Objective To evaluate extrathyroidal extension (ETE) in papillary thyroid microcarcinoma (PTMC) with three-dimensional tomographic ultrasound imaging (3D-TUI). Methods A total of 97 thyroid nodules of 79 patients with PTMC treated in PUMC Hospital from February 2016 to January 2018 were included in this study.Two ultrasound experts performed independent blinded assessment of the relationship between thyroid nodules and thyroid capsule by two-dimensional ultrasound (2D-US) and 3D-TUI.The results of 2D-US and 3D-TUI in evaluating ETE were compared with intraoperative findings and postoperative histological and pathological results. Results Among the 97 nodules,54 (55.7%) nodules had ETE.The diagnostic sensitivity (68.5% vs.37.0%;χ²=10.737,P=0.002),accuracy (74.5% vs.56.7%;χ²=6.686,P=0.015),and area under the receiver operating characteristic curve[0.761 (95%CI=0.677-0.845) vs.0.592 (95%CI=0.504-0.680);Z=3.500,P<0.001] of 3D-TUI were higher than those of 2D-US.However,3D-TUI and 2D-US showed no significant difference in the specificity (84.1% vs.81.4%;χ²=0.081,P=0.776),negative predictive value (67.9% vs.50.7%;χ²=3.645,P=0.066),or positive predictive value (84.1% vs.71.4%;χ²=1.663,P=0.240). Conclusion Compared with 2D-US,3D-TUI demonstrates increased diagnostic efficiency for ETE of PTMC.
Humans ; Thyroid Nodule ; Thyroid Neoplasms/diagnosis* ; Carcinoma, Papillary/pathology* ; Ultrasonography/methods* ; Retrospective Studies

OBJECTIVE: To test whether the impact of thyroid-nodule size on the malignancy risk differs according to the ultrasonography (US) patterns of nodules. MATERIALS AND METHODS: This study is a post hoc analysis using data from the Thyroid Imaging Reporting and Data System (TIRADS) multicenter retrospective study which included 2000 consecutive thyroid nodules (≥ 1 cm) with final diagnoses. A total of 2000 consecutive thyroid nodules from 1802 patients (1387 women and 613 men; mean age, 51.2 ± 12.2 years) were enrolled in this study. The malignancy risk of the nodules was assessed according to the nodule size and US patterns (Korean-TIRADS). RESULTS: Overall, the malignancy risk did not increase as nodules enlarged. In high-suspicion nodules, the malignancy rate had no association with nodule size (p = 0.467), whereas in intermediate- or low-suspicion nodules there was a trend toward an increasing malignancy risk as the nodule size increased (p = 0.004 and 0.002, respectively). The malignancy rate of large nodules (≥ 3 cm) was higher than that of small nodules (< 3 cm) in intermediate-suspicion nodules (40.3% vs. 22.6%, respectively; p = 0.001) and low-suspicion nodules (11.3% vs. 7.0%, respectively; p = 0.035). There was a trend toward a decreasing risk and proportion of papillary carcinoma and an increasing risk and proportion of follicular carcinoma or other malignant tumors as nodule size increased (p < 0.001, respectively). CONCLUSION: The impact of nodule size on the malignancy risk differed according to the US pattern. A large nodule size (≥ 3 cm) showed a higher malignancy risk than smaller nodules in intermediate- and low-suspicion nodules.
Carcinoma, Papillary ; Diagnosis ; Female ; Humans ; Information Systems ; Male ; Retrospective Studies ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

