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

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.

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Can preoperative ultrasound predict extrathyroidal extension of differentiated thyroid cancer?

Acta Endocrinologica ◽

10.1530/eje-21-0091 ◽

2021 ◽

Author(s):

Livia Lamartina ◽

Sophie Bidault ◽

Julien Hadoux ◽

Joanne Guerlain ◽

Elizabeth Girard ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Thyroid Nodules ◽

Extrathyroidal Extension ◽

Predictive Values ◽

Median Size ◽

Preoperative Ultrasound ◽

Ultrasound Evaluation ◽

Initial Surgery ◽

Sensitivity Specificity

Objective The presence of extrathyroidal extension (ETE) is generally considered an indication for total thyroidectomy for differentiated thyroid cancer. The accuracy of neck ultrasound for the diagnosis of ETE is controversial. The aim of this study was to assess the diagnostic accuracy of preoperative ultrasound evaluation of ETE. Methods Retrospective and observational study of consecutive patients operated between 2016 and 2019 for cytologically suspicious or indeterminate thyroid nodules. US images obtained preoperatively were retrospectively reviewed to identify signs of minimal or gross ETE. Histology was considered the gold standard for diagnosis of ETE. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of US were evaluated. Results A cohort of 305 patients (75% females, median age 48 years) with 378 nodules (median size 18 mm) was studied. Seventy-five percent of the nodules (n=228) were malignant on histology and ETE was present in 106 cases (28%): 83 minimal ETE and 23 gross ETE. Suspicion of minimal ETE on preoperative ultrasound was found in 50 (13%) with a sensitivity of 30%, a specificity of 93%, a PPV 62% and a NPV of 78%, with an accuracy of 76%. Gross ETE on ultrasound was found in 19 (5%) nodules with a sensitivity of 78%, a specificity of 99.7% a PPV 94.7% an NPV of 98.6% and an accuracy of 98%. Conclusions Preoperative US is very specific and accurate in diagnosing gross ETE which impacts the extent of initial surgery for thyroid cancers.

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Patient Preferences in Low-Risk Thyroid Cancer: Deciding on the Extent of Surgery Using a Discrete Choice Experiment

Clinical Thyroidology ◽

10.1089/ct.2020;32.229-232 ◽

2020 ◽

Vol 32 (5) ◽

pp. 229-232

Author(s):

Valeria Ramundo ◽

David S. Cooper

Keyword(s):

Thyroid Cancer ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Patient Preferences ◽

Choice Experiment ◽

Low Risk ◽

Extent Of Surgery

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The Effect of Extent of Surgery and Number of Lymph Node Metastases on Overall Survival in Patients with Medullary Thyroid Cancer

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2013-2942 ◽

2014 ◽

Vol 99 (2) ◽

pp. 448-454 ◽

Cited By ~ 41

Author(s):

Nazanene H. Esfandiari ◽

David T. Hughes ◽

Huiying Yin ◽

Mousumi Banerjee ◽

Megan R. Haymart

Keyword(s):

Overall Survival ◽

Thyroid Cancer ◽

Lymph Node ◽

Lymph Node Metastases ◽

Medullary Thyroid Cancer ◽

Medullary Thyroid ◽

Extent Of Surgery ◽

Node Metastases

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Re: Extent of Surgery Affects Papillary Thyroid Cancer

Annals of Surgery ◽

10.1097/sla.0b013e3181758d93 ◽

2008 ◽

Vol 247 (6) ◽

pp. 1082-1083 ◽

Cited By ~ 8

Author(s):

Jatin P. Shah

Keyword(s):

Thyroid Cancer ◽

Papillary Thyroid Cancer ◽

Papillary Thyroid ◽

Extent Of Surgery

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Thyroid Cancer Patients With No Evidence of Disease: The Need for Repeat Neck Ultrasound

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2019-00962 ◽

2019 ◽

Vol 104 (11) ◽

pp. 4981-4989 ◽

Cited By ~ 27

Author(s):

Giorgio Grani ◽

Valeria Ramundo ◽

Rosa Falcone ◽

Livia Lamartina ◽

Teresa Montesano ◽

...

Keyword(s):

Thyroid Cancer ◽

Lymph Nodes ◽

Intermediate Risk ◽

Serum Thyroglobulin ◽

Predictive Values ◽

Academic Center ◽

Ultrasound Findings ◽

Risk Patients ◽

Recorded Data ◽

Neck Lymph Nodes

Abstract Context Ultrasonography (US) is considered the most sensitive tool for imaging persistent or recurrent papillary thyroid cancer (PTC) in the neck. Objective To clarify the usefulness of routine neck US in low- and intermediate-risk patients with PTC with no evidence of disease 1 year after thyroidectomy. Design Retrospective analysis of prospectively recorded data. Setting Academic center. Patients Two hundred twenty-six patients with PTC with sonographically normal neck lymph nodes and unstimulated serum thyroglobulin (Tg) levels that were either undetectable (<0.20 ng/mL) or low (0.21 to 0.99 ng/mL) at the 1-year evaluation. Interventions Yearly assessment: unstimulated serum Tg level, anti-Tg-antibody (TgAb) titer, TSH levels, and ultrasound examination of neck lymph nodes. Main Outcome Measures Rates of ultrasonographic lymph node abnormalities at the 3-year and last follow-up visits. Results In patients with an undetectable Tg level at the 1-year evaluation, sonographically suspicious neck lymph nodes were found in 1.2% of patients at 3 years and in 1.8% at the last visit [negative predictive values (NPVs) of 1-year Tg < 0.2 ng/mL: 98.8% (95% CI 95.8% to 99.9%) and 98.2% (95% to 99.6%), respectively]. Similar NPVs emerged for low detectable 1-year Tg levels [98.2% (90.3% to 99.9%) and 94.5% (84.9% to 98.9%) at the 3-year and last visits, respectively]. Seventy-five percent of the nodal lesions were likely false positive; none required treatment. Conclusions Low- and intermediate-risk patients with PTC with negative ultrasound findings and unstimulated Tg levels <1 ng/mL at the 1-year evaluation can be safely followed with clinical assessments and unstimulated serum Tg determinations. Neck US might be repeated if TgAb titers rise, or unstimulated Tg levels exceed 1 ng/mL.

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