Preoperative Ultrasonography in the Evaluation of Suspected Familial Non-Medullary Thyroid Cancer: Are We Able to Predict Multifocality and Extrathyroidal Extension?

Abstract

Family history of thyroid cancer increases the risk of harboring thyroid malignancies that end up having extrathyroidal extension (ETE) and multifocality on histology; some authors suggest a more aggressive surgical approach. Their pre-operative identification could allow more conservative surgical procedures if none of these features are suspected. Our aim was to assess if neck ultrasonography could identify or exclude multifocality or ETE in these patients to tailor the extent of surgery. This retrospective study included patients with previous thyroid surgery, ≥1 first-grade relative with thyroid cancer, and who had undergone pre-surgical ultrasound. ETE was suspected in the case of thyroid border interruption or gross invasion of perithyroidal tissues. Multiple suspicious nodules were defined as suspicion of multifocal cancer. The cohort consisted of 45 patients (median age 49 years, 40 with thyroid cancer, 30 females). The positive predictive value of ultrasonography in predicting multifocality and ETE was 57.14% (25.25–84.03) and 41.67% (21.5–65.1%), respectively, while the negative predictive values were 63.2% (56.4–69.4%) and 72.7% (63.3–80.5%). Pre-operative ultrasound examination is unable to reliably identify or exclude multifocal disease or extrathyroidal extension. In patients scheduled for surgery and with a first-degree relative affected by DTC, a “negative” pre-operative US report does not exclude the potential finding of multifocality and ETE at final histopathology.

Laterocervical lymph node metastases from suspected thyroidal primary site that turned out to be metastases of lung cancer: A case report

“…The important lesson to be learned from our case report is that the possibility of long‐distance metastasis must be considered in the differential diagnosis of any cervical lymph nodes metastasis, especially when thyroid nodule subjected to FNAB results negative. This is particularly true when lymph node cytological evaluation does not provide useful guidance for management of the case or, as in this case, is inconsistent with thyroid cytological findings and sonographic features 27 . In such situations, metastasis can be the first sign of an unsuspected cancer, such as LC.…”

“…This is particularly true when lymph node cytological evaluation does not provide useful guidance for management of the case or, as in this case, is inconsistent with thyroid cytological findings and sonographic features. 27 In such situations, metastasis can be the first sign of an unsuspected cancer, such as LC. Management decisions in these cases require multidisciplinary input and need additional diagnostic tools, like neck and chest CT scans, rather than immediate surgery.…”

Drawing as a Way of Knowing: How a Mapping Model Assists Preoperative Evaluation of Patients with Thyroid Carcinoma

“…The attempt to achieve better pre-operation results has been the department’s goal for years [ 12 , 13 ]. We learned that the complete thyroid mapping that we have been using allows for less mediated communication with the operating surgeon regarding their preparation, a more distinctive analysis of the surgery, and an even better understanding of the patient regarding their medical situation.…”

The Size of a Thyroid Nodule with ACR TI-RADS Does Not Provide a Better Prediction of the Nature of the Nodule: A Single-Center Retrospective Real-Life Observational Study

“…All nodules of the thyroid have a pre-evaluation likelihood of being malignant and, for those ones with the appropriate constellation of clinical and radiographic findings, fine-needle aspiration biopsy should be proposed, regardless of size [ 31 , 32 ]. Finally, although many studies advocate that ACR TIRADS classification has the best diagnostic performance, especially in terms of lowest percentage of unnecessary biopsies [ 8 , 33 ], an Italian consensus defined lower thresholds to recommend FNAB, according to different US features [ 14 ].…”