrasonography in Differential Diagnosis of Cervical Tuberculous Lymphadenitis and Lymph Node Metastasis of Papillary Thyroid Carcinoma. Front Oncol 2021; 11:694449. [PMID: 34722243 PMCID: PMC8551861 DOI: 10.3389/fonc.2021.694449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/24/2021] [Indexed: 12/31/2022] Open
Abstract
Aim We aimed to evaluate the ability of contrast-enhanced ultrasonography (CEUS) to perform differential diagnosis of cervical tuberculous lymphadenitis and lymph node metastasis from papillary thyroid cancer (PTC). Methods We analyzed 102 enlarged cervical lymph nodes as diagnosed by conventional ultrasound (US) and CEUS. The US and CEUS enhancement pattern and the time intensity curve (TIC) of the metastatic lymph nodes or tuberculous lymph nodes were compared following standard pathological protocols. The TIC included peak time (TTP), peak intensity (PI), and area under the gamma curve (AUC). Results Pathological results demonstrated that 48 out of the 102 enlarged lymph nodes were lymph node metastasis from PTC, while 54 were tuberculous lymphadenitis. There was statistically significant differences in hyperechoic islands, pulse-like enhancement, and asynchronous enhancement between tuberculous lymphadenitis and lymph node metastasis (P < 0.05), but their diagnostic sensitivity and specificity were unsatisfactory. In addition, our data did not show statistically significant difference in enhancement direction, enlarged range on CEUS, and perfusion defect (P > 0.05). Similarly, quantitative parameters such as PI, TTP, and AUC did not yield significant differences between the groups. Conclusion Taken together, the present results demonstrate that CEUS can provide valuable information on lymph node blood flow, which can be used to identify tuberculous lymphadenitis and lymph node metastasis of PTC.
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Affiliation(s)
- Xu Zhang
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lingling Wang
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Na Feng
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tu Ni
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Tang
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Lee JY, Kim JH, Yeon EK, Hwang I, Yoo RE, Kang KM, Yun TJ, Choi SH, Sohn CH. Computed tomography complements ultrasound for the differential diagnosis of traumatic neuroma from recurrent tumor in patients with postoperative thyroid cancer. Eur Radiol 2021; 32:2760-2768. [PMID: 34665316 DOI: 10.1007/s00330-021-08321-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/27/2021] [Accepted: 06/30/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Traumatic neuromas (TNs) mimic recurrent tumors in US after total thyroidectomy (TT) and lateral neck dissection (LND) for thyroid cancer. We aimed to evaluate whether CT could complement US in the differential diagnosis of TNs from recurrent thyroid cancer in the dissected neck. MATERIAL AND METHODS We retrospectively included a total of 97 consecutive US-detected lesions (28 TNs and 69 recurrent tumors) in patients with a previous history of TT and LND for thyroid cancer. The lesions were classified as benign, indeterminate, or suspicious according to the presence of benign or suspicious features on US and CT. Imaging features and categories on US and CT were compared between TNs and recurrent tumors. The diagnostic performances of US and CT for differentiating between TNs and recurrent tumors were calculated. RESULTS On US, most TNs and recurrent tumors showed internal hyperechogenicity without hilar echogenicity or hilar vascularity and were categorized as suspicious lesions (23/28, 82.1% vs. 53/69, 76.8%). On CT, all TNs lacked strong enhancement without hilar fat or hilar vessel enhancement and were categorized as indeterminate lesions (28/28, 100%). In contrast, most recurrent tumors showed strong enhancement and were categorized as suspicious lesions (63/69, 91.3%). The addition of CT to US corrected 23 false-positive diagnoses in 28 TNs and 10 false-negative diagnoses in 69 recurrent tumors. CONCLUSIONS CT complements US for the correct differentiation of TNs from recurrent tumors in postoperative thyroid cancer patients. The addition of CT to US may prevent unnecessary painful biopsy or surgery. KEY POINTS • In the dissected neck, traumatic neuromas could mimic US suspicious LNs owing to its internal hyperechogenicity. • CT effectively differentiated traumatic neuromas from recurrent thyroid cancers by demonstrating significantly different enhancement patterns. • CT could complement US and may prevent unnecessary painful biopsy or surgery for US-detected lesions after thyroidectomy and neck dissection.
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Affiliation(s)
- Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongnogu, Seoul, 03080, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongnogu, Seoul, 03080, Korea.
| | - Eung Koo Yeon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongnogu, Seoul, 03080, Korea
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongnogu, Seoul, 03080, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongnogu, Seoul, 03080, Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongnogu, Seoul, 03080, Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongnogu, Seoul, 03080, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongnogu, Seoul, 03080, Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongnogu, Seoul, 03080, Korea
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Shu X, Tang L, Hu D, Wang Y, Yu P, Yang Z, Deng C, Wang D, Su X. Prediction Model of Pathologic Central Lymph Node Negativity in cN0 Papillary Thyroid Carcinoma. Front Oncol 2021; 11:727984. [PMID: 34646771 PMCID: PMC8503674 DOI: 10.3389/fonc.2021.727984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background Most patients with papillary thyroid carcinoma (PTC) have an excellent prognosis. Although central lymph node invasion is frequent, management via central lymph node dissection (CLND) remains controversial. The present study retrospectively investigated independent predictors of pathologic central lymph node negativity (pCLN-) and established a prediction model for pCLN- in clinical lymph node negativity (cN0) PTC. Methods A total of 2,687 patients underwent thyroid surgery for cN0 PTC from 2013 to 2018 at the First Affiliated Hospital of Chongqing Medical University, and lobectomy plus ipsilateral CLND was the basic surgical extent. Clinicopathological characteristics were reviewed and analyzed. Univariate and multivariate analyses were performed to identify factors related to pCLN-. A prediction model was established based on the results of multivariate analyses. Results The pCLN- rate was 51.5% (1,383/2,687). Multivariate analysis revealed that sex, age, thyroid stimulating hormone (TSH), size, location, laterality, unifocality and extrathyroidal extension negativity (ETE-) were independent predictors of pCLN-. The nomogram showed good discriminative ability (C-index: 0.784 and 0.787 in derivation and validation groups, respectively) and was well calibrated. We quantified the clinical usefulness of the nomogram by decision curve analysis. The median length of follow-up was 30 (range 12– 83) months, and 190 cases were lost, with a follow-up rate of 92.9% (2,497/2,687). Of the 2,687 patients included, 21 (0.8%) experienced recurrence. Conclusion This nomogram, which integrates available preoperative clinicopathological features and intraoperative frozen biopsy outcomes, is a reliable tool with high accuracy to predict pCLN- in cN0 PTC.
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Affiliation(s)
- Xiujie Shu
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingfeng Tang
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Wang
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Yu
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhixin Yang
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chang Deng
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Denghui Wang
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinliang Su
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Chasen NN, Wang JR, Gan Q, Ahmed S. Imaging of Cervical Lymph Nodes in Thyroid Cancer: Ultrasound and Computed Tomography. Neuroimaging Clin N Am 2021; 31:313-326. [PMID: 34243866 DOI: 10.1016/j.nic.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sonographic evaluation of cervical lymph nodes in patients with thyroid malignancy is important both for preoperative staging and for post-treatment surveillance, and contrast-enhanced computed tomography plays a complementary role. Knowledge of anatomy and surgical approaches, combined with an understanding of the various imaging features that distinguish malignant from benign lymph nodes, allows for accurate staging, thereby enabling complete surgical initial resection.
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Affiliation(s)
- Noah Nathan Chasen
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1482, Houston, TX 77030-4009, USA
| | - Jennifer Rui Wang
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030-4009, USA
| | - Qiong Gan
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0085, Houston, TX 77030-4009, USA
| | - Salmaan Ahmed
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1482, Houston, TX 77030-4009, USA.
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27
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Song Y, Liu F, Ruan W, Hu F, Younis MH, Gao Z, Ming J, Huang T, Cai W, Lan X. Head-to-Head Comparison of Neck 18F-FDG PET/MR and PET/CT in the Diagnosis of Differentiated Thyroid Carcinoma Patients after Comprehensive Treatment. Cancers (Basel) 2021; 13:cancers13143436. [PMID: 34298651 PMCID: PMC8307331 DOI: 10.3390/cancers13143436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/13/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The most advanced positron emission tomography–magnetic resonance (PET/MR) combines the high soft tissue contrast of MRI with the high functional/metabolic sensitivity of PET and has the potential to achieve the highest level of diagnostic performance for refractory malignancies in differentiated thyroid cancer (DTC) patients. The utility of PET/MR in the postoperative follow-up of DTC patients has been relatively ambiguous. This retrospective study compared 18F-fluorodeoxyglucose neck PET/MR with PET/CT head-to-head, in order to evaluate the diagnostic efficacy of PET/MR in assessment malignancy in DTC patients after comprehensive treatment. We determined that PET/MR presented better detection rates, image conspicuity, and sensitivity than PET/CT in recurrent DTC lesions and cervical lymph node metastases. The addition of neck PET/MR scan after whole-body PET/CT may provide more favorable diagnostic information. Abstract We explored the clinical value of 18F-FDG PET/MR in a head-to-head comparison with PET/CT in loco-regional recurrent and metastatic cervical lymph nodes of differentiated thyroid carcinoma (DTC) patients after comprehensive treatment. 18F-FDG PET/CT and neck PET/MR scans that were performed in DTC patients with suspected recurrence or cervical lymph node metastasis after comprehensive treatment were retrospectively analyzed. Detection rates, diagnostic efficacy, image conspicuity, and measured parameters were compared between 18F-FDG PET/CT and PET/MR. The gold standard was histopathological diagnosis or clinical and imaging follow-up results for more than 6 months. Among the 37 patients enrolled, no suspicious signs of tumor were found in 10 patients, 24 patients had lymph node metastasis, and 3 patients had both recurrence and lymph node metastases. A total of 130 lesions were analyzed, including 3 malignant and 6 benign thyroid nodules, as well as 74 malignant and 47 benign cervical lymph nodes. Compared with PET/CT, PET/MR presented better detection rates (91.5% vs. 80.8%), image conspicuity (2.74 ± 0.60 vs. 1.9 ± 0.50, p < 0.001, especially in complex level II), and sensitivity (80.5% vs. 61.0%). SUVmax differed in benign and malignant lymph nodes in both imaging modalities (p < 0.05). For the same lesion, the SUVmax, SUVmean, and diameters measured by PET/MR and PET/CT were consistent and had significant correlation. In conclusion, compared with 18F-FDG PET/CT, PET/MR was more accurate in determining recurrent and metastatic lesions, both from a patient-based and from a lesion-based perspective. Adding local PET/MR after whole-body PET/CT may be recommended to provide more precise diagnostic information and scope of surgical resection without additional ionizing radiation. Further scaling-up prospective studies and economic benefit analysis are expected.
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Affiliation(s)
- Yangmeihui Song
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.S.); (F.L.); (W.R.); (F.H.); (Z.G.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430030, China
| | - Fang Liu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.S.); (F.L.); (W.R.); (F.H.); (Z.G.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430030, China
| | - Weiwei Ruan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.S.); (F.L.); (W.R.); (F.H.); (Z.G.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430030, China
| | - Fan Hu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.S.); (F.L.); (W.R.); (F.H.); (Z.G.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430030, China
| | - Muhsin H. Younis
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53705, USA; (M.H.Y.); (W.C.)
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Zairong Gao
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.S.); (F.L.); (W.R.); (F.H.); (Z.G.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430030, China
| | - Jie Ming
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (J.M.); (T.H.)
| | - Tao Huang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (J.M.); (T.H.)
| | - Weibo Cai
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53705, USA; (M.H.Y.); (W.C.)
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.S.); (F.L.); (W.R.); (F.H.); (Z.G.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430030, China
- Correspondence:
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Randle RW, Pitt SC. The Role of Node Dissection for Thyroid Cancer. Adv Surg 2021; 55:131-145. [PMID: 34389088 DOI: 10.1016/j.yasu.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Reese W Randle
- Department of Surgery, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA. https://twitter.com/ReeseRandle
| | - Susan C Pitt
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA.
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Di Meo G, Prete FP, De Luca GM, Pasculli A, Sgaramella LI, Minerva F, Logoluso FA, Calculli G, Gurrado A, Testini M. The Value of Intraoperative Ultrasound in Selective Lateral Cervical Neck Lymphadenectomy for Papillary Thyroid Cancer: A Prospective Pilot Study. Cancers (Basel) 2021; 13:cancers13112737. [PMID: 34073149 PMCID: PMC8198597 DOI: 10.3390/cancers13112737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Lymph node metastases from papillary thyroid cancer (PTC) are frequent. Selective neck dissection (SND) is indicated in PTC with clinical or imaging evidence of lateral neck nodal disease. Both preoperative ultrasound (PreUS) and intraoperative palpation or visualization may underestimate actual lateral neck nodal involvement, particularly for lymph-nodes located behind the sternocleidomastoid muscle, where dissection may also potentially increase the risk of postoperative complications. The significance of diagnostic IOUS in metastatic PTC is under-investigated. (2) Methods: We designed a prospective diagnostic study to assess the diagnostic accuracy of IOUS compared to PreUS in detecting metastatic lateral neck lymph nodes from PTC during SND. (3) Results: There were 33 patients with preoperative evidence of lateral neck nodal involvement from PTC based on PreUS and fine-needle cytology. In these patients, IOUS guided the excision of additional nodal compartments that were not predicted by PreUS in nine (27.2%) cases, of which eight (24.2%) proved to harbor positive nodes at pathology. The detection of levels IIb and V increased, respectively, from 9% (PreUS) to 21% (IOUS) (p < 0.0001) and from 15% to 24% (p = 0.006). (4) Conclusions: In the context of this study, IOUS showed higher sensitivity and specificity than PreUS scans in detecting metastatic lateral cervical nodes. This study showed that IOUS may enable precise SND to achieve oncological radicality, limiting postoperative morbidity.