PURPOSE: A papillary thyroid microcarcinoma (PTMC) measures 1 cm or less in diameter. The diagnosis, and thus the apparent incidence, of PTMC has recently increased owing to an increase in the detection of subclinical small and low-risk carcinomas with ultrasonography and fine needle aspiration cytology. However, central neck lymph node metastasis (CLNM) can occur in patients with PTMC. We evaluated the factors influencing CLNM in patients with PTMC. METHODS: We reviewed medical records including clinical information and pathologic reports, and analyzed 622 patients with PTMC who underwent thyroid surgery from January 2002 to December 2012. RESULTS: CLNM was detected in 119 patients (19.1%) of the 622 with PTMC. Lymph node metastasis occurred more frequently in males (P=0.025), and those with bilateral tumors (P=0.016), more than two tumors (P=0.035), tumor size greater than 5 mm (P<0.001), and lymphovascular invasion (P=0.024). There were no statistically significant differences in age and capsular invasion. Multivariate analysis showed that significant factors affecting lymph node metastasis included age at operation (odds ratio [OR]=0.647, 95% confidence interval [CI]=0.422∼0.990, P=0.045), sex (OR=0.489, 95% CI=0.268∼0.891, P=0.020), tumor size (OR=3.034, 95% CI=1.761∼5.224, P<0.001), and lymphovascular invasion (OR=15.036, 95% CI=1.450∼155.911, P=0.023). CONCLUSION: Age less than 45 years, male sex, tumor size greater than 5 mm, and lymphovascular invasion were risk factors associated with CLNM.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Diagnosis ; Humans ; Incidence ; Lymph Nodes* ; Male ; Medical Records ; Multivariate Analysis ; Neck* ; Neoplasm Metastasis* ; Risk Factors ; Thyroid Gland* ; Ultrasonography

BACKGROUNDSome ultrasonographic (US) signs overlap between benign and malignant nodules. The purpose of this study was to raise a special US sign of benign thyroid nodules, termed the "onion skin-liked sign."

METHODSTwenty-seven patients with 27 nodules who shrank naturally and the "onion skin-liked sign" appeared on the final US images were enrolled in the study. The ultrasound characters and risk stratifications at the start and end of observation were compared. Then, thirty goiters with fibrosis and thirty papillary thyroid carcinomas (PTC) were randomly selected from the database of our hospital, matched the sizes of 27 nodules at the end point of observation. The differences of "onion skin-liked sign" between the two groups were analyzed.

RESULTSThe average duration of follow-up of 27 nodules was 24.0 ± 12.2 months (range, 12-65 months). At the end of the follow-up, the size of the nodules decreased on average by 1.26 ± 0.82 cm (range, 0.3-3.4 cm) and calcification was found in 21 nodules, compared with only 2 nodules with calcification at the start of the follow-up. In addition, only negligible or no blood flow signal could be detected at the periphery of all the nodules and 100% (27/27) were high suspicion at the end of observation. In matched groups, all PTC showed high suspicion of malignancy, 18/30 (60%) goiters with fibrosis were high suspicion and 11/30 (37%) were intermediate suspicion. Twenty-two patients in the group of nodular fibrosis presented "onion skin-liked sign," which was not shown in any patient of PTC group. The sensitivity, specificity, positive predictive value, and negative predictive value of "onion skin-liked sign" in predicting nodular goiter with fibrosis were 73.3%, 100%, 100%, and 78.9%, respectively.

CONCLUSIONSThe "onion skin-liked sign" was a characteristic US feature of benign thyroid nodules detected in the follow-up of thyroid nodules. It is useful to differentiate PTCs and nodular goiters with fibrosis.

Adult ; Aged ; Carcinoma, Papillary ; diagnosis ; Female ; Goiter, Nodular ; diagnosis ; Humans ; Male ; Middle Aged ; Thyroid Gland ; pathology ; Thyroid Nodule ; pathology ; Ultrasonography ; methods

BACKGROUNDThe clinical behavior and management of poorly differentiated thyroid carcinoma (PDTC) are very different from papillary thyroid carcinoma (PTC). By comparing the clinical and ultrasonographic features between the two tumors, we proposed to provide more possibilities for recognizing PDTC before treatment.

METHODSThe data of 13 PDTCs and 39 age- and gender-matched PTCs in Peking Union Medical College Hospital between December 2003 and September 2013 were retrospectively reviewed. The clinical and ultrasonic features between the two groups were compared.

RESULTSThe frequencies of family history of carcinoma, complication with other thyroid lesions, lymph node metastases, recurrent laryngeal nerve injuries, and distant metastases were higher in PDTCs (30.8%, 61.6%, 69.2%, 23.1%, and 46.2%, respectively) than those in PTCs (2.6%, 23.1%, 25.6%, 2.6%, and 2.6%, respectively) (P < 0.05). The mortality rate of PDTCs was greatly higher than PTCs (P < 0.01). Conventional ultrasound showed that the size of PDTCs was larger than that of PTCs (3.1 ± 1.9 cm vs. 1.7 ± 1.0 cm). Clear margins and rich and/or irregular blood flow were found in 92.3% of PDTCs, which differed substantially from PTCs (51.7% and 53.8%, respectively) (P < 0.05).

