Nodule Size Effect on Diagnostic Performance of Ultrasonography and Computed Tomography for Papillary Thyroid Carcinoma

Author(s): Jia-wei LI, Cai Chang, Jia-ying Chen, Zhao-ting Shi, Min Chen*

Journal Name: Current Medical Imaging
Formerly: Current Medical Imaging Reviews

Volume 15 , Issue 5 , 2019


Become EABM
Become Reviewer
Call for Editor

Graphical Abstract:


Abstract:

Background: To compare the abilities of ultrasonography (US) and Computed Tomography (CT) to identify calcifications and to predict probability of malignancy for Papillary Thyroid Carcinoma (PTC) and Papillary Thyroid Microcarcinoma (PTMC).

Methods: We reviewed 1008 cases of PTC/PTMC with calcifications reported by pre-operative US, CT, or post-operative pathology. The size of the thyroid nodule was obtained from the US report and the maximum diameter (d) was documented. According to the nodule size (d), the PTC and PTMC groups were each divided into two subgroups, as follows: large PTC group (d ≥ 2 cm), small PTC group (1 cm < d < 2 cm), large PTMC group (0.6 cm ≤ d ≤ 1 cm), and small PTMC group (d < 0.6 cm).

Results: In the 1008 patients, the ratio of females to males was 2.29 and the mean age was 40.9 years (standard deviation: 11.7 years). Of the 1008 records, 92.8% were found to have calcifications according to the US report, while 50.4% showed calcifications according to the CT report. This difference between US and CT reports was statistically significant (p < 0.0005). The percentages of US reports showing calcifications were similar for all four PTC and PTMC subgroups (93.7%, 94.3%, 92.1%, and 85.1%, respectively; p = 0.052), while the percentages of CT reports showing calcifications were significantly different among the PTC and PTMC subgroups (62.3%, 52.2%, 45.4%, and 31.3%, respectively; p < 0.0005). As for the prediction of malignancy, US was superior to CT in all four subgroups (large PTC group: 97.1% vs. 54.1%, small PTC group: 94.8% vs. 42.9%, large PTMC group: 97.2% vs. 32.0%, small PTMC group: 95.5% vs. 14.9%; p < 0.0005 for all pairwise comparisons). No significant difference was observed in terms of the ability of US to predict the malignancy of PTC versus PTMC (p = 0.31), while CT showed significant superiority in diagnosing PTC versus PTMC (p < 0.0005). The predictive value of CT for PTC declined as the nodule size decreased (p < 0.05 for all pairwise comparisons).

Conclusion: Our results showed that US detected calcifications and predicted the malignancy of all nodule sizes of thyroid papillary carcinoma equally well, while the performance of CT declined with the reduction of nodule size.

Keywords: Nodule size, papillary thyroid carcinoma, papillary thyroid microcarcinoma, ultrasound, computed tomography, calcifications.

