Value of Contrast-Enhanced Ultrasound in Partially Cystic Papillary Thyroid Carcinomas

Partially cystic papillary thyroid carcinomas (PCPTCs) are rarely reported papillary thyroid carcinomas (PTCs) and are usually misdiagnosed as benign nodules. The objective of this study was to provide the various sonographic characteristics of partially cystic thyroid nodules for differentiation between malignant and benign nodules, including those for conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). Twenty-three PCPTC patients and 37 nodular goiter patients were enrolled in this study. We evaluated the size, cystic percentage, solid echogenicity, calcification, vascularity, and CEUS parameters for each nodule. The final diagnosis of all patients was confirmed via surgery. Univariate analysis demonstrated that compared with benign nodular goiters, PCPTCs more frequently presented with calcification, hypoechogenicity of the solid part, hypoenhancement, heterogeneous enhancement, centrifugal perfusion, peak intensity index <1, time to peak index ≥1, and area under the curve index <1 on preoperative US and CEUS. Binary logistic regression analysis demonstrated that heterogeneous enhancement, centrifugal perfusion, and peak intensity index <1 are independent CEUS characteristics related to malignant PCPTCs and can be used for their differentiation from benign nodular goiters (all p < 0.05). Our study indicated that preoperative CEUS characteristics may serve as a useful tool to distinguish malignant PCPTCs from benign thyroid nodules.

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Diagnostic Value of Contrast-Enhanced Ultrasound Evaluation of Malignant and Benign Solitary Thyroid Nodules

Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences ◽

10.1515/prolas-2016-0001 ◽

2016 ◽

Vol 70 (1) ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Pēteris Priedītis ◽

Maija Radziņa ◽

Ilze Štrumfa ◽

Zenons Narbuts ◽

Arturs Ozoliņs ◽

...

Keyword(s):

Contrast Enhancement ◽

Thyroid Nodules ◽

Fine Needle Biopsy ◽

Diagnostic Value ◽

Contrast Enhanced Ultrasound ◽

Clinical Value ◽

Additional Tool ◽

Ultrasound Evaluation ◽

Contrast Enhanced ◽

Benign Nodules

Abstract The aim of the study was to investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) in differentiating benign and malignant thyroid nodules. Thirty-five patients with morphologically proved thyroid nodules (17 malignant; 18 benign), underwent CEUS examination. Five enhancement patterns were evaluated: vascularisation, homogeneity, presence of peripheral rim type enhancement, wash-out rate of the contrast medium, and enhancement using microvascular imaging application. Time-intensity curves (TIC) were analysed in post-processing and defined as three types: slow versus rapid and stable versus rapid biphasic wash-out. Diagnostic value of the listed CEUS parameters was calculated. The results showed medium strength correlation between morphology (benign versus malignant nodule) and type of TIC curve rs = 0.38 (p = 0.021), as well as between mode of contrast enhancement rs = 0.39 (p = 0.022) and wash-out pattern rs =0.39 (p = 0.024). The overall pooled sensitivity of selected diagnostic parameters was 82%, specificity 57%, and accuracy 70%. Malignant nodules were characterised by iso- or hypovascular contrast enhancement and slow wash-out, while benign nodules showed hypervascular enhancement with rapid wash-out TIC curve and rim-like pattern. The CEUS patterns significantly differed between malignant and benign thyroid nodules with high diagnostic accuracy. Thus, CEUS has important clinical value as an additional tool to ultrasound and fine needle biopsy.

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Contrast-Enhanced Ultrasound Improves the Accuracy of the ACR TI-RADS in the Diagnosis of Thyroid Nodules Located in the Isthmus

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1543-6033 ◽

2021 ◽

Author(s):

Yunlin Huang ◽

Yurong Hong ◽

Wen Xu ◽

Kai Song ◽

Pintong Huang

Keyword(s):