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Affiliation(s)
- Giovanna Di Meo
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
- Correspondence: ; Tel.: +39-3492123970
| | - Francesco Paolo Prete
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
| | - Giuseppe Massimiliano De Luca
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
| | - Alessandro Pasculli
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
| | - Lucia Ilaria Sgaramella
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
| | - Francesco Minerva
- Unit of Academic Internal Medicine “A. Murri”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy;
| | - Francesco Antonio Logoluso
- Unit of Academic Endocrinology, Department of Emergency and Organ Transplantations, University of Bari, Polyclinic Hospital, 70124 Bari, Italy;
| | - Giovanna Calculli
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
| | - Angela Gurrado
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
| | - Mario Testini
- Unit of Academic General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari, Polyclinic Hospital, 70124 Bari, Italy; (F.P.P.); (G.M.D.L.); (A.P.); (L.I.S.); (G.C.); (A.G.); (M.T.)
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30
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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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Frates MC, Parziale MP, Alexander EK, Barletta JA, Benson CB. Role of Sonographic Characteristics of Thyroid Bed Lesions Identified Following Thyroidectomy in the Diagnosis or Exclusion of Recurrent Cancer. Radiology 2021; 299:374-380. [PMID: 33650902 DOI: 10.1148/radiol.2021201596] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background US of the thyroid bed in patients with thyroid cancer often depicts small lesions, but it is unclear whether US characteristics of lesions can help predict cancer recurrence. Purpose To determine whether size or US features of lesions in the thyroid bed after thyroidectomy in conjunction with clinical features can help predict thyroid cancer recurrence. Materials and Methods With use of a US reporting database, all patients imaged between July 2006 and June 2016 with an indication of post-thyroidectomy follow-up were retrospectively identified. Recorded data included patient demographic characteristics; date of thyroidectomy; thyroid cancer type; presence, size, and US characteristics of thyroid bed lesions; and results of fine-needle aspiration (FNA). Images were reviewed for lesions that underwent FNA. The Fisher exact test was used for analysis. Results A total of 1885 patients (mean age ± standard deviation, 48 years ± 15; 1493 female patients) underwent 5732 US examinations. Most patients (1541 of 1885 [82%]) had papillary cancer. Overall, 3163 thyroid bed lesions were reported in 5732 US examinations (40.4%). More than half of these lesions (1860 of 3163 [58.8%]) had a maximum measurement of 6 mm or greater. FNA was performed in 144 of the 3163 lesions (4.6%), of which 61 (42.4%) were malignant, 33 (22.9%) were benign, and 50 (34.7%) were nondiagnostic. Five nondiagnostic lesions eventually proved malignant. Only the presence of punctate echogenicities in the lesion (28 of 61 malignant lesions [45.9%]; three of 33 benign lesions [9%]; 12 of 50 nondiagnostic lesions [24%]; P < .001) or the history of positive lymph nodes at thyroidectomy (44 of 61 malignant lesions [72.1%]; 10 of 33 benign lesions [30%]; 19 of 50 nondiagnostic lesions [38%]; P < .001) were associated with malignancy. Of 3019 thyroid bed lesions that did not undergo FNA, three were malignant and 2248 showed no growth at follow-up US ranging from 6 months to 10 years and are presumed benign. Of the 1303 lesions smaller than 6 mm, only two (0.2%) were malignant. Conclusion Small lesions are commonly found in the thyroid bed after thyroidectomy, and most are likely to be benign. Lesions smaller than 6 mm with no punctate echogenicities had a minimal risk for malignancy. © RSNA, 2021 See also the editorial by Grant and Malhi in this issue.
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Affiliation(s)
- Mary C Frates
- From the Department of Radiology (M.C.F., C.B.B.), Department of Medicine, Division of Endocrinology, Diabetes and Hypertension (E.K.A.), and Department of Pathology (J.A.B.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02067; and University of Vermont Medical School, Burlington, Vt (M.P.P.)
| | - Melanie P Parziale
- From the Department of Radiology (M.C.F., C.B.B.), Department of Medicine, Division of Endocrinology, Diabetes and Hypertension (E.K.A.), and Department of Pathology (J.A.B.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02067; and University of Vermont Medical School, Burlington, Vt (M.P.P.)
| | - Erik K Alexander
- From the Department of Radiology (M.C.F., C.B.B.), Department of Medicine, Division of Endocrinology, Diabetes and Hypertension (E.K.A.), and Department of Pathology (J.A.B.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02067; and University of Vermont Medical School, Burlington, Vt (M.P.P.)
| | - Justine A Barletta
- From the Department of Radiology (M.C.F., C.B.B.), Department of Medicine, Division of Endocrinology, Diabetes and Hypertension (E.K.A.), and Department of Pathology (J.A.B.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02067; and University of Vermont Medical School, Burlington, Vt (M.P.P.)
| | - Carol B Benson
- From the Department of Radiology (M.C.F., C.B.B.), Department of Medicine, Division of Endocrinology, Diabetes and Hypertension (E.K.A.), and Department of Pathology (J.A.B.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02067; and University of Vermont Medical School, Burlington, Vt (M.P.P.)
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Lee JY, Baek JH, Ha EJ, Sung JY, Shin JH, Kim JH, Lee MK, Jung SL, Lee YH, Ahn HS, Yoon JH, Choi YJ, Park JS, Lee YJ, Choi M, Na DG. 2020 Imaging Guidelines for Thyroid Nodules and Differentiated Thyroid Cancer: Korean Society of Thyroid Radiology. Korean J Radiol 2021; 22:840-860. [PMID: 33660459 PMCID: PMC8076832 DOI: 10.3348/kjr.2020.0578] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
Imaging plays a key role in the diagnosis and characterization of thyroid diseases, and the information provided by imaging studies is essential for management planning. A referral guideline for imaging studies may help physicians make reasonable decisions and minimize the number of unnecessary examinations. The Korean Society of Thyroid Radiology (KSThR) developed imaging guidelines for thyroid nodules and differentiated thyroid cancer using an adaptation process through a collaboration between the National Evidence-based Healthcare Collaborating Agency and the working group of KSThR, which is composed of radiologists specializing in thyroid imaging. When evidence is either insufficient or equivocal, expert opinion may supplement the available evidence for recommending imaging. Therefore, we suggest rating the appropriateness of imaging for specific clinical situations in this guideline.
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Affiliation(s)
- Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Eun Ju Ha
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jin Yong Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyoung Lee
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hye Shin Ahn
- Department of Radiology and Thyroid Center, Chungang University Hospital, Chungang University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Yoo Jin Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
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Iqbal MA, Wang X, Guoliang Z, Moazzam NF, Shahid AD, Qian X, Qian W. A comparison of the efficiency of diagnostic ultrasound and magnetic resonance imaging of cervical lymph nodes in papillary thyroid carcinoma. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:1033-1044. [PMID: 34511478 DOI: 10.3233/xst-210927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To compare and evaluate diagnostic capabilities of preoperative ultrasonography (US) and magnetic resonance imaging (MRI) in the cervical lymph nodes of patients with papillary thyroid cancer. METHODS A retrospective dataset involving 156 patients who had undergone thyroidectomy and preoperative US and MRI was assembled. Among these, 69 had cervical lymph node metastasis and 87 did not. At least four radiologists unilaterally and spontaneously investigated the US and MRI attributes of the cervical lymph nodes. The efficiency of diagnostic imaging for cervical lymph nodes, including their true-positive rate or sensitivity, true-negative rate or specificity, positive predictive value, negative predictive value, and predictive accuracy were analysed and assessed. RESULTS In the assessment of cervical lymph node metastases of papillary thyroid cancer, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of diagnostic US vs. MRI were 58.0% vs. 79.7%, 69.0% vs. 83.9%, 59.7% vs. 79.7%, 67.4% vs. 83.9%, and 64.1% vs. 82.1%, respectively. The accuracy consistency of the two imaging modalities was 83.5%. CONCLUSIONS MRI is more effective than US in diagnosing and assessing cervical lymph node metastases of papillary thyroid cancer.
