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 explore the feasibility of radiomics for predicting lymph node metastasis in the central region of the neck in patients with thyroid papillary carcinoma (PTC). METHODS: A total of 189 patients with PTC confirmed by thyroid fine needle aspiration biopsy were prospectively enrolled in this study. The cross-sectional and longitudinal ultrasound images and the images of both sections were analyzed for predicting central lymph node metastasis using a radiomics approach with pathological results as the gold standard. RESULTS: In the 189 patients, the accuracy, sensitivity and specificity of preoperative thyroid ultrasonography for diagnosis of central lymph node metastasis was 69.39%, 64% and 73%, respectively. Based on the ultrasound images of the cross-sections, longitudinal sections and both sections, the accuracy, sensitivity and specificity of radiomics for predicting central lymph node metastasis was 66.06%/68.12%/77.69%, 53%/46%/40%, and 52%/53%/51%, respectively. CONCLUSIONS Radiomics with combined analysis of the ultrasound images on the cross-section and longitudinal section images achieves a higher accuracy for predicting central lymph node metastasis than analysis a single section, and its diagnostic accuracy is much higher than that of conventional ultrasound examination.
Carcinoma, Papillary ; diagnostic imaging ; pathology ; Humans ; Image Interpretation, Computer-Assisted ; Lymph Nodes ; Lymphatic Metastasis ; diagnostic imaging ; Neck ; Prospective Studies ; Thyroid Neoplasms ; diagnostic imaging ; pathology ; Ultrasonography

BACKGROUNDPrevious studies have demonstrated that ultrasonography is the recommended imaging modality for preoperative staging of papillary thyroid carcinomas (PTCs). However, only a few studies have kept watch on preoperative evaluation of capsular invasion (CI) or extracapsular extension (ECE) and cervical lymph node metastasis using preoperative ultrasonography. This study aimed to investigate the relationship between the CI or ECE and the cervical lymph node metastasis in PTCs using preoperative ultrasonography and postoperative pathology in Chinese patients.

METHODSThe data of preoperative ultrasonography and postoperative pathology of 166 patients who had a definitive diagnosis of PTCs from October 2011 to July 2014 at Xuanwu Hospital, Beijing were collected and reviewed. Preoperative ultrasonic parameters of thyroid nodules were compared with those of postoperative pathological diagnoses. All the patients were divided into bilateral PTCs group (n = 42, 78 nodules) and unilateral PTCs group (n = 124, 124 nodules), and the data of the nodule sizes, CI or ECE, and cervical lymph node metastasis by preoperative ultrasonography were compared between two groups.

RESULTSA total of 202 nodules of 166 patients which were confirmed by preoperative ultrasonography and postoperative pathology were analyzed. Hypoechogenicity (n = 201, 99.5%) and irregular margins (n = 167, 82.7%) were the main ultrasonic characteristics of PTCs. A significant moderate agreement between preoperative ultrasonic examination and postoperative pathology for CI or ECE (κ = 0.622, P< 0.001) was observed. The diagnostic sensitivity was 92.0%, and specificity was 71.1%. In bilateral PTCs group, 81.0% had CI or ECE, and 61.9% had cervical lymph node metastasis. In unilateral PTCs group, 76.6% had CI or ECE, and 58.1% had cervical lymph node metastasis. There were no significant differences in the incidence of CI or ECE and cervical lymph node metastasis between two groups (all P > 0.05).

CONCLUSIONSUltrasonography was proved to be a valuable method for preoperative diagnosis of PTCs. Hypoechogenicity and irregular margins were strongly associated with PTCs. CI or ECE in unilateral PTCs strongly implied the cervical lymph node metastasis. Therefore, the cervical lymph nodes should be carefully examined by ultrasonography in patients with PTCs.

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

Follicular variant papillary thyroid cancer (FVPTC) is the second most common subtype after conventional PTC. We compared ultrasonographic (US) features of FVPTC to those of conventional PTC according to tumor size. We reviewed US findings, pathologic reports, and medical charts of 249 PTC patients with surgically proven disease (83 FVPTCs, 166 conventional PTCs) at our institution from January 2007 to December 2012. FVPTCs were divided into PTC-like and follicular neoplasm (FN)-like based on sonographic characteristics. PTC-like features were defined as having at least one malignant feature (taller-than-wide shape, infiltrative margin, marked hypoechogenicity, and micro-calcifications), whereas FN-like cancers showed oval solid features without malignant features. FVPTCs showed a higher rate of FN-like features than conventional PTCs. Of 166 conventional PTCs, 13 (7.8%) had FN-like features and 153 (92.2%) had PTC-like features, whereas of the 83 FVPTCs, 31 (37.3%) had FN-like features and 52 (62.7%) had PTC-like features. Macro-FVPTCs showed a higher rate of FN-like features than micro-FVPTCs (P < 0.001). Of 21 macro-FVPTCs, 18 (85.7%) had FN-like features and 3 (14.3%) had PTC-like features, whereas of the 62 micro-FVPTCs, 13 (21%) had FN-like features and 49 (79%) had PTC-like features. There were no differences in multifocality, extrathyroidal invasion, and lymph node metastasis between PTC-like FVPTCs and FN-like FVPTCs. FVPTCs showed fewer sonographic malignant features than conventional PTCs. In particular, FVPTCs larger than 1 cm had a more frequent benign sonographic appearance. Therefore, if fine-needle aspiration result is suspicious for PTC in a nodule larger than 1 cm with no suspicious US features, the possibility of FVPTC might be considered.
Adult ; Carcinoma, Papillary, Follicular/*diagnostic imaging/pathology ; Demography ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Thyroid Neoplasms/*diagnostic imaging/pathology ; *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

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

OBJECTIVETo compare the size of papillary thyroid carcinoma on ultrasonography(US)and the actual size measured during histological examination and to discuss the potential causes of such discrepancy.