Diagnostic Performance ◽

Thyroid Nodules ◽

Characteristic Curve ◽

Diagnostic Value ◽

Contrast Enhanced Ultrasound ◽

Institutional Review ◽

Contrast Enhanced ◽

Significant Difference ◽

Image Reporting ◽

Benign Nodules

Abstract Objectives To evaluate the diagnostic performance of the American College of Radiology (ACR) Thyroid Image Reporting and Data System (TI-RADS), contrast-enhanced ultrasound (CEUS), and a modified TI-RADS in differentiating benign and malignant nodules located in the isthmus. Methods This retrospective study was approved by the institutional review board. Informed consent was obtained. Grayscale ultrasound (US) and CEUS images were obtained for 203 isthmic thyroid nodules (46 benign and 157 malignant) in 198 consecutive patients (156 women, mean age: 44.7 years ± 11.3 [standard deviation]; 47 men, mean age: 40.9 years ± 11.0). The area under the receiver operating characteristic curve (AUC) of the diagnostic performance of the ACR TI-RADS, CEUS, and the modified TI-RADS were evaluated. Results Lobulated or irregular margins (P = 0.001; odds ratio [OR] = 9.250) and punctate echogenic foci (P = 0.007; OR = 4.718) on US and hypoenhancement (P < 0.001; OR = 20.888) on CEUS displayed a significant association with malignancy located in the isthmus. The most valuable method to distinguish benign nodules from malignant nodules was the modified TI-RADS (AUC: 0.863 with modified TR5), which was significantly better than the ACR TI-RADS (AUC: 0.738 with ACR TR5) (P < 0.001) but showed no significant difference with respect to CEUS (AUC: 0.835 with hypoenhancement) (P = 0.205). The diagnostic value was significantly different between CEUS and the ACR TI-RADS (P = 0.028). Conclusion The modified TI-RADS could significantly improve the accuracy of the diagnosis of thyroid nodules located in the isthmus.

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Utility of quantitative contrast-enhanced ultrasound for the prediction of lymph node metastasis in patients with papillary thyroid carcinoma

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-200909 ◽

2020 ◽

pp. 1-12

Author(s):

Zhi-Yan Luo ◽

Yu-Rong Hong ◽

Cao-Xin Yan ◽

Yong Wang ◽

Qin Ye ◽

...

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Univariate Analysis ◽

Contrast Enhanced Ultrasound ◽

Papillary Thyroid ◽

Optimal Parameters ◽

Diagnostic Efficacy ◽

Contrast Enhanced ◽

Conventional Ultrasound ◽

Higher Sensitivity

OBJECTIVES: The aim of this study was to find the optimal parameters and cutoffs to differentiate metastatic lymph nodes (LNs) from benign LNs in the patients with papillary thyroid carcinoma (PTC) on the quantitative contrast-enhanced ultrasound (CEUS) features. METHODS: A total of 134 LNs in 105 patients with PTCs were retrospectively enrolled. All LNs were evaluated by conventional ultrasound (US) and CEUS before biopsy or surgery. The diagnostic efficacy of CEUS parameters was analyzed. RESULTS: Univariate analysis indicated that metastatic LNs more often manifested centripetal or asynchronous perfusion, hyper-enhancement, heterogeneous enhancement, ring-enhancing margins, higher PI, larger AUC, longer TTP and DT/2 than benign LNs at pre-operative CEUS (p < 0.001, for all). Multivariate analysis showed that centripetal or asynchronous perfusion (OR = 3.163; 95% CI, 1.721–5.812), hyper-enhancement(OR = 0.371; 95% CI, 0.150–0.917), DT/2 (OR = 7.408; 95% confidence interval CI, 1.496–36.673), and AUC (OR = 8.340; 95% CI, 2.677–25.984) were predictive for the presence of metastatic LNs. The sensitivity and accuracy of the quantitative CEUS were higher than qualitative CEUS (75% vs 55 % and 83.6% vs 76.1 % , respectively). CONCLUSIONS: Quantitative CEUS parameters can provide more information to distinguish metastatic from benign LNs in PTC patients; In particular, DT/2 and AUC have a higher sensitivity and accuracy in predicting the presence of metastatic LNs and reduce unnecessary sampling of benign LNs.

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MON-504 VEGFA and VEGFR2 Expression in Different Histological Types of Thyroid Nodules: Could Immunohistochemistry Have a Clinical Utility?