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Affiliation(s)
- Muhammad Asad Iqbal
- Department of Otolaryngology-Head & Neck Surgery, Affiliated People's Hospital of Jiangsu University, (The First People's Hospital of Zhenjiang), Jiangsu Province, China
| | - Xian Wang
- Department of Ultrasound, Affiliated People's Hospital of Jiangsu University, (The First People's Hospital of Zhenjiang), Jiangsu Province, China
| | - Zhang Guoliang
- Department of General Surgery, Affiliated People's Hospital of Jiangsu University, (The First People's Hospital of Zhenjiang), Jiangsu Province, China
| | | | | | - Xiaoqin Qian
- Department of Ultrasound, Affiliated People's Hospital of Jiangsu University, (The First People's Hospital of Zhenjiang), Jiangsu Province, China
| | - Wei Qian
- Department of Otolaryngology-Head & Neck Surgery, Affiliated People's Hospital of Jiangsu University, (The First People's Hospital of Zhenjiang), Jiangsu Province, China
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Rosario PW, Mourão GF, Calsolari MR. Can patients with papillary thyroid carcinoma and low postoperative thyroglobulin in the presence of clinically apparent lymph node metastases (cN1) be spared from radioiodine? Endocrine 2020; 70:552-557. [PMID: 32653994 DOI: 10.1007/s12020-020-02414-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/01/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The study evaluated the recurrence rate in patients with papillary thyroid carcinoma (PTC) and clinically apparent lymph node metastases (LNM) (cN1) who had low thyroglobulin (Tg) after total thyroidectomy and who were not submitted to adjuvant therapy with 131I. METHODS This was a prospective study. It included 82 cN1 patients (≤3 LNM ≤1.5 cm without macroscopic extracapsular extension) with tumors ≤4 cm without macroscopic extrathyroid invasion (T1-2) and who after thyroidectomy had unstimulated Tg (u-Tg) < 0.3 ng/ml, negative antithyroglobulin antibodies (TgAb), and neck ultrasonography (US) showing no anomalies. The patients were not submitted to therapy with 131I. RESULTS The time of follow-up ranged from 24 to 156 months (median 84 months). Seventy-nine patients (96.3%) continued to have u-Tg < 0.3 ng/ml and negative US. Three patients (3.6%) exhibited an increase in Tg and structural recurrence was detected in two. After treatment, these patients achieved u-Tg < 1 ng/ml and the imaging methods revealed no apparent tumor. CONCLUSIONS The results suggest that even cN1 patients, given the absence of extensive LNM or other adverse findings, who have low Tg and neck US showing no anomalies after thyroidectomy do not require radioiodine.
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Yoo RE, Kim JH, Bae JM, Hwang I, Kang KM, Yun TJ, Choi SH, Sohn CH, Rhim JH, Park SW. Ultrasonographic Indeterminate Lymph Nodes in Preoperative Thyroid Cancer Patients: Malignancy Risk and Ultrasonographic Findings Predictive of Malignancy. Korean J Radiol 2020; 21:598-604. [PMID: 32323505 PMCID: PMC7183832 DOI: 10.3348/kjr.2019.0755] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/05/2020] [Indexed: 02/07/2023] Open
Abstract
Objective Proper management of lymph nodes (LNs) with ultrasonographic (US) indeterminate features in thyroid cancer patients remains elusive. We aimed to evaluate the malignancy risk and US findings predictive of malignancy for US indeterminate LNs in preoperative thyroid cancer patients through node-by-node correlation. Materials and Methods A total of 348 LNs in 284 thyroid cancer patients, who underwent fine-needle aspiration or core-needle biopsy between December 2006 and June 2015, were included. We determined the malignancy risks for US probably benign, indeterminate, and suspicious categories. For US indeterminate LNs, which had neither echogenic hilum nor hilar vascularity in the absence of any suspicious finding, US findings were compared between benign and metastatic LNs using Mann-Whitney U test and Fisher's exact test. Results US imaging diagnoses were probably benign in 20.7% (n = 72) cases, indeterminate in 23.6% (n = 82), and suspicious in 55.7% (n = 194). Malignancy risk of US indeterminate LNs (19.5% [16/82]) differed from those of the US probably benign (2.8% [2/72]) (p = 0.002) and US suspicious LNs (78.4% [152/194]) (p < 0.001). Among US indeterminate LNs, there were no significant differences in short, long, and long-to-short diameter (L/S) ratios between benign and metastatic LNs (3.9 vs. 3.8 mm, p = 0.619; 7.3 vs. 7.3 mm, p = 0.590; 1.9 vs. 1.9, p = 0.652). Conclusion US indeterminate LNs were frequently encountered during preoperative evaluation and had intermediate malignancy risk. Given the lack of discriminative power of size criteria and L/S ratio, clinical factors such as surgical strategy and node size should be considered for proper triage of US indeterminate LNs in thyroid cancer.
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Affiliation(s)
- Roh Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Jeong Mo Bae
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Chul Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hyo Rhim
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sun Won Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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Lee S, Lee JY, Yoon RG, Kim JH, Hong HS. The Value of Microvascular Imaging for Triaging Indeterminate Cervical Lymph Nodes in Patients with Papillary Thyroid Carcinoma. Cancers (Basel) 2020; 12:cancers12102839. [PMID: 33019664 PMCID: PMC7601686 DOI: 10.3390/cancers12102839] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Papillary thyroid carcinomas (PTC) are indolent tumors associated with excellent long-term survival, albeit frequently accompanied by cervical lymph node (LN) metastasis. The imaging criteria using conventional ultrasound (US) techniques showed high diagnostic performance for the suspicious and probably benign LN categories, but showed low diagnostic performance for the indeterminate category. In this retrospective study, we aimed to assess the added value of Superb Microvascular Imaging (SMI) for detecting metastatic PTC in the indeterminate LN category. We confirmed that SMI could effectively stratify indeterminate LNs by visualizing additional vascular signals. The reclassified categories of SMI provided a high diagnostic performance to distinguish metastasis from benign LNs. Therefore, adding SMI to conventional US scans can be useful when evaluating indeterminate LNs in patients with PTC. Abstract Assessment of lymph node (LN) status in patients with papillary thyroid carcinoma (PTC) is often troublesome because of cervical LNs with indeterminate US (ultrasound) features. We aimed to explore whether Superb Microvascular Imaging (SMI) could be helpful for distinguishing metastasis from indeterminate LNs when combined with power Doppler US (PDUS). From 353 consecutive patients with PTC, LNs characterized as indeterminate by PDUS were evaluated by SMI to distinguish them from metastasis. Indeterminate LNs were reclassified according to the SMI, the malignancy risk of each category was assessed, and the diagnostic performance of suspicious findings on SMI was calculated. The incidence of US-indeterminate LNs was 26.9%. Eighty PDUS-indeterminate LNs (39 proven as benign, 41 proven as malignant) were reclassified into probably benign (n = 26), indeterminate (n = 20), and suspicious (n = 34) categories according to SMI, with malignancy risks of 19.2%, 20.0%, and 94.1%, respectively. After combining SMI with PDUS, 80.8% (21/26) of probably benign LNs and 94.1% (32/34) of suspicious LNs could be correctly diagnosed as benign and metastatic, respectively. The diagnostic sensitivity, specificity, and accuracy of categorizing LNs as suspicious based on SMI were 78.1%, 94.9%, and 86.3%, respectively. In conclusion, the combination of SMI with PDUS was helpful for the accurate stratification of indeterminate LNs based on US in patients with PTC.