CONCLUSIONSPDTC is more aggressive and its mortality rate is higher than PTCs. Accordingly, more attention should be given to suspicious thyroid cancer nodules that show large size, regular shape, and rich blood flow signals on ultrasound to exclude the possibility of PDTCs.

Adult ; Aged ; Carcinoma ; diagnosis ; pathology ; Carcinoma, Papillary ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Neoplasms ; diagnosis ; pathology ; Ultrasonography

PURPOSE: The goal of this study was to validate the ultrasonography (US) and cytopathological features that are used in the diagnosis of the follicular variant of papillary thyroid carcinoma (FVPTC) and to characterize the role of BRAF(V600E) mutation analysis in the diagnosis of FVPTC. METHODS: From May 2012 to February 2014, 40 thyroid nodules from 40 patients (mean age, 56.2 years; range, 26 to 81 years) diagnosed with FVPTC were included in this study. The US features of the nodules were analyzed and the nodules were classified as probably benign or suspicious for malignancy. Twenty-three thyroid nodules (57.5%) underwent BRAF(V600E) mutation analysis. Clinical information and histopathologic results were obtained by reviewing the medical records of the patients. RESULTS: Thirty nodules (75.0%) were classified as suspicious for malignancy, while 10 (25.0%) were classified as probably benign. Seven of the eight nodules (87.5%) with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) cytology showed suspicious US features, while one of the two nodules (50.0%) with follicular neoplasm cytology presented suspicious US features. Five of the 23 nodules (21.7%) that underwent BRAF(V600E) mutation analysis had positive results, all of which were diagnosed as suspicious for malignancy or malignant based on cytology. None of the nodules with benign, AUS/FLUS, or follicular neoplasm cytology were positive for the BRAF(V600E) mutation. CONCLUSION: US features allow nodules to be classified as suspicious for malignancy, and the presence of suspicious US features in nodules with ambiguous cytology may aid in the diagnosis of FVPTC. BRAF(V600E) mutation analysis is of limited value in the diagnosis of FVPTC.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Carcinoma, Papillary, Follicular ; Diagnosis ; Humans ; Medical Records ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Ultrasonography*

OBJECTIVETo evaluate the prognostic impact of tumor size, ultrasonography, central neck lymph node involvement, and age of patients in papillary thyroid microcarcinoma (PTMC).

METHODSTwo hundred and fifty-four patients who underwent total thyroidectomy and central neck dissection for PTMC between 2012 and 2014 were included in this retrospective study. Statistical correlation between tumor size and various clinicopathological parameters was assessed by univariate and multivariate analyses. The ultrasound findings were also evaluated.

RESULTSA total of 254 patients (199 females and 55 males) were included in this study. PTMC showed a predilection for female patients, 41-50 years of age (43.3% of all cases, 110/254), and ultrasound showed hypoechoic nodules. Statistically significant correlation was demonstrated between central neck lymph node involvement and the following factors: age and tumor size. A tumor diameter greater than 0.5 mm (67.3% of all cases) most commonly occurred in patients older than 41 years, and was associated with a higher risk of metastatic central neck lymph node involvement (P<0.05). Hashimoto's thyroiditis was noted in the background in 39.4%(100/254) of cases.

CONCLUSIONSTumor size appears to have a prognostic impact in PTMC, and larger size is more likely to be associated with a higher risk of central neck lymph node involvement. It is controversial whether the etiology of papillary thyroid carcinoma is related to Hashimoto's thyroiditis.

