Int J Thyroidol.  2024 Nov;17(2):266-271. 10.11106/ijt.2024.17.2.266.

Extrathyroidal Extension in Papillary Thyroid Cancer Could be Predicted Through Preoperative Sonography

• Yang GE
• Cho SW
• Ryu YJ
• Lee KY
• Kim HS
• Ohk TG
• Choi H

• KMID: 2561606
• DOI: http://doi.org/10.11106/ijt.2024.17.2.266

Abstract

Background and Objectives
Surgical decision-making for papillary thyroid cancer (PTC) relies on accurate preoperative staging, where ultrasonography plays a crucial role in predicting outcomes. We aimed to analyze the predictive effects of preoperative sonographic findings on pathological characteristics.
Materials and Methods
Retrospective study was performed using ultrasonographic images and clinico-pathologic data of papillary thyroid cancer patients who underwent total thyroidectomy or lobectomy between March 2016 and May 2020. Finally, 152 patients and 169 tumors were analyzed.
Results
Mean age of patients was 54.2±14.2 years and the proportion of female was 75.7%. Tumor size was 13.6±10.3 mm and the proportions of extrathyroidal extension (ETE) and lymph node (LN) involvement were 52.2% and 23.0%, respectively. Preoperative sonographic findings, including ETE, tumor margin, echogenicity, and K-TIRDAS, were significantly associated with pathological ETE. Other pathological characteristics, including LN involvement, lymphovascular invasion, and resection margin positivity, were more observed in patients with more aggressive findings on preoperative sonography; however, we could not find statistical significances.
Conclusion
This study showed that preoperative sonographic characteristics, such as sonographic ETE, tumor margin, echogenicity, and K-TIRADS, can provide valuable insights into predicting pathological ETE in PTC patients.

Keyword

Papillary thyroid cancer; Ultrasonography; Extrathyroidal extension; Lymph node involvement; K-TIRADS

Figure

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  Fig. 1 Risk effect of each preoperative sonographic characteristics for pathological characteristics. The diamond point on the graph indicates the odds ratios, and the horizontal bar indicates the its 95% confidence intervals. ETE: extrathyroidal extension, K-TIRADS: Korean Thyroid Imaging Reporting and Data System, LN: lymph-node, LVI: lymphovascular invasion, Spi/lobul: spiculated/lobulated, RM: resection margin

Reference

References

1. Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, et al. 2016; Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol. 17(3):370–95. DOI: 10.3348/kjr.2016.17.3.370. PMID: 27134526. PMCID: PMC4842857.

2. Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, et al. 2017; ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS Committee. J Am Coll Radiol. 14(5):587–95. DOI: 10.1016/j.jacr.2017.01.046. PMID: 28372962.

3. Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. 2017; European Thyroid Association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. Eur Thyroid J. 6(5):225–37. DOI: 10.1159/000478927. PMID: 29167761. PMCID: PMC5652895.

4. Lan X, Sun W, Zhang H, Dong W, Wang Z, Zhang T. 2015; A meta-analysis of central lymph node metastasis for predicting lateral involvement in papillary thyroid carcinoma. Otolaryngol Head Neck Surg. 153(5):731–8. DOI: 10.1177/0194599815601412. PMID: 26307575.

5. Yan H, Zhou X, Jin H, Li X, Zheng M, Ming X, et al. 2016; A study on central lymph node metastasis in 543 cN0 papillary thyroid carcinoma patients. Int J Endocrinol. 2016:1878194. DOI: 10.1155/2016/1878194. PMID: 27127507. PMCID: PMC4834155.

6. Marques B, Martins RG, Couto J, Santos J, Martins T, Rodrigues F. 2020; Microscopic extrathyroid extension in papillary thyroid carcinoma: impact on response to therapy. Arch Endocrinol Metab. 64(2):144–9. DOI: 10.20945/2359-3997000000210. PMID: 32236308. PMCID: PMC10118941.

