Conventional US, elastography, and contrast enhanced US features of papillary thyroid microcarcinoma predict central compartment lymph node metastases

Lymph node metastases at the time of diagnosis have a major impact on both therapeutic strategy and tumor recurrence for patients with papillary thyroid microcarcinoma (PTMC). Our objective was to evaluate the usefulness of PTMC characteristics on ultrasonography for predicting central compartment lymph node metastases (CCLNM) of PTMC. One hundred twenty seven patients who underwent surgery for PTMC were enrolled in this study. The relationship between the CCLNM and the characteristics on conventional US, elastographic, and contrast enhanced ultrasound (CEUS) were investigated. Univariate analysis indicated that PTMCs with CCLNM were more often nodule irregular shape, microcalcifications, hyperenhancing or isoenhancing parametric maps, and peak index ≥1 at preoperative US and CEUS than those without CCLNM (P< 0.01, 0.05, 0.01 and 0.05 respectively). Multivariate analysis showed that microcalcification (OR:2.378, 95% CI: 1.096–5.158) and hyperenhancement or isoenhancement (OR:2.8, 95% CI: 1.287–6.094) were predictive for the presence of CCLNM. Elastography score was not significantly different between the groups. Our study indicated that preoperative thyroid nodule characteristics on conventional US and CEUS may serve as a useful tool to predict central compartment lymph node metastases in PTMC.

[1]  M. Rivera,et al.  Prognostic factors in papillary microcarcinoma with emphasis on histologic subtyping: a clinicopathologic study of 148 cases. , 2014, Thyroid : official journal of the American Thyroid Association.

[2]  Paul G Gauger,et al.  The most commonly occurring papillary thyroid cancer in the United States is now a microcarcinoma in a patient older than 45 years. , 2011, Thyroid : official journal of the American Thyroid Association.

[3]  D. Rubello,et al.  Aggressive Papillary Thyroid Microcarcinoma: Prognostic Factors and Therapeutic Strategy , 2013, Clinical nuclear medicine.

[4]  M. Di Nicola,et al.  Ultrasoundelastography: Can it provide valid information for differentiation of benign and malignant thyroid nodules? , 2011, Journal of ultrasound.

[5]  Qing Dai,et al.  Utility of contrast-enhanced ultrasound for evaluation of thyroid nodules. , 2010, Thyroid : official journal of the American Thyroid Association.

[6]  A. Pinchera,et al.  Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. , 2007, The Journal of clinical endocrinology and metabolism.

[7]  Bo Hyun Kim,et al.  Preoperative ultrasonographic tumor characteristics as a predictive factor of tumor stage in papillary thyroid carcinoma , 2011, Head & neck.

[8]  J. Choi,et al.  Integrated 18F‐FDG PET/CT for the initial evaluation of cervical node level of patients with papillary thyroid carcinoma: comparison with ultrasound and contrast‐enhanced CT , 2006, Clinical endocrinology.

[9]  Jae Hoon Chung,et al.  Preoperative ultrasonographic features of papillary thyroid carcinoma predict biological behavior. , 2013, The Journal of clinical endocrinology and metabolism.

[10]  Pulse Inversion Imaging of Liver Blood Flow: Improved Method for Characterizing Focal Masses with Microbubble Contrast , 2000 .

[11]  E. Papini,et al.  Contrast-Enhanced Ultrasound in the Management of Thyroid Nodules , 2008 .

[12]  S. Roman,et al.  Aggressive variants of papillary thyroid microcarcinoma are associated with extrathyroidal spread and lymph-node metastases: a population-level analysis. , 2013, Thyroid : official journal of the American Thyroid Association.

[13]  J. Charboneau,et al.  Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. , 2006, Archives of surgery.

[14]  J. Ricarte-Filho,et al.  Molecular, morphologic, and outcome analysis of thyroid carcinomas according to degree of extrathyroid extension. , 2010, Thyroid : official journal of the American Thyroid Association.

[15]  Anna Crescenzi,et al.  Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. , 2002, The Journal of clinical endocrinology and metabolism.

[16]  H. Moon,et al.  Clinical Implication of Elastography as a Prognostic Factor of Papillary Thyroid Microcarcinoma , 2012, Annals of Surgical Oncology.

[17]  Stephanie L. Lee,et al.  Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. , 2009, Thyroid : official journal of the American Thyroid Association.