METHODSA total of 148 patients with histologically confirmed papillary thyroid carcinoma underwent thyroid surgery in our center from December 2012 to May 2013. Patients were stratified based on the size,morphology,margin,cystic component,and presence of Hashimoto's disease to compare the discrepancy of the US and pathalogical measurements.

RESULTSThe mean sizes of the nodules measured by US and pathology were(1.58±0.94)cm and(1.33±0.84)cm,respectively(P=0.000). In 70.9%(105/148)of the nodules,the sizes measured by US were larger than those measured by pathology. In 17.6%(26/148)of the nodules,the sizes measured by US were smaller than those measured by pathology. In 1.1-1.4 cm size subgroup,the difference between mean ultrasound diameter and pathologic diameter was not significant [(1.21±0.11)cm vs.(1.11±0.32)cm,P=0.062]. In 0.1-1.0 cm size subgroup,the mean sizes of the nodules measured by US and pathology were(0.75±0.19)cm and(0.62±0.23)cm,respectively(P=0.000). In ≥1.5 cm size subgroup,the mean sizes of the nodules measured by US and pathology were(2.48±0.70)cm and(2.03±0.81)cm(P=0.000).

CONCLUSIONSThere is a significant discrepancy between US and pathologic size measurements for papillary thyroid carcinoma. However,for nodules sized 1.1-1.4 cm,the ultrasound and pathologic measurements are more likely to be consistent.

Carcinoma ; diagnostic imaging ; pathology ; Carcinoma, Papillary ; Hashimoto Disease ; Humans ; Thyroid Neoplasms ; diagnostic imaging ; pathology ; Ultrasonography

PURPOSE: The aim of this study was to investigate the prognosis of papillary thyroid carcinoma (PTC) patients according to different pathologic grades of lymphocytic thyroiditis (LT). MATERIALS AND METHODS: This study included 144 PTC patients who underwent total thyroidectomy with radioactive iodine remnant ablation therapy. Pathologic grades of LT were separated at two points, chronic lymphocytic thyroiditis (CLT) and Hashimoto thyroiditis (HT). Patients were divided into two groupings according to the presence of the diseases (Grouping 1; patients with CLT or HT and without CLT or HT, Grouping 2; patients with HT and without HT). The groupings were compared according to recurrence, clinicopathologic and ultrasound (US) characteristics, and disease free survival. RESULTS: Of 144 patients, 41 had CLT and 19 had HT. There were 10 patients (6.9%) with tumor recurrence. In both groupings, the presence of calcification was more frequently associated with patients with LT (p=0.041 and 0.047, respectively). In Grouping 2, the mean age at diagnosis was older in patients without HT compared to patients with HT (p=0.032). On multivariate analysis, the presence of LT was not an independent predictor of recurrence in both groupings. For both groupings, pathologic tumor size and taller than wide shape on US were independent predictors of recurrence. The presence of LT in PTC patients did not affect recurrence. CONCLUSION: There was no relationship between PTC prognosis and different grades of LT. Pathologic tumor size and taller than wide shape on ultrasound were independent predictors of PTC recurrence regardless of concurrent LT.
Adult ; Aged ; Carcinoma/*pathology/ultrasonography ; Carcinoma, Papillary/pathology/ultrasonography ; Female ; Hashimoto Disease/*pathology/ultrasonography ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Neoplasms/*pathology/ultrasonography

PURPOSE: The aim of this study was to investigate the prognosis of papillary thyroid carcinoma (PTC) patients according to different pathologic grades of lymphocytic thyroiditis (LT). MATERIALS AND METHODS: This study included 144 PTC patients who underwent total thyroidectomy with radioactive iodine remnant ablation therapy. Pathologic grades of LT were separated at two points, chronic lymphocytic thyroiditis (CLT) and Hashimoto thyroiditis (HT). Patients were divided into two groupings according to the presence of the diseases (Grouping 1; patients with CLT or HT and without CLT or HT, Grouping 2; patients with HT and without HT). The groupings were compared according to recurrence, clinicopathologic and ultrasound (US) characteristics, and disease free survival. RESULTS: Of 144 patients, 41 had CLT and 19 had HT. There were 10 patients (6.9%) with tumor recurrence. In both groupings, the presence of calcification was more frequently associated with patients with LT (p=0.041 and 0.047, respectively). In Grouping 2, the mean age at diagnosis was older in patients without HT compared to patients with HT (p=0.032). On multivariate analysis, the presence of LT was not an independent predictor of recurrence in both groupings. For both groupings, pathologic tumor size and taller than wide shape on US were independent predictors of recurrence. The presence of LT in PTC patients did not affect recurrence. CONCLUSION: There was no relationship between PTC prognosis and different grades of LT. Pathologic tumor size and taller than wide shape on ultrasound were independent predictors of PTC recurrence regardless of concurrent LT.
Adult ; Aged ; Carcinoma/*pathology/ultrasonography ; Carcinoma, Papillary/pathology/ultrasonography ; Female ; Hashimoto Disease/*pathology/ultrasonography ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Neoplasms/*pathology/ultrasonography