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Affiliation(s)
- Seongyong Lee
- Department of Radiology, Eulji Medical Center, Eulji University College of Medicine, Seoul 01830, Korea; (S.L.); (R.G.Y.)
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
- Correspondence: ; Tel.: 82-2-2072-3696
| | - Ra Gyoung Yoon
- Department of Radiology, Eulji Medical Center, Eulji University College of Medicine, Seoul 01830, Korea; (S.L.); (R.G.Y.)
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Hyun Sook Hong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 14584, Korea;
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Lee SE, Kim EK, Moon HJ, Yoon JH, Park VY, Han K, Kwak JY. Guideline Implementation on Fine-Needle Aspiration for Thyroid Nodules: Focusing on Micronodules. Endocr Pract 2020; 26:1017-1025. [PMID: 33471690 DOI: 10.4158/ep-2020-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/28/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We investigated patients who were referred to our institution after fine-needle aspiration (FNA) was performed at outside clinics to evaluate how many nodules satisfied the FNA indications of the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and compare that to the number of thyroid nodules that satisfy the FNA indications of the American College of Radiology (ACR)-TIRADS and American Thyroid Association (ATA) guidelines. METHODS Between January 2018 and December 2018, 2,628 patients were included in our study. The included patients were those referred for thyroid surgery after having a suspicious thyroid nodule. We retrospectively applied the three guidelines to each thyroid nodule and determined whether each nodule satisfied the FNA indications. We compared the proportion of nodules satisfying the FNA indications of each guideline using a generalized linear model and generalized estimating equation. RESULTS The median size of the 2,628 thyroid nodules was 0.9 cm (range, 0.2 to 9.5 cm). We found that FNA was not indicated for 54.1%, 47.7%, and 19.1% of nodules and 87.3%, 99.0%, and 97.8% among them were micronodules (<1 cm) according to the ACR-TIRADS, ATA guideline, and K-TIRADS, respectively. The proportion of micronodules which satisfied the FNA indications was significantly higher for the K-TIRADS (65.1%) compared to the ACR TIRADS (12.1%) and ATA guideline (12.1%) (P<.001). CONCLUSION Among patients referred for thyroid surgery to our institutions, about 35% of the micronodules underwent FNA despite not being appropriate for indications by the K-TIRADS. Systematic training for physicians as well as modifications to increase the sensitivity of the guideline may be needed to reduce the overdiagnosis of thyroid cancers, especially for micronodules.
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Affiliation(s)
- Si Eun Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Vivian Youngjean Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea..
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Balica A, Kohut A, Tsai TJ, Groszmann YS, Brandt JS. A Bibliometric Analysis of Citation Classics in the Journal of Ultrasound in Medicine. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1289-1297. [PMID: 31944354 DOI: 10.1002/jum.15220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/23/2019] [Accepted: 12/28/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES A bibliometric analysis of articles in the Journal of Ultrasound in Medicine (JUM) identified the journals' most impactful articles. METHODS A bibliometric analysis of citation classics that were published in the JUM from its inception in 1982 to 2019 was performed. All citation classics, defined as articles cited 100 or more times, were evaluated for the number of citations, citations per year, publication year, subspecialty, design, and country of origin. Characteristics were compared before and after 1998 by the Mann-Whitney test for unpaired data and 2-sample z tests of sample proportions. The Kruskal-Wallis test for nonparametric continuous data was used to compare the median number of citations per year by decade of publication. RESULTS A total of 7868 articles were published in the JUM between 1982 and 2019; 54 (0.7%) were citation classics. The median citation classics year of publication was 1998 (interquartile range [IQR], 1991-2003). Most citation classics originated from the United States (36 of 54 [66.7%]), were observational (47 of 54 [87%]), and were related to obstetric and gynecologic topics (16 of 54 [29.6%]). Citation classics after 1998 received significantly more citations per year (9.3 versus 4.7; P < .001), with no other differences noted. The median number of citations per year increased for each decade, with medians of 4 citations (IQR, 3.6-4.7) in 1982 to 1991 and 11.2 citations (IQR, 9-13.9) in 2002 to 2012 (P < .001). CONCLUSIONS This list provides insight into the most influential articles that were published in the JUM. Most citation classics were observational, were from the United States, and covered obstetric and gynecologic topics. Citation classics received more citations per year after 1998.
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Affiliation(s)
- Adrian Balica
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Adrian Kohut
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Te-Jung Tsai
- Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Yvette S Groszmann
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Diagnostic Ultrasound Associates, Brookline, Massachusetts, USA
| | - Justin S Brandt
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Xing Z, Qiu Y, Yang Q, Yu Y, Liu J, Fei Y, Su A, Zhu J. Thyroid cancer neck lymph nodes metastasis: Meta-analysis of US and CT diagnosis. Eur J Radiol 2020; 129:109103. [PMID: 32574937 DOI: 10.1016/j.ejrad.2020.109103] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Ultrasound (US) is the first imaging technique in the assessment of cervical lymph nodes metastasis (LNM) of papillary thyroid cancer (PTC) patients preoperatively. Computed tomography (CT) exerts an influence on surgical strategy especially for patients with lateral cervical LNM. This meta-analysis aimed at assessing the diagnostic values of US and CT in detecting the cervical LNM in thyroid cancer patients. METHODS Medline, Embase and Cochrane Library (CENTRAL) were retrieved up to 16th Sep, 2019 for studies about comparison of the diagnostic performance between US and CT. The pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR and diagnostic odds ratio (DOR), with each's 95 % CI were calculated. RESULTS A total of 5656 thyroid cancer patients in 10 studies were included. CT had a higher sensitivity in central (0.400 [0.385, 0.416] vs 0.284 [0.270, 0.298], P < 0.001), lateral (0.811 [0.778, 0.416] vs 0.758 [0.722, 0.792], P = 0.029) and the whole (0.664 [0.633, 0.694] vs 0.593 [0.561, 0.625], P = 0.002) compartments regions. US had a higher specificity in central (0.895 [0.885,0.903] vs 0.950 [0.944, 0.956], P < 0.001), lateral (0.84 [0.813,0.864] vs 0.88 [0.856, 0.901], P = 0.012) and the whole (0.834 [0.804,0.862] vs 0.911 [0.887, 0.932], P < 0.001) compartments regions. CONCLUSIONS US and CT performed poorly when trying to identify the presence of central LNM. CT has a higher sensitivity while US has a higher specificity for the assessment of central, lateral and the whole cervical LNM. Performing CT to detect the lateral cervical LNM will effectively reduce the rate of missed diagnosis and improve surgical planning. Both US and CT are needed for neck lymph nodes staging preoperatively owning to low sensitivities.
