Risk assessment of thyroid papillary carcinoma with ultrasound_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HE Yushuang ,  MA Buyun , PENG Yulan , ZHOU Jiehong

Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

MA Buyun, Email: ws_mby@126.com

Keywords：

papillary thyroid carcinoma; ultrasonic diagnosis; preoperative diagnosis; risk grading

DOI：

10.7507/1007-9424.201807003

Video：

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Objective To evaluate the value of preoperative risk assessment of papillary thyroid carcinoma with ultrasound for clinic diagnosis and treatment.Methods The data of 400 patