This article is more than 5 years old. Information may no longer be current.
Ultrasound predicted biologic behavior of papillary thyroid cancer
Click Here to Manage Email Alerts
Ultrasound criteria have been used to differentiate benign from malignant thyroid lesions. However, researchers in Korea now suggest that ultrasound features at the time of a papillary thyroid cancer diagnosis can be a predictive tool for the biological behavior of the disease.
“Although papillary thyroid carcinomas usually carry a favorable prognosis, some tumors are progressive and become life-threatening for patients. It is useful to identify patients with poor prognosis using easily accessible parameters,” Sang Yu Nam, MD, of the department of radiology in Samsung Medical Center at Sungkyunkwan University School of Medicine in Seoul, Korea, and colleagues wrote.
They retrospectively reviewed the clinical records, histological data and ultrasound findings of index tumors among 488 patients who underwent surgery there for papillary thyroid carcinoma (PTC).
According to data, benign-looking PTCs justified 74 (15.2%) of 488 PTCs. Although the mean tumor size was not considered significantly different between the groups (1.1 cm for malignant-looking PTCs; 1.11 cm for benign-looking PTCs; P=.947), univariate and multivariate analyses demonstrated that malignant-looking PTCs displayed lymph node metastasis, extrathyroidal extension, and a higher stage more frequently compared with benign-looking PTCs (all P<.05). The researchers also reported significant size in tumors 1 cm or larger, but not in tumors smaller than 1 cm.
Additionally, the risk for recurrence was independently associated with lymph node metastasis (OR=4.362; 95% CI, 1.226-15.521) and larger tumor size (OR=1.769; 95% CI, 1.175-2.665), they wrote.
The researchers determined there was a greater chance for advanced age (P=.028), multifocality (P=.002), extrathyroidal extension (P<.001), lymph node metastasis (P=.007), a higher stage (P<.001), and receiving radioiodine therapy (P<.007) when the number of malignant ultrasound features increased.
Therefore, findings indicate ultrasound features could serve as an important differentiating factor in the diagnosis of PTC. Furthermore, ultrasound features have the potential to predict clinical outcomes or appropriate management of patients with PTC.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to Top
Iain J. Nixon, MBCHB
This report is not surprising. Ultrasound has a long history of being predictive of malignancy, and I see no reason for surprise that worrying appearance on ultrasound translates to worrying appearance on pathology.
It should be remembered that, after 5 years, the difference in recurrence rate, although significant (P<.05), was only 3%, so clinical significance is unclear.
Perhaps the findings of ultrasound could be used to select the lowest-risk patients for less aggressive therapy (no radioactive iodine and lobectomy, rather than total thyroidectomy). Those with aggressive features were more likely to have nodal disease and extra thyroid extension, which would mandate total thyroidectomy and probable radioactive iodine.
Click Here to Manage Email Alerts