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Affiliation(s)
- Zhichao Xing
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuxuan Qiu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qianru Yang
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yang Yu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jingyan Liu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuan Fei
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Anping Su
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
| | - Jingqiang Zhu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Jiwang L, Yahong L, Kai L, Bo H, Yuejiao Z, Haotian W, Tao Y. Clinicopathologic factors and preoperative ultrasonographic characteristics for predicting central lymph node metastasis in papillary thyroid microcarcinoma: a single center retrospective study. Braz J Otorhinolaryngol 2020; 88:36-45. [PMID: 32571753 PMCID: PMC9422721 DOI: 10.1016/j.bjorl.2020.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/21/2020] [Accepted: 05/03/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction The treatment of papillary thyroid microcarcinoma remains controversial. Central lymph node metastasis is common in papillary thyroid microcarcinoma and it is an important consideration in treatment strategy selection. Objective The aim of this study was to investigate clinicopathologic risk factors and thyroid nodule sonographic characteristics for central lymph node metastasis in papillary thyroid microcarcinoma. Methods We retrospectively reviewed the data of 599 papillary thyroid microcarcinoma patients who underwent surgery from 2005 to 2017 at a single institution. Univariate and multivariate analyses were used to identify the clinicopathologic factors and preoperative sonographic features of central lymph node metastasis. A receiver-operating characteristic, ROC curve analysis, was performed to identify the efficacy of ultrasonographic features in predicting central lymph node metastasis. A nomogram based on the risk factors was established to predict central lymph node metastasis. Results The incidence of central lymph node metastasis was 22.4%. The univariate and multivariate analyses suggested that gender, age, multifocality, extrathyroidal invasion, and lateral lymph node metastasis were independent risk factors for central lymph node metastasis. The univariate and multivariate analyses revealed that nodular shape, margin, and calcification were independently associated with central lymph node metastasis. The ROC curve analysis revealed that the combination of shape, margin and calcification had excellent accuracy in predicting central lymph node metastasis. The nomogram was developed based on the identified risk factors for predicting central lymph node metastasis, and the calibration plot analysis indicated the good performance and clinical utility of the nomogram. Conclusions Central lymph node metastasis is associated with male gender, younger age (<45 years), extrathyroidal invasion, multifocality and lateral lymph node metastasis in papillary thyroid microcarcinoma patients. The ultrasongraphic features, such as irregular shape, ill-defined margin and calcification, may improve the efficacy of predicting central lymph node metastasis. Surgeons and radiologists should pay close attention to the patients who have these risk factors. The nomogram may help guide surgical decision making in papillary thyroid microcarcinoma.
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Affiliation(s)
- Liang Jiwang
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Head and Neck Surgery, Liaoning Province, People's Republic of China
| | - Luo Yahong
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Medical Imaging, Liaoning Province, People's Republic of China
| | - Liang Kai
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Medical Imaging, Liaoning Province, People's Republic of China
| | - Huang Bo
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Pathology, Liaoning Province, People's Republic of China
| | - Zhao Yuejiao
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Head and Neck Surgery, Liaoning Province, People's Republic of China
| | - Wang Haotian
- Grade 2016 Clinical Medicine Class 5, The First Clinical College, Dalian Medical University, Liaoning Province, People's Republic of China
| | - Yu Tao
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Medical Imaging, Liaoning Province, People's Republic of China.
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Added Value of Computed Tomography to Ultrasonography for Assessing LN Metastasis in Preoperative Patients with Thyroid Cancer: Node-By-Node Correlation. Cancers (Basel) 2020; 12:cancers12051190. [PMID: 32397148 PMCID: PMC7281101 DOI: 10.3390/cancers12051190] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022] Open
Abstract
Diagnostic accuracy of US in the evaluation of lymph node (LN) metastasis for thyroid cancer patients is limited. We investigated the value of CT added to US for characterizing LNs in preoperative thyroid cancer patients by node-by-node correlation. A total of 225 primary thyroid cancer patients who underwent LN biopsy were included. Based on node-by-node correlation, 274 LNs were classified into probably benign, indeterminate, and suspicious categories on US, CT, and combined US/CT. Malignancy risks were calculated for each category and were compared between US/CT concordant and discordant cases. On US, CT, and combined US/CT, malignancy risks were 1.7%, 8.7%, and 0% in the probably benign category, 22.4%, 5.9%, and 8.0% in the indeterminate category, and 77.2%, 82.0%, and 75.6% in the suspicious category, respectively. Malignancy risk of the concordant suspicious category was higher than that of the discordant suspicious category (84.7% vs. 43.2%, p < 0.001). The addition of CT helped correctly detect additional metastasis in 16.4% of the US indeterminate LNs and in 1.7% of the US probably benign LNs. CT may complement US for LN characterization in thyroid cancer patients by suggesting the diagnostic confidence level for the suspicious category and helping correctly detect metastasis in US indeterminate LNs.
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Li H, Zhang B, Zhang Y, Liu W, Mao Y, Huang J, Wei L. A semi-automated annotation algorithm based on weakly supervised learning for medical images. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2020.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Weslley Rosario P, Franco Mourão G, Regina Calsolari M. Role of adjuvant therapy with radioactive iodine in patients with elevated serum thyroglobulin after neck reoperation due to recurrent papillary thyroid cancer: a monoinstitutional comparative study. Endocrine 2020; 68:144-150. [PMID: 31865556 DOI: 10.1007/s12020-019-02165-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most patients with papillary thyroid cancer (PTC) and lymph node metastases (LNM) undergoing reoperation do not show apparent disease after this procedure, but serum thyroglobulin (Tg) continues to be elevated in part of them. This study evaluated adjuvant therapy with 131I in these patients. METHODS Patients with PTC and LNM diagnosed after initial therapy were selected. Patients undergoing reoperation and those without apparent disease after this procedure, but with nonstimulated Tg ≥1 ng/ml 6 months after reoperation, were included. The first 25 patients were submitted to therapy with 131I (groups A) and the subsequent 30 patients did not receive this therapy (group B). RESULTS Groups A and B were similar. During further follow-up, 21 patients developed structural disease and 34 continued without detectable disease (eight achieved complete remission). The outcomes were similar in groups A and B. Patients with Tg reduction >50% after reoperation tended to have a lower risk of recurrence (22.7 versus 48.5%), notably distant metastases (0 versus 15.1%), and were more likely to achieve complete remission (28 versus 3%). Patients with LNM FDG-positive had a higher risk of recurrence (54.5 versus 11.7%) and were less likely to achieve complete remission (3 versus 29.4%) after reoperation. CONCLUSION Our results suggest that therapy with 131I apparently does not prevent recurrences among patients who continue to have elevated Tg after neck reoperation. Further studies involving these patients are necessary, especially those who are at high risk of recurrence.
