Characterization of Papillary Thyroid Microcarcinomas Using Sonographic Features in Malignant Papillary Thyroid Cancer

Gu, Weijun; Yan, Hong; Luo, Yukun; Wang, Fulin; Yang, Guoqing; Guo, Qinghua; Jin, Nian; Zang, Li; Chen, Kang; Du, Jin; Wang, Xian-ling; Yang, Lijuan; Ba, Jianming; Dou, Jingtao; Mu, Yiming; Pan, Changyu; Lv, Zhaohui

doi:10.1097/md.0000000000000841

Cited by 14 publications

(12 citation statements)

References 19 publications

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“…Although ultrasonography is very sensitive for the identification of cervical nodal compartments metastases, the specificity is low and the prescribed regions are limited, which impedes its use in the identification of distant metastases. [ 26 , 27 ] Meanwhile, controversies on the utility of Dx-WBS in guiding 131 I therapeutic decision making still exist, and predictors on the outcome of 131 I therapy of DTC are unavailable at present. [ 2 ]…”

Section: Discussionmentioning

confidence: 99%

99mTc-pertechnetate-avid metastases from differentiated thyroid cancer are prone to benefit from 131I therapy

et al. 2017

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The aim of this study is to determine the contribution of neck and chest 99mTc-pertechnetate scan to the management of postoperative patients with suspicious metastatic differentiated thyroid cancer (DTC), particularly to the prediction of response to radioiodine (131I) therapy. Just before 131I administration, a total of 184 postoperative DTC patients with stimulated serum thyroglobulin (ssTg) >10 ng/mL were enrolled to undergo neck and chest 99mTc-pertechnetate scan, which were directly compared with post-therapeutic 131I scan to determine the concordance of site and number of metastatic lesions. The percentage changes in ssTg between 99mTc-pertechnetate-avid group and 99mTc-pertechnetate-nonavid group were compared, and the response to 131I in both groups was analyzed according to the nature of 99mTc-pertechnetate avidity as well. The percentages of concordance between 99mTc-pertechnetate and 131I scan in detecting metastases were 65.7% and 26.0% in per-patient and per-site analyses with low unweighted kappa, respectively. 99mTc-pertechnetate scan led to a change in therapeutic decision making in 19/184 (10.3%) patients. In 72 patients with 131I-avid metastases, the ssTg in 99mTc-pertechnetate-avid group (n = 13) decreased significantly compared with that in 99mTc-pertechnetate-nonavid group (n = 59) (median: −81.56% vs −48.14%; Z = −4.276, P = .000). The difference of therapeutic response between 99mTc-pertechnetate-avid group and 99mTc-pertechnetate-nonavid group was statistically significant (χ2 = 8.4; P = .03). Although the consistency between 99mTc-pertechnetate scan before 131I administration and post-therapy 131I scan in detecting metastases is low, identifying metastases in postoperative DTC patients with elevated ssTg via 99mTc-pertechnetate scan prior to 131I therapy provides incremental value for therapeutic decision making. Notably, patients with 99mTc-pertechnetate-avid metastases may be more prone to benefit from 131I therapy than those with 99mTc-pertechnetate-nonavid metastases.

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Section: Discussionmentioning

confidence: 99%

99mTc-pertechnetate-avid metastases from differentiated thyroid cancer are prone to benefit from 131I therapy

et al. 2017

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“…Currently, thyroid nodules are primarily evaluated by ultrasonography and fine-needle aspiration biopsy. For suspected thyroid nodules, though cytology is an effective diagnostic method, invasiveness limited the clinical application [ 7 ]. Ultrasonography is a convenient, cost effective, highly sensitive and noninvasive preoperative diagnostic method, and it has been the preferred screening method [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Similar to our results, Moon et al reported that fewer malignant nodules ≤10 mm had microcalcification than larger nodules, and the diagnostic value of microcalcification was greater for large nodules than for small nodules [ 9 ]. In some nodules ≤10 mm, it might be difficult to differentiate microcalcifications from colloid crystals, and this may be an explanation for why calcification was more common in PTMC >5 mm [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Sonographic and Clinical Features of Papillary Thyroid Microcarcinoma Less than or Equal to Five Millimeters: A Retrospective Study

et al. 2016

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ObjectiveTo retrospectively compare the sonographic and clinical features of papillary thyroid microcarcinoma (PTMC) ≤5 mm and PTMC >5 mm to improve the diagnostic value of ultrasonography.MethodsA total of 367 cases of PTMC between January 2013 and December 2014 was included in this study. The patients were classified into group A (≤5 mm, n = 181) or group B (>5 mm, n = 186), and the sonographic and clinical features were reviewed and compared between the two groups.ResultsThere was no significant difference in the shape, ratio of length/width, boundary, peripheral halo ring, echogenicity, cystic change and accompanying Hashimoto's thyroiditis between these two groups. However, the calcification (61.3% vs. 72.6%) and hypervascularity (13.8% vs. 24.7%) were more frequent in group B (p = 0.026 and 0.008, respectively). The patients were younger, and more patients were aged less than 45 years (41.4% vs. 57.0%) in group B. Capsular invasion (7.2% vs. 34.4%), multifocality (21.5% vs. 48.9%), bilaterality (17.1% vs. 39.8%), central lymph node metastasis (13.8% vs. 38.2%) and lateral lymph node metastasis (1.1% vs. 5.4%) were more frequent in group B. No clinical or sonographic feature was related to cervical lymph node metastasis in group A, while less than 45 years in age (p = 0.010), male gender (p = 0.040), capsular invasion (p<0.001), multifocality (p = 0.016) and calcification (p = 0.042) were related to cervical lymph node metastasis in group B.ConclusionsThe sonographic features of PTMC ≤5 mm were similar to those of PTMC >5 mm, including an irregular shape, a length/width ratio of ≥1, an unclear boundary, no peripheral halo ring, hypoechogenicity, no cystic change, calcification, no hypervascularity and no accompanying Hashimoto's thyroiditis. The clinical features of PTMC ≤5 mm were less aggressive than those of PTMC >5 mm.

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“…For a person to be detected, there must exist a nodule greater than 3 mm, which represents a conservative limit of sonographic technology [19–21]. The model input parameters (prior to calibration) are shown in Table 1.…”

Section: Methodsmentioning

confidence: 99%

The thyroid cancer policy model: A mathematical simulation model of papillary thyroid carcinoma in The U.S. population

et al. 2017

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BackgroundThyroid cancer affects over ½ million people in the U.S. and the incidence of thyroid cancer has increased worldwide at a rate higher than any other cancer, while survival has remained largely unchanged. The aim of this research was to develop, calibrate and verify a mathematical disease model to simulate the natural history of papillary thyroid cancer, which will serve as a platform to assess the effectiveness of clinical and cancer control interventions.MethodsHerein, we modeled the natural pre-clinical course of both benign and malignant thyroid nodules with biologically relevant health states from normal to detected nodule. Using established calibration techniques, optimal parameter sets for tumor growth characteristics, development rate, and detection rate were used to fit Surveillance Epidemiology and End Results (SEER) incidence data and other calibration targets.ResultsModel outputs compared to calibration targets demonstrating sufficient calibration fit and model validation are presented including primary targets of SEER incidence data and size distribution at detection of malignancy. Additionally, we show the predicted underlying benign and malignant prevalence of nodules in the population, the probability of detection based on size of nodule, and estimates of growth over time in both benign and malignant nodules.ConclusionsThis comprehensive model provides a dynamic platform employable for future comparative effectiveness research. Future model analyses will test and assess various clinical management strategies to improve patient outcomes related to thyroid cancer and optimize resource utilization for patients with thyroid nodules.

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Characterization of Papillary Thyroid Microcarcinomas Using Sonographic Features in Malignant Papillary Thyroid Cancer

Cited by 14 publications

References 19 publications

99mTc-pertechnetate-avid metastases from differentiated thyroid cancer are prone to benefit from 131I therapy

99mTc-pertechnetate-avid metastases from differentiated thyroid cancer are prone to benefit from 131I therapy

Sonographic and Clinical Features of Papillary Thyroid Microcarcinoma Less than or Equal to Five Millimeters: A Retrospective Study

The thyroid cancer policy model: A mathematical simulation model of papillary thyroid carcinoma in The U.S. population

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