[1]
Jemal A, Siegel R, Ward E. Cancer statistics. Cancer J Clin 2008; 58: 71-96.
[2]
Dideban S, Abdollahi A, Meysamie A, Sedghi S, Shahriari M. Thyroid papillary microcarcinoma: Etiology, clinical manifestations, diagnosis, follow-up, histopathology and prognosis. Iran J Pathol 2016; 11(1): 1-19.
[3]
Hedinger C, Sobin LH. Histologic typing of thyroid tumours. In: Hedinger C, Williams ED, Sobin LH, eds. International histological classification of tumors. 2nd ed. New York: Springer-Verlag; 1988. pp. 9-10.
[4]
Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016; 26(1): 1-133.
[5]
Burgess JR, Tucker P. Incidence trends for papillary thyroid carcinoma and their correlation with thyroid surgery and thyroid fine-needle aspirate cytology. Thyroid 2006; 16(1): 47-53.
[6]
Lesnik D, Cunnane ME, Zurakowski D, et al. Papillary thyroid carcinoma nodal surgery directed by a preoperative radiographic map utilizing CT scan and ultrasound in all primary and reoperative patients. Head Neck 2014; 36(2): 191-202.
[7]
Kim E, Park JS, Son KR, Kim JH, Jeon SJ. NA DG. Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: Comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography. Thyroid 2008; 18(4): 411-8.
[8]
Ahn JE, Lee JH, Yi JS, et al. Diagnostic accuracy of CT and ultrasonography for evaluating metastatic cervical lymph nodes in patients with thyroid cancer. World J Surg 2008; 32(7): 1552-8.
[9]
Chen G, Zhu XQ, Zou X, Yao J, Liang JX. Retrospective analysis of thyroid nodules by clinical and pathological characteristics, and ultrasonographically detected calcification correlated to thyroid carcinoma in South China. Eur Surg Res 2009; 42(3): 137-42.
[10]
Taki S, Terahata S, Yamashita R, et al. Thyroid calcifications: Sonographic patterns and incidence of cancer. J Clin Imaging 2004; 28(5): 368-71.
[11]
Kim BK, Choi YS, Kwon HJ, Lee JS, Heo JJ. Relationship between patterns of calcification in thyroid nodules and histopathologic findings. Endocr J 2013; 60(2): 155-60.
[12]
Kakkos SK, Scopa CD, Chalmoukis AK, et al. Relative risk of cancer in sonographically detected thyroid nodules with calcifications. J Clin Ultrasound 2000; 28(7): 347-52.
[13]
Oh EM, Chung YS, Song WJ, Lee YD. The pattern and significance of the calcifications of papillary thyroid microcarcinoma presented in preoperative neck ultrasonography. Ann Surg Treat Res 2014; 86(3): 115-21.
[14]
Park YJ, Kim JA, Son EJ, et al. Thyroid nodules with macrocalcification: Sonographic findings predictive of malignancy. Yonsei Med J 2014; 55(2): 339-44.
[15]
Wu CW, Dionigi G, Lee KW, et al. Calcifications in thyroid nodules identified on preoperative computed tomography: Patterns and clinical significance. Surgery 2012; 151(3): 464-70.
[16]
Kim DW. Computed tomography features of papillary thyroid carcinomas. J Comput Assist Tomogr 2014; 38(6): 936-40.
[17]
Liu W, Dong X, Zhu C, et al. Association between computed tomography-detected calcification and thyroid carcinoma. Neoplasma 2015; 62(4): 641-5.
[18]
Cordes M, Kondrat P, Uder M, Kuwert T, Sasiadek M. Differential diagnostic ultrasound criteria of papillary and follicular carcinomas: A multivariate analysis. RoFo 2014; 186(5): 489-95.
[19]
Li JW, Chang C, Chen M, et al. Is ultrasonography more sensitive than computed tomography for identifying calcifications in thyroid nodules? J Ultrasound Med 2016; 35(10): 2183-90.
[20]
Choi JS, Kim J, Kwak JY, Kim MJ, Chang HS, Kim EK. Preoperative staging of papillary thyroid carcinoma: Comparison of ultrasound imaging and CT. Am J Roentgenol 2009; 193(3): 871-8.
[21]
Merritt CRB. Physics of ultrasound. In: Rumack CM, Wilson SR, Charboneau JW, Levine D, eds. Diagnostic ultrasound. 4th ed. Philadelphia, PA: Elsevier Mosby; 2011; pp. 2-33.
[22]
Lin E, Alessio A. What are the basic concepts of temporal, contrast, and spatial resolution in cardiac CT? J Cardiovasc Comput Tomogr 2009; 3(6): 403-8.
[23]
Kim GR, Kim MH, Moon HJ, Chung WY, Kwak JY, Kim EK. Sonographic characteristics suggesting papillary thyroid carcinoma according to nodule size. Ann Surg Oncol 2013; 20(3): 906-13.
[24]
Gu WJ, Yan HX, Luo YK, et al. Characterization of papillary thyroid microcarcinomas using sonographic features in malignant papillary thyroid cancer: A retrospective analysis. Medicine 2015; 94(21)e841
[25]
Moon WJ, Jung SL, Lee JH, et al. Benign and malignant thyroid nodules: US differentiation-multicenter retrospective study. Radiology 2008; 247(3): 762-70.
[26]
Cappelli C, Castellano M, Pirola I, et al. Thyroid nodule shape suggests malignancy. Eur J Endocrinol 2006; 155(1): 27-31.
[27]
Lee C, Chalmers B, Treister D, et al. Thyroid lesions visualized on CT: Sonographic and pathologic correlation. Acad Radiol 2015; 22(2): 203-9.
[28]
Seiberling KA, Dutra JC, Grant T, Bajramovic S. Role of intrathyroidal calcifications detected on ultrasound as a marker of malignancy. Laryngoscope 2004; 114(10): 1753-7.
[29]
Kim MJ, Kim E, Kwak JY, et al. Differentiation of thyroid nodules with macrocalcifications: Role of suspicious sonographic findings. J Ultrasound Med 2008; 27(8): 1179-84.
[30]
Wang N, Xu Y, Ge C, Guo R, Guo K. Association of sonographically detected calcification with thyroid carcinoma. Head Neck 2006; 28(12): 1077-83.
[31]
Khoo MLC, Asa SL, Witterick IJ, Freeman JL. Thyroid calcification and its association with thyroid calcinoma. Head Neck 2002; (24): 651-5.
[32]
Triggiani V, Guastamacchia E, Licchelli B, Tafaro E. Microcalcifications and psammoma bodies in thyroid tumors. Thyroid 2008; 18(9): 1017-8.
[33]
Shetty SK, Maher MM, Hahn PF, Halpern EF, Aquino SL. Significance of incidental thyroid lesions detected on CT: Correlation among CT, sonography, and pathology. AJR Am J Roentgenol 2006; 187(5): 1349-56.
[34]
Isik A, Eken H, Soyturk M, Firat D, Yilmaz I. A rare presentation of accessory breast in axilla. Galician Med J 2016; 23(4)201645
[35]
Isik A, Firat D. Bilateral intra-areolar polythelia. Breast J 2018; 24(1): 89-90.
[36]
Zhang L, Wei WJ, Ji QH, et al. Risk factors for neck nodal metastasis in papillary thyroid microcarcinoma: A study of 1066 patients. J Clin Endocrinol Metab 2012; 97(4): 1250-7.


open access plus

Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 15
ISSUE: 5
Year: 2019
Page: [489 - 495]
Pages: 7
DOI: 10.2174/1573405614666180425142141

Article Metrics

PDF: 40
HTML: 7
PRC: 1