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Affiliation(s)
- Pedro Weslley Rosario
- Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Rua Domingos Vieira, 590, Santa Efigênia, CEP 30150-240, Belo Horizonte, MG, Brazil.
| | - Gabriela Franco Mourão
- Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Rua Domingos Vieira, 590, Santa Efigênia, CEP 30150-240, Belo Horizonte, MG, Brazil
| | - Maria Regina Calsolari
- Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Rua Domingos Vieira, 590, Santa Efigênia, CEP 30150-240, Belo Horizonte, MG, Brazil
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The Application of Ultrasound and Fine-Needle Aspiration in Low-Volume Lateral Lymph Nodes of Papillary Thyroid Carcinoma Patients. Ultrasound Q 2020; 35:240-245. [PMID: 30516734 DOI: 10.1097/ruq.0000000000000397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This research investigates the application of high-frequency ultrasound (US) examination and US-guided fine-needle aspiration (US-FNA) in diagnosing low-volume metastatic lateral lymph nodes (LLNs) from papillary thyroid carcinoma patients. This study reviewed the medical records of 996 LLNs from 858 patients with suspicious thyroid nodules or after thyroidectomy from January 2013 to January 2016. All patients took US-FNA. The US characteristics and the malignancy rate of LLNs classified into group A and group B based on size were analyzed and compared (group A, ≥6 mm; group B, <6 mm). Size was not an independent predictor for malignancy (P > 0.005) in multiple regression analysis, whereas the malignancy rate in the large LLNs (286/425; 67.3%) was slightly higher than that in the small LLNs (338/571; 59.2%) (P = 0.01). However, no significant difference was observed between the groups in terms of calcification, absence of hilum, and peripheral vascularization. The prevalence of malignant LLNs was slightly higher in the small LLNs than that in the large ones when there were less than 3 suspicious US features (P < 0.05), and there was no significant difference between the small and large LLNs when there were 3 or more suspicious US features (P > 0.05). The results indicate that metastases may occur in the lymph nodes even when they were small. Ultrasound and US-FNA showed excellent performance in the diagnosis of low-volume metastatic lateral lymph nodes from papillary thyroid carcinoma patients.
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Fang D, Ma W, Xu L, Liu Y, Ma X, Lu H. A Predictive Model to Distinguish Papillary Thyroid Carcinomas from Benign Thyroid Nodules Using Ultrasonographic Features: A Single-Center, Retrospective Analysis. Med Sci Monit 2019; 25:9409-9415. [PMID: 31820741 PMCID: PMC6924132 DOI: 10.12659/msm.917825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background We developed a model based on ultrasound (US) features of thyroid nodules and cervical lymph nodes to distinguish papillary thyroid carcinomas (PTC) from benign thyroid nodules. Material/Methods We retrospectively collected data on preoperative ultrasonographic characteristics and postoperative histological data from 1119 patients who underwent thyroidectomy in our center from January 2017 to January 2018. Variables of age, sex, and US features of thyroid nodule and lymph nodes features were analyzed. A logistic regression model was established for PTC prediction. Results Logistic regression analysis confirmed that age under 45 years (OR=2.22, p=0.00), hypoechogenicity (OR=3.70, p=0.00), irregular shape (OR=2.13, p=0.004), ill-defined margin (OR=2.26, p=0.08), spiculate margin (OR=3.30, p=0.00), indefinite border (OR=2.45, p=0.00), capsular invasion (OR=7.76, p=0.006), taller-than-wide shape (OR=2.94, p=0.00), solid structure (OR=2.46, p=0.001), microcalcifications (OR=3.92, p=0.00), coexistence of microcalcifications and macrocalcifications (OR=5.84, p=0.006), and central vascularity (OR=2.10, p=0.001) were independently associated with increased risks for PTC, as well as lymph nodes metastasis features (absence of an echogenic hilum [OR=3.74, p=0.027] and increased vascularization [OR=3.55, p=0.086]). The area under the curve (AUC) for the risk score diagnosis system was 0.916. Conclusions This predictive model is a reliable, simple, and cost-effective diagnostic tool for PTC.
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Affiliation(s)
- Da Fang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Wenting Ma
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Lu Xu
- Department of Nutriology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Ying Liu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Xianghua Ma
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Department of Nutriology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Hui Lu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
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Cheng SCH, Ahuja AT, Ying M. Quantification of intranodal vascularity by computer pixel-counting method enhances the accuracy of ultrasound in distinguishing metastatic and tuberculous cervical lymph nodes. Quant Imaging Med Surg 2019; 9:1773-1780. [PMID: 31867231 DOI: 10.21037/qims.2019.10.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Ultrasound is a common imaging method for assessment of cervical lymph nodes. However, metastatic and tuberculous lymph nodes have similar sonographic features in routine ultrasound examination. Computer-aided assessment could be a potential adjunct to enhance the accuracy of differential diagnosis. Methods Gray-scale and power Doppler sonograms of 100 patients with palpable cervical lymph nodes were reviewed and analyzed (60 metastatic nodes, 40 tuberculous nodes). Final diagnosis of lymph nodes was based on fine needle aspiration and cytology. Sonograms were reviewed and assessed for nodal shape, echogenic hilus, intranodal necrosis and vascular distribution (conventional assessment). Intranodal vascularity was quantified using a customized computer algorithm to determine vascularity index (VI). The diagnostic accuracy of using conventional assessment and its combination with intranodal VI method was evaluated and compared. Results Metastatic and tuberculous nodes tended to be round (75.0% vs. 50.0%), without echogenic hilus (86.7% vs. 72.5%) and have peripheral vascularity (73.3% vs. 85.0%). Intranodal necrosis is more common in tuberculous nodes (27.5%) than metastatic nodes (8.3%). Using conventional assessment in differentiating metastatic and tuberculous nodes, the diagnostic accuracy was 56% with a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 56.7%, 55%, 65.4% and 45.8% respectively. The VI of metastatic nodes (23.4%±2.1%) was significantly higher than that of tuberculous nodes (12.0%±1.6%) (P<0.05). The optimum cut-off of VI for the differential diagnosis was 20%. By combining conventional assessment and intranodal VI quantification, the diagnostic accuracy was increased to 69% with a sensitivity, specificity, PPV and NPV of 80%, 52.5%, 71.6%, 63.6% respectively. The increase in sensitivity was statistically significant (P=0.006). Conclusions Computer-aided quantification of intranodal vascularity provides added value in routine ultrasound assessment of cervical lymph nodes. It enhances the accuracy of ultrasound in distinguishing metastatic and tuberculous cervical lymph nodes.