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.945 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Natassia Elena Bufalo ◽

Karina Colombera Peres ◽

Larissa Teodoro ◽

Paulo Latufi-Filho ◽

Icleia Siqueira Barreto ◽

...

Keyword(s):

Protein Expression ◽

Clinical Utility ◽

Thyroid Nodules ◽

Vascular Endothelial ◽

Papillary Thyroid ◽

Thyroid Carcinomas ◽

Tall Cell ◽

Benign Nodules ◽

Endothelial Growth Factors ◽

Current Guidelines

Abstract Vascular endothelial growth factors (VEGFs) are a family of proteins involved in several elements that play an important role in the development of blood vessels. Besides acting in angiogenesis, VEGFA has important roles in chemotaxis, for macrophages and granulocytes, and vasodilation. VEGFA binds to VEGFR2, that acts on the MAPK and PI3K pathways, fundamental pathways for thyroid carcinogenesis. In order to assess the expression of VEGFA and VEGFR2, in different thyroid nodules, we used a Tissue MicroArray including 91 benign (74 females, 16 males, 49.84±12.65years old) and 125 malignant thyroid nodules (97 females, 28 males, 46.57±14.87 years old). Clinical and pathology data were obtained from 47 goiters; 43 follicular adenomas (FA) and a total of 104 papillary thyroid carcinomas (PTC), including 35 classic papillary thyroid carcinomas (CPTC), 30 follicular variant of PTC (FVPTC), 25 oxifilic variant of PTC (OVPTC), 14 tall cell papillary thyroid carcinomas (TCPTC); and 21 follicular thyroid carcinomas (FTC). All patients were managed according to a standard protocol based on current guidelines and followed-up for 116.9±70.8 months. VEGFA protein expression did not differentiate benign from malignant thyroid nodules. However, VEGFA was more frequently expressed in the less differentiated thyroid tissues. In fact, 95.8% of the FTC had positive expression. On the contrary, the intensity of this protein expression was progressively lower according to the process of cellular dedifferentiation (Goiter: 21.4%; FA: 16.3%; PTC: 8.7% and FTC: 0.0%; x2 = 0.031). There was no difference in VEGFR2 expression between malignant and benign nodules (x2= 0.108), but this protein showed more intense expression in tissues that also presented Hürthle cells (x2 <0.0001). We were not able to find any correlation, neither of VEGFA nor with VEGFR2 expression, and any other feature of aggressiveness, including invasion, metastasis, lymph node metastasis, and distant metastasis. We conclude that VEGFA and VEGFR2 expression may help identify less differentiated tumors and the analysis of a larger cohort may prove the clinical utility of these markers.

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Evaluation of characteristics of thyroid nodules on contrast-enhanced ultrasonography: a retrospective analysis of 252 cases

Medical Ultrasonography ◽

10.11152/mu-2252 ◽

2020 ◽

Vol 22 (2) ◽

pp. 164

Author(s):

Wen Luo ◽

Xiao Yang ◽

Jiani Yuan ◽

Lina Pang ◽

Peidi Zhang ◽

...

Keyword(s):

