Adult ; Carcinoma, Adenoid Cystic ; complications ; Female ; Humans ; Thyroid Gland ; pathology ; Thyroid Neoplasms ; secondary ; Ultrasonography

The goal of this study was to evaluate the sonographic findings of thyroid metastases arising from non-thyroid primaries. The study over a 5-year period comprised nine patients who had histopathologically proven metastatic disease to the thyroid. Ultrasonography was available in all cases. Ultrasound-guided needle aspiration was performed on 10 suspected nodules as determined by ultrasound. The Ultrasonographic findings were analyzed in two different ways. The first analysis included only those nodules biopsed, and the second analysis included all the nodules, biopsed and non- biopsed. The primary neoplasms were breast carcinoma (n=6), uterine leiomyosarcoma (n=1), cervical carcinoma (n=1), and nasopharyngeal carcinoma (n=1). Excluding 2 nodules, the 8 remaining metastatic nodules exhibited ill-defined hypoechoic character with heterogeneous texture. The other two nodules showed relatively circumscribed iso- or hypo-echoic character with cystic portion. From the analysis of ultrasonographic findings including all thyroid nodules irrespective of pathologic proof, 7 cases - excluding the 2 cases from the 9 cases - showed unilateral or bilateral multiple nodules suspected of metastasis. There was no evidence of microcalcification in any thyroid nodules. In conclusion, the sonographic findings of the thyroid metastatic nodules were not specific, but unilateral or bilateral multiple suspected thyroid nodules without evidence of microcalcification may be suggestive of metastatic nodules among patients with a known primary non-thyroidal tumor.
Adult ; Female ; Human ; Middle Age ; Retrospective Studies ; Thyroid Neoplasms/pathology/*secondary/*ultrasonography

PURPOSE: The purpose was to compare the frequency of metastatic and nonmetastatic lymph nodes diagnosed by fine needle aspiration biopsy cytology (FNAC) and thyroglobulin concentration from fine needle aspiration biopsy washout fluid (FNAB-Tg) in an indeterminate range (0.2-100 ng/mL), and to evaluate the most appropriate threshold value of FNAB-Tg in an indeterminate range. MATERIALS AND METHODS: We performed ultrasound-guided FNAB and FNAB-Tg in suspicious metastatic cervical lymph nodes of papillary thyroid carcinoma and performed surgery. Ninety-five lymph nodes with indeterminate values of FNAB-Tg ranging from 0.2-100 ng/mL in ninety-two patients were included in this study. The diagnostic performances in multiple Tg levels (0.7, 1.0, 5.0, 10.0, 20.0, 50.0) were evaluated to compare with FNAB cytology using sensitivity, specificity, and accuracy with area under the curve (AUC) analysis. RESULTS: Forty-two were metastatic lymph nodes and fifty three were nonmetastatic lymph nodes. FNAB-Tg ranged from 0.22 to 90.9 ng/mL in metastatic lymph nodes (mean; 34.3+/-33.3 ng/mL) and 0.20 to 56.7 ng/mL in nonmetastatic lymph nodes (mean; 4.9+/-11.1 ng/mL) (p<0.001). The most excellent diagnostic performance was displayed in 5 ng/mL of FNAB-Tg with AUC of 0.76, sensitivity, specificity, accuracy, 69.0, 83.0, and 76.8, respectively. However, there was no significant difference from 10 ng/mL FNAB. CONCLUSION: We ascertained that 5 ng/mL yielded the most excellent diagnostic performance among FNAB-Tg levels in the present setting with a large series with the indeterminate range (0.2-100 ng/mL) of FNAB-Tg values. These results need additional confirmation under different laboratory conditions.
Biopsy, Fine-Needle/*methods/standards/statistics & numerical data ; Body Fluids/metabolism ; Carcinoma, Papillary/*metabolism/*secondary/ultrasonography ; Humans ; Lymph Nodes/metabolism/pathology/ultrasonography ; Lymphatic Metastasis ; Retrospective Studies ; Sensitivity and Specificity ; Thyroglobulin/*metabolism ; Thyroid Neoplasms/*metabolism/*secondary/ultrasonography ; Ultrasonography, Interventional

OBJECTIVETo evaluate the role of preoperative ultrasonography in detecting early cervical lymph node metastasis in differentiated thyroid carcinoma.

