Abstract
Purpose
To assess the ultrasonographic features affect accuracy of extrathyroid extension (ETE) evaluation on preoperative ultrasonography (US) in papillary thyroid microcarcinoma (PTMC).
Methods
Of the total patients who underwent thyroid surgery, 516 patients with a tumor measuring less than 1 cm on preoperative US were enrolled in this study. One blinded head and neck radiologist reviewed the preoperative US images to evaluate the US features of PTMC, and the pathologic reports were reviewed. The diagnostic accuracy rates, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, were calculated, and the factors associated with false-negative and false-positive results for ETE were analyzed.
Results
The sensitivity, specificity, PPV, NPV, and accuracy for predicting ETE according to sonographic criteria were 32.8%, 87.5%, 51.0%, 76.6%, and 71.7%, respectively. Non-adjacent to the trachea and unilateral lesion on US were significant factors associated with false-negative results.
Conclusion
Size, shape, and location of PTMC on US are important factors that affect the US results in ETE evaluation.
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References
Choi JS, Kim J, Kwak JY, Kim MJ, Chang HS, Kim EK (2009) Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. Am J Roentgenol 193(3):871–878. https://doi.org/10.2214/ajr.09.2386
Shimamoto K, Satake H, Sawaki A, Ishigaki T, Funahashi H, Imai T (1998) Preoperative staging of thyroid papillary carcinoma with ultrasonography. Eur J Radiol 29(1):4–10
Ito Y, Kudo T, Kihara M, Takamura Y, Kobayashi K, Miya A, Miyauchi A (2012) Prognosis of low-risk papillary thyroid carcinoma patients: its relationship with the size of primary tumors. Endocr J 59(2):119–125
Wada N, Nakayama H, Suganuma N, Masudo Y, Rino Y, Masuda M, Imada T (2007) Prognostic value of the sixth edition AJCC/UICC TNM classification for differentiated thyroid carcinoma with extrathyroid extension. J Clin Endocrinol Metab 92(1):215–218. https://doi.org/10.1210/jc.2006-1443
Ortiz S, Rodriguez JM, Soria T, Perez-Flores D, Pinero A, Moreno J, Parrilla P (2001) Extrathyroid spread in papillary carcinoma of the thyroid: clinicopathological and prognostic study. Otolaryngol Head Neck Surg 124(3):261–265. https://doi.org/10.1067/mhn.2001.113141
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016) 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1):1–133. https://doi.org/10.1089/thy.2015.0020
Edge SB, Compton CC (2010) The American joint committee on cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17(6):1471–1474
Moon HJ, Kim EK, Chung WY, Yoon JH, Kwak JY (2011) Minimal extrathyroidal extension in patients with papillary thyroid microcarcinoma: is it a real prognostic factor? Ann Surg Oncol 18(7):1916–1923. https://doi.org/10.1245/s10434-011-1556-z
Ahn D, Sohn JH, Jeon JH, Jeong JY (2014) Clinical impact of microscopic extrathyroidal extension in patients with papillary thyroid microcarcinoma treated with hemithyroidectomy. J Endocrinol Invest 37(2):167–173. https://doi.org/10.1007/s40618-013-0025-x
Kim H, Kim JA, Son EJ, Youk JH, Chung TS, Park CS, Chang HS (2014) Preoperative prediction of the extrathyroidal extension of papillary thyroid carcinoma with ultrasonography versus MRI: a retrospective cohort study. Int J Surg 12(5):544–548. https://doi.org/10.1016/j.ijsu.2014.03.003
Park M, Park SH, Kim EK, Yoon JH, Moon HJ, Lee HS, Kwak JY (2013) Heterogeneous echogenicity of the underlying thyroid parenchyma: how does this affect the analysis of a thyroid nodule? BMC Cancer 13:550. https://doi.org/10.1186/1471-2407-13-550
Kim GR, Kim MH, Moon HJ, Chung WY, Kwak JY, Kim EK (2013) Sonographic characteristics suggesting papillary thyroid carcinoma according to nodule size. Ann Surg Oncol 20(3):906–913. https://doi.org/10.1245/s10434-012-2830-4
Kwak JY, Kim EK, Youk JH, Kim MJ, Son EJ, Choi SH, Oh KK (2008) Extrathyroid extension of well-differentiated papillary thyroid microcarcinoma on US. Thyroid 18(6):609–614. https://doi.org/10.1089/thy.2007.0345
Park SJ, Park SH, Choi YJ, Kim DW, Son EJ, Lee HS, Yoon JH, Kim EK, Moon HJ, Kwak JY (2012) Interobserver variability and diagnostic performance in US assessment of thyroid nodule according to size. Ultraschall Med 33(7):E186–E190. https://doi.org/10.1055/s-0032-1325404
Choi SH, Han KH, Yoon JH, Moon HJ, Son EJ, Youk JH, Kim EK, Kwak JY (2011) Factors affecting inadequate sampling of ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf) 74(6):776–782. https://doi.org/10.1111/j.1365-2265.2011.04011.x
Acknowledgements
This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea government (MSIP) (NRF-2017R1C1B5017244), by a Grant from Kyung Hee University in 2018(KHU- 20181063), the Bio and Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIP&MOHW) and by a Grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (Grant no: HI18C1039).
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YCL, study design, data collection and analysis, writing; ARJ, study design, data collection, analysis and revising article; Y-MS, study design, data collection, analysis and revising article; E-JK, study design, data collection, analysis and revising article; Y-GE, study design, data collection and analysis, revising article, and supervising this study.
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Lee, Y.C., Jung, A.R., Sohn, YM. et al. Ultrasonographic features associated with false-negative and false-positive results of extrathyroidal extensions in papillary thyroid microcarcinoma. Eur Arch Otorhinolaryngol 275, 2817–2822 (2018). https://doi.org/10.1007/s00405-018-5115-0
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DOI: https://doi.org/10.1007/s00405-018-5115-0