Retrospective Review ◽

Thyroid Nodules ◽

Contrast Enhanced Ultrasound ◽

Diagnostic Specificity ◽

Benign Lesions ◽

Predictive Values ◽

Contrast Enhanced ◽

Contrast Enhanced Ultrasonography ◽

Benign Nodules ◽

Sensitivity Specificity

Aim: This study investigated the enhancement patterns observed on contrast-enhanced ultrasound (CEUS) images for differentiating thyroid nodules.Material and methods: A retrospective review was conducted of CEUS cine loops of 252 nodules by two independent readers. Seven categories of enhancement patterns were identified: concentric hypoenhancement; heterogeneous hypoenhancement; hypoenhancement with sharp margin; homogeneous hyper/isoenhancement; hyper/isoenhancement with ring-like vascularity; island-like enhancement; and no perfusion. Associations between these patterns and the confirmed pathological/cytological outcomes (178 malignant, 74 benign) were analyzed and the sensitivity, specificity and positive predictive values (PPVs) determined. The agreement of the readers’ assessments was evaluated by Kappa value.Results: For malignant nodules, the predominant 3 patterns were: concentric hypoenhancement, heterogeneous hypoenhancement and homogeneous hyper/isoenhancement. For each of these, the diagnostic specificity was above 87% and the PPV more than 85%. Combining these patterns for malignancy the rates of sensitivity, specificity and PPV for reader 1 (reader 2) were 96.1% (98.9%), 71.6% (71.6%), and 89.1% (89.3%), respectively. For benign nodules, the predominant 4 patterns were: hypoenhancement with sharp margin; hyper/isoenhancement with ring-like vascularity; island-like enhancement; and no perfusion. The specificity for each was above 98% and the PPV more than 70%. Combining these patterns for benignity, the rates of sensitivity, specificity and PPV for reader 1 (reader 2) were 71.6% (71.6%), 96.1% (98.9%) and 88.3% (96.3%), respectively. The inter-reviewers agreement for classifying enhancement patterns was excellent (κ = 0.84, 95% CI: 0.79-0.89).Conclusions: Enhancement patterns of thyroid nodules on CEUS investigation, enable differentiation between malignant and benign lesions with good diagnostic sensitivity, specificity and PPV.

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Value of Contrast-Enhanced Ultrasound in Differentiating Clinically Atypical Subacute Thyroiditis from Papillary Thyroid Carcinomas

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2021.09.001 ◽

2021 ◽

Author(s):

Qi Zhang ◽

Liyan Liao ◽

Qinghai Peng ◽

Kui Tang ◽

Yan Xu ◽

...

Keyword(s):

Subacute Thyroiditis ◽

Contrast Enhanced Ultrasound ◽

Papillary Thyroid ◽

Thyroid Carcinomas ◽

Contrast Enhanced

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MicroRNA expression profile helps to distinguish benign nodules from papillary thyroid carcinomas starting from cells of fine-needle aspiration

Acta Endocrinologica ◽

10.1530/eje-12-0400 ◽

2012 ◽

Vol 167 (3) ◽

pp. 393-400 ◽

Cited By ~ 52

Author(s):

Patrizia Agretti ◽

Eleonora Ferrarini ◽

Teresa Rago ◽

Antonio Candelieri ◽

Giuseppina De Marco ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Mirna Expression ◽

Thyroid Nodules ◽

Expression Profiles ◽

False Negative ◽

Needle Aspiration ◽

Papillary Thyroid ◽

Fine Needle ◽

Thyroid Carcinomas ◽

Benign Nodules

ObjectiveMicroRNAs (miRNAs) are small endogenous noncoding RNAs that pair with target messengers regulating gene expression. Changes in miRNA levels occur in thyroid cancer. Fine-needle aspiration (FNA) with cytological evaluation is the most reliable tool for malignancy prediction in thyroid nodules, but cytological diagnosis remains undetermined for 20% of nodules.DesignIn this study, we evaluated the expression of seven miRNAs in benign nodules, papillary thyroid carcinomas (PTCs), and undetermined nodules at FNA.MethodsThe prospective study included 141 samples obtained by FNA of thyroid nodules from 138 patients. miRNA expression was evaluated by quantitative RT-PCR and statistical analysis of data was performed. Genetic analysis of codon 600 of BRAF gene was also performed.ResultsUsing data mining techniques, we obtained a criterion to classify a nodule as benign or malignant on the basis of miRNA expression. The decision model based on the expression of miR-146b, miR-155, and miR-221 was valid for 86/88 nodules with determined cytology (97.73%), and adopting cross-validation techniques we obtained a reliability of 78.41%. The prediction was valid for 31/53 undetermined nodules with 16 false-positive and six false-negative predictions. The mutated form V600E of BRAF gene was demonstrated in 19/43 PTCs and in 1/53 undetermined nodules.ConclusionsThe expression profiles of three miRNAs allowed us to distinguish benign from PTC starting from FNA. When the assay was applied to discriminate thyroid nodules with undetermined cytology, a low sensitivity and specificity despite the low number of false-negative predictions was obtained, limiting the practical interest of the method.

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