Adult ; Age Factors ; Analysis of Variance ; Carcinoma ; Carcinoma, Papillary ; diagnostic imaging ; pathology ; surgery ; Female ; Hashimoto Disease ; diagnosis ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck ; Neck Dissection ; Prognosis ; Retrospective Studies ; Risk Factors ; Thyroid Neoplasms ; diagnostic imaging ; pathology ; surgery ; Thyroidectomy ; Tumor Burden ; Ultrasonography

We report a case of cribriform-morular variant of papillary thyroid carcinoma associated with familial adenomatous polyposis. A 21-year-old woman presented with multiple, well-defined, oval shaped thyroid nodules, which showed hypo-echoic and solid mixed with some cystic components by ultrasound, and poorly enhancing and low dense by CT scan. Cytological finding was compatible with papillary carcinoma. Total thyroidectomy was performed and nodules were palated soft. Histologic analysis confirmed the diagnosis of cribriform-morular variant of papillary thyroid carcinoma. Familial adenomatous polyposis, thereafter, was diagnosed by family history and colonoscopy, and preventive colectomy was performed.
Adenomatous Polyposis Coli* ; Carcinoma, Papillary ; Colectomy ; Colonoscopy ; Diagnosis ; Female ; Humans ; Thyroid Neoplasms* ; Thyroid Nodule ; Thyroidectomy ; Tomography, X-Ray Computed ; Ultrasonography ; Young Adult

Differentiated thyroid cancers are rarely associated with distant metastases and have 10-year survival rates higher than 80%; however, the prognosis deteriorates significantly if metastasis occurs. Bone is the second most common site of metastasis after the lungs in cases of thyroid cancer. Here we describe a case in which a 57-year-old female patient had extremely severe pain on the posterior neck. After magnetic resonance imaging, 18F-FDG PET CT and ultrasonography guided biopsy, right papillary thyroid carcinoma with cervical spine metastasis was suspected; therefore, she underwent surgery for removal of thyroid carcinoma and seventh cervical spine metastasis. Pathologic diagnosis was confirmed as left thyroid follicular carcinoma with seventh cervical spine metastasis and synchronous right thyroid papillary carcinoma. The patient then underwent an additional spinal tumor removal operation, I131 treatment and external radiation therapy. Complete removal of the cervical spine tumor could not be achieved due to intra-operative bleeding and the need to prevent damage to the spinal cord. Following treatment, the patient reported great relief from severe neck pain. This is a rare presentation of follicular thyroid carcinoma with cervical spine metastasis in Korea.
Adenocarcinoma, Follicular* ; Biopsy ; Carcinoma, Papillary ; Diagnosis ; Female ; Fluorodeoxyglucose F18 ; Hemorrhage ; Humans ; Korea ; Lung ; Magnetic Resonance Imaging ; Middle Aged ; Neck ; Neck Pain ; Neoplasm Metastasis ; Prognosis ; Spinal Cord ; Spine* ; Survival Rate ; Thyroid Gland ; Thyroid Neoplasms ; Ultrasonography

PURPOSE: Papillary thyroid carcinoma is the most common malignant tumor originating from the thyroid. The recent increase in frequency of thyroid ultrasonography is increasing the diagnostic rate of thyroid cancer, especially of the small-sized cancer. The appropriate extent of surgery for thyroid micropapillary carcinoma is still under debate, and bilaterality of the tumor may be an important factor determining the extent. Therefore, this study analyzed the clinicopathologic factors related to tumor bilaterality in order to help decide the extent of treatment. METHODS: Subjects included 134 patients who received total thyroidectomy and central neck lymph node dissection at Wonju Christian Hospital under the diagnosis of thyroid micropapillary cancer from January 1(st), 1994 to December 31(st), 2009. The frequency of bilateral tumor among the subjects were studied, and the relationship between bilaterality and clinicopathologic factors, including patients' gender, age, tumor size, multiple mass in single lobe, capsule invasion, extrathyroidal extension, lymphovascular space invasion, central neck node invasion and lateral neck node invasion was analyzed. RESULTS: There were 32 cases (23.9%) of bilateral tumor. Statistically significant factors related to bilaterality included two or more mass in a single lobe, perithyroidal soft tissue invasion. CONCLUSION: When we plan thyroidectomy for thyroid micropapillary cancer, one cannot rule out the possibility of bilateral thyroid micropapillary cancer in patients with clinicopathologic factors related to bilaterality. Closer preoperative examination is thought to be required for such patients.
Carcinoma, Papillary* ; Diagnosis ; Gangwon-do ; Humans ; Lymph Node Excision ; Neck ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Ultrasonography