[18]  F. Pacini,et al.  Clinical features and therapeutic implication of papillary thyroid microcarcinoma. , 2007, Thyroid : official journal of the American Thyroid Association.

[19]  C. Catalano,et al.  Ultrasound elastography in the evaluation of thyroid pathology. Current status. , 2014, European journal of radiology.

[20]  Impact of nodular size on the predictive values of gray-scale, color-Doppler ultrasound, and sonoelastography for assessment of thyroid nodules , 2012, Journal of Zhejiang University SCIENCE B.

[21]  Clinicopathologic predictors of thyroid bed recurrence of differentiated thyroid cancer using ultrasound-guided fine-needle aspiration biopsies. , 2013, Thyroid : official journal of the American Thyroid Association.

[22]  Christian Czerny,et al.  Quantitative evaluation of contrast-enhanced ultrasound after intravenous administration of a microbubble contrast agent for differentiation of benign and malignant thyroid nodules: assessment of diagnostic accuracy , 2012, European Radiology.

[23]  P. Burns,et al.  Pulse inversion imaging of liver blood flow: improved method for characterizing focal masses with microbubble contrast. , 2000, Investigative radiology.

[24]  Yongmin Kim,et al.  Differential diagnosis of thyroid nodules with US elastography using carotid artery pulsation. , 2008, Radiology.

[25]  A. Miyauchi,et al.  Prognosis of Patients with Papillary Thyroid Carcinoma Showing Postoperative Recurrence to the Central Neck , 2011, World Journal of Surgery.

[26]  Robert A. Levine,et al.  Thyroid ultrasound and ultrasound-guided FNA , 2008 .

[27]  Yu-rong Hong,et al.  Real‐time Ultrasound Elastography in the Differential Diagnosis of Benign and Malignant Thyroid Nodules , 2009, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[28]  B. Garra.  Elastography: Current Status, Future Prospects, and Making It Work for You , 2011, Ultrasound quarterly.

[29]  Jeong Hyun Lee,et al.  Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. , 2008, Radiology.

[30]  C. Benbassat,et al.  Differentiated thyroid cancer is associated with less aggressive disease and better outcome in patients with coexisting Hashimotos thyroiditis. , 2013, The Journal of clinical endocrinology and metabolism.

[31]  Stacey A. Milan,et al.  Management of microcarcinomas (papillary and medullary) of the thyroid , 2013, Current opinion in oncology.

[32]  A. Rizzuto,et al.  Predictive value of nodal metastases on local recurrence in the management of differentiated thyroid cancer. Retrospective clinical study , 2013, BMC Surgery.

[33]  F. Schick,et al.  Magnetic resonance perfusion imaging without contrast media , 2010, European Journal of Nuclear Medicine and Molecular Imaging.

[34]  F. Consorti,et al.  Prospective comparative evaluation of quantitative-elastosonography (Q-elastography) and contrast-enhanced ultrasound for the evaluation of thyroid nodules: preliminary experience. , 2013, European journal of radiology.

[35]  N. Jackson.  Population-level Analysis , 2006 .

[36]  A. Dackiw,et al.  Tumor size and presence of calcifications on ultrasonography are pre‐operative predictors of lymph node metastases in patients with papillary thyroid cancer , 2011, Journal of surgical oncology.

[37]  C. Jung,et al.  Impact of Clinicopathologic Factors on Subclinical Central Lymph Node Metastasis in Papillary Thyroid Microcarcinoma , 2012, Yonsei medical journal.

[38]  C. Hsieh,et al.  Long‐term outcomes of distant metastasis from differentiated thyroid carcinoma , 2012, Clinical endocrinology.

[39]  David Cosgrove,et al.  Imaging of perfusion using ultrasound , 2010, European Journal of Nuclear Medicine and Molecular Imaging.

[40]  Stephanie R Wilson,et al.  Focal liver masses: enhancement patterns on contrast-enhanced images--concordance of US scans with CT scans and MR images. , 2007, Radiology.

[41]  Is there a real diagnostic impact of elastosonography and contrast-enhanced ultrasonography in the management of thyroid nodules? , 2013, Journal of Zhejiang University SCIENCE B.

[42]  Tao Huang,et al.  Multifocality and Total Tumor Diameter Predict Central Neck Lymph Node Metastases in Papillary Thyroid Microcarcinoma , 2013, Annals of Surgical Oncology.