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Affiliation(s)
- Sammy C H Cheng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Anil T Ahuja
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Michael Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Jin ZQ, Yu HZ, Mo CJ, Su RQ. Clinical Study of the Prediction of Malignancy in Thyroid Nodules: Modified Score versus 2017 American College of Radiology's Thyroid Imaging Reporting and Data System Ultrasound Lexicon. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1627-1637. [PMID: 31064698 DOI: 10.1016/j.ultrasmedbio.2019.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/17/2019] [Accepted: 03/24/2019] [Indexed: 06/09/2023]
Abstract
The clinical importance of thyroid nodules rests with the need to exclude thyroid cancer. In the present study, we developed a modified Thyroid Imaging Reporting and Data System (TI-RADS) score using gray-scale ultrasound, contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE) images to predict malignancy of thyroid nodules and compared this modified score system with the subjective scoring criteria based on the Thyroid Imaging Reporting and Data System (TI-RADS, 2017 edition). The results revealed that by using SWE and CEUS (enhanced pattern) to downgrade TI-RADS category 4 and 5 nodules, the malignancy rate for TI-RADS category 4 and 5 nodules increased from 47.6% with American College of Radiology (ACR) TI-RADS assessment alone to 49.4% with ACR TI-RADS combined with shear wave elastography (SWE) and CEUS (enhanced pattern). Likewise, by using the modified TI-RADS to adjust TI-RADS category 3 nodules, the malignancy rate for TI-RADS category 3 nodules increased from 13.9%-20.0%. The discriminating power for detection of malignancy of the variable score 2 (ACR TI-RADS + SWE + CEUS), with an area under the curve (AUC) of 0.899 (95% confidence interval [CI]: 86.1%-93.6%), was higher than that of score 1 (ACR TI-RADS), with an AUC of 0.862 (95% CI: 81.9%-90.6%; p > 0.05). With a point 4.5 as the optimal cutoff value, a score of 1 predicted malignancy with an accuracy of 75.6%, sensitivity of 85.0% and specificity of 71.6%. However, with a point 5.5 as the optimal cutoff value, a score of 2 predicted malignancy with an accuracy of 84.9%, sensitivity of 81.0% and specificity of 86.6%. The modified TI-RADS based on ACR TI-RADS + SWE + CEUS (enhanced pattern) could contribute to a reduction in the number of biopsies performed on benign nodules and the implementation of consistent follow-up in clinical practice.
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Affiliation(s)
- Zhan-Qiang Jin
- Department of Ultrasound, Affiliated Hospital of Guilin Medical University, Guilin, China.
| | - Hong-Zhen Yu
- Department of Ultrasound, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Chun-Jian Mo
- Department of Ultrasound, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Rong-Qing Su
- Department of Ultrasound, Affiliated Hospital of Guilin Medical University, Guilin, China
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Rosario PW, Mourão G, Calsolari MR. Risk of recurrence in patients with papillary thyroid carcinoma and minimal extrathyroidal extension not treated with radioiodine. J Endocrinol Invest 2019; 42:687-692. [PMID: 30353424 DOI: 10.1007/s40618-018-0969-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/19/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE This study evaluated the recurrence rate in patients with papillary thyroid carcinoma (PTC) and minimal extrathyroidal extension (mETE) who had low thyroglobulin (Tg) after total thyroidectomy, and therefore, did not receive radioactive iodine (RAI). METHODS This was a prospective study including 182 patients with tumors ≤ 4 cm and mETE without aggressive histology or clinically apparent lymph node involvement (cN0pNx). After thyroidectomy, all patients had nonstimulated Tg ≤ 0.3 ng/ml, negative antithyroglobulin antibodies (TgAb), and neck ultrasonography (US) showing no anomalies. Because of these results, the patients were not submitted to RAI. RESULTS The time of follow-up ranged from 24 to 132 months (median 72 months). One hundred and seventy-eight patients (97.8%) continued to have nonstimulated Tg ≤ 0.3 ng/ml and negative US. Four patients (2.2%) exhibited an increase in Tg and lymph node metastases (structural recurrence). After surgery, these patients obtained nonstimulated Tg < 1 ng/ml and no apparent tumor was detected by the imaging methods. CONCLUSION The results suggest that patients with mETE and without other adverse features, who have low nonstimulated Tg and negative neck US after thyroidectomy, do not require ablation with RAI.
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Affiliation(s)
- P W Rosario
- Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil.
- Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Rua Domingos Vieira, 590, Santa Efigênia, CEP 30150-240, Belo Horizonte, Minas Gerais, Brazil.
| | - G Mourão
- Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - M R Calsolari
- Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
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Belotta AF, Gomes MC, Rocha NS, Melchert A, Giuffrida R, Silva JP, Mamprim MJ. Sonography and sonoelastography in the detection of malignancy in superficial lymph nodes of dogs. J Vet Intern Med 2019; 33:1403-1413. [PMID: 30883935 PMCID: PMC6524127 DOI: 10.1111/jvim.15469] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 02/14/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The clinical applicability of sonography and sonoelastography (SOE) in the detection of lymph node malignancy in dogs has not been established. OBJECTIVES To compare sonographic and sonoelastographic findings between malignant and benign superficial lymph nodes and to evaluate the diagnostic performance of those methods. ANIMALS One-hundred sixteen lymph nodes of 54 dogs. METHODS A prospective observational study was used to investigate sonographic features and elasticity scores of malignant and benign superficial lymph nodes. Lymph nodes were categorized as malignant or benign according to cytology or histopathology. Quantitative variables were compared using Student's unpaired t test. Prevalence of categorical variables was compared using nonparametric Mann-Whitney U test. Diagnostic performance was calculated by receiver-operating characteristic analysis. RESULTS Forty-nine malignant and 67 benign lymph nodes were included. Malignant nodes had larger long axis (LA; P = .0002), short axis (SA; P < .0001) and short-to-long axis ratio (P < .0001) in comparison with benign nodes. Malignant nodes had a higher prevalence of mixed vascular distribution on Doppler color flow mapping (P < .005) and on power Doppler (P < .0001) and higher resistivity index (RI; P < .0001), pulsatility index (P < .0001), and elasticity score (P < .0001) in comparison with benign nodes. Short axis, elasticity score, and RI offered the best accuracies, 80.2%, 78.1%, and 77.7% (P < .05), respectively, for malignancy detection. CONCLUSIONS AND CLINICAL IMPORTANCE Results support the use of Doppler sonography and SOE as auxiliary methods to brightness mode sonography to detect nodal malignancy.
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Affiliation(s)
- Alexandra F Belotta
- Department of Animal Reproduction and Veterinary Radiology, School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Brazil
| | - Marcela C Gomes
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Brazil
| | - Noeme S Rocha
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Brazil
| | - Alessandra Melchert
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Brazil
| | - Rogério Giuffrida
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Oeste Paulista University, Presidente Prudente, Brazil
| | - Jeana P Silva
- Department of Animal Reproduction and Veterinary Radiology, School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Brazil
| | - Maria J Mamprim
- Department of Animal Reproduction and Veterinary Radiology, School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Brazil
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Abstract
The presence of a thyroid nodule may be recognized by the patient or the clinician on palpation of the neck or it may be an incidental finding during an imaging study for some other indication. The method of detection is less important, however, than distinguishing benign lesions from more aggressive neoplasms. This article outlines the diagnostic algorithm for the evaluation of thyroid nodules including biochemical testing, imaging, and, when appropriate, fine-needle aspiration. In addition, the authors review the natural history of benign nodules, follow-up strategies, and indications for repeat aspiration.
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Affiliation(s)
- Carolyn Maxwell
- Division of Endocrinology and Metabolism, Stony Brook University School of Medicine, 26 Research Way, East Setauket, NY 11733, USA
| | - Jennifer A Sipos
- Division of Endocrinology and Metabolism, The Ohio State University Wexner Medical Center, 1581 Dodd Drive, 5th Floor McCampbell Hall, South, Columbus, OH 43210, USA.
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