METHODSData were reviewed retrospectively from medical records between July 2003 and July 2005, in which patients were divided into 2 groups: group A (study group): 51 (55 sides) patients of differentiated thyroid carcinoma patients with impalpable node but with ultrasonic positive nodal metastasis; group B (control group): 57 (64 sides) patients with preoperative palpable cervical lymph nodes. All patients had been undergone modified neck dissection. The preoperative ultrasonographic results and the preoperative pathologic finding had been compared in group A.

RESULTSIn 51 patients (55 sides of preoperative positive ultrasonography 49 sides had been demonstrated cervical lymph nodes metastasis pathologically. The sensitivity of ultrasonography was 89.1%. Ultrasonography detected cervical lymph node believed to be uninvolved by physical examination in 41.2% of patients. 65.5% of the cervical lymph metastasis was multilevel and the most frequent involvement site was middle neck and the involvement rate was 70.9% in ultrasonography. 75.5% of the cervical lymph metastasis was multilevel and the most frequent involvement site was level Ill (65.3%) in pathologic finding.

CONCLUSIONSPreoperative ultrasonograpy is a mainstay in detecting cervical lymph nodes metastasis in thyroid cancer patients. It can detect the early cervical lymph node metastasis and localize the position of the cervical metastasis. All the thyroid cancer patients should undergo preoperative ultrasonography and the extent of the neck dissection relies on the preoperative ultrasonic finding of the neck.

Adult ; Aged ; Carcinoma, Papillary ; diagnostic imaging ; secondary ; Female ; Humans ; Lymph Nodes ; diagnostic imaging ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck ; Preoperative Care ; Thyroid Neoplasms ; diagnostic imaging ; pathology ; Ultrasonography

Cases of metastases to the thyroid gland seem to be increasing in recent years. The clinical and ultrasonographic findings of diffuse metastases have been sparsely reported. Thirteen cases of diffuse metastases to the thyroid gland were documented by thyroid ultrasonography-guided fine needle aspiration cytology between 2004 and 2013. We retrospectively reviewed the patients with diffuse thyroid metastases. The most common primary site was the lung (n=9), followed by unknown origin cancers (n=2), cholangiocarcinoma (n=1), and penile cancer (n=1). Eleven patients were incidentally found to have thyroid metastases via surveillance or staging FDG-PET. Other 2 patients were diagnosed during work-up for hypothyroidism and palpable cervical lymph nodes. On ultrasonography, the echogenicity of the enlarged thyroid gland was heterogeneously hypoechoic or isoechoic, and reticular pattern internal hypoechoic lines were observed without increased vascularity found by power Doppler ultrasonography (3 right lobe, 2 left lobe, and 8 both lobes). In the 8 patients who had involvement of both lobes, 3 had hypothyroidism. In conclusion, ultrasonographic finding of diffuse metastasis is a diffusely enlarged heterogeneous thyroid with reticular pattern internal hypoechoic lines. Thyroid function testing should be performed in all patients with diffuse thyroid metastases, especially those with bilateral lobe involvement.
Aged ; Bile Duct Neoplasms/pathology ; Biopsy, Fine-Needle ; Cholangiocarcinoma/pathology ; Female ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Hypothyroidism/complications ; Lung Neoplasms/pathology ; Male ; Middle Aged ; Penile Neoplasms/pathology ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Thyroid Function Tests ; Thyroid Gland/pathology/*ultrasonography ; Thyroid Neoplasms/pathology/secondary/*ultrasonography