7. Clain JB, Scherl S, Dos Reis L, Turk A, Wenig BM, Mehra S, et al. 2014; Extrathyroidal extension predicts extranodal extension in patients with positive lymph nodes: an important association that may affect clinical management. Thyroid. 24(6):951–7. DOI: 10.1089/thy.2013.0557. PMID: 24443878.

8. Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, et al. 2004; Preoperative ultrasonographic examination for lymph node metastasis: usefulness when designing lymph node dissection for papillary microcarcinoma of the thyroid. World J Surg. 28(5):498–501. DOI: 10.1007/s00268-004-7192-z. PMID: 15085396.

9. Kouvaraki MA, Shapiro SE, Fornage BD, Edeiken-Monro BS, Sherman SI, Vassilopoulou-Sellin R, et al. 2003; Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 134(6):946–54. discussion 54–5. DOI: 10.1016/S0039-6060(03)00424-0. PMID: 14668727.

10. González HE, Cruz F, O'Brien A, Goni I, Leon A, Claure R, et al. 2007; Impact of preoperative ultrasonographic staging of the neck in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 133(12):1258–62. DOI: 10.1001/archotol.133.12.1258. PMID: 18086969.

11. Gweon HM, Son EJ, Youk JH, Kim JA, Park CS. 2014; Preoperative assessment of extrathyroidal extension of papillary thyroid carcinoma: comparison of 2- and 3-dimensional sonography. J Ultrasound Med. 33(5):819–25. DOI: 10.7863/ultra.33.5.819. PMID: 24764337.

12. Wu LM, Gu HY, Qu XH, Zheng J, Zhang W, Yin Y, et al. 2012; The accuracy of ultrasonography in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma: a meta-analysis. Eur J Radiol. 81(8):1798–805. DOI: 10.1016/j.ejrad.2011.04.028. PMID: 21536396.

13. Xing Z, Qiu Y, Yang Q, Yu Y, Liu J, Fei Y, et al. 2020; Thyroid cancer neck lymph nodes metastasis: meta-analysis of US and CT diagnosis. Eur J Radiol. 129:109103. DOI: 10.1016/j.ejrad.2020.109103. PMID: 32574937.

14. Issa PP, Albuck AL, Hossam E, Hussein M, Aboueisha M, Attia AS, et al. 2022; The diagnostic performance of ultrasonography in the evaluation of extrathyroidal extension in papillary thyroid carcinoma: a systematic review and meta-analysis. Int J Mol Sci. 24(1):371. DOI: 10.3390/ijms24010371. PMID: 36613811. PMCID: PMC9820513.

15. Chung SR, Baek JH, Choi YJ, Sung TY, Song DE, Kim TY, et al. 2020; Sonographic assessment of the extent of extrathyroidal extension in thyroid cancer. Korean J Radiol. 21(10):1187–95. DOI: 10.3348/kjr.2019.0983. PMID: 32729261. PMCID: PMC7458864.

16. Ha EJ, Chung SR, Na DG, Ahn HS, Chung J, Lee JY, et al. 2021; 2021 Korean thyroid imaging reporting and data system and imaging-based management of thyroid nodules: Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol. 22(12):2094–123. DOI: 10.3348/kjr.2021.0713. PMID: 34719893. PMCID: PMC8628155.

17. Manzardo OA, Cellini M, Indirli R, Dolci A, Colombo P, Carrone F, et al. 2020; TNM 8th edition in thyroid cancer staging: is there an improvement in predicting recurrence? Endocr Relat Cancer. 27(6):325–36. DOI: 10.1530/ERC-19-0412. PMID: 32229701.

18. Youngwirth LM, Adam MA, Scheri RP, Roman SA, Sosa JA. 2017; Extrathyroidal extension is associated with compromised survival in patients with thyroid cancer. Thyroid. 27(5):626–31. DOI: 10.1089/thy.2016.0132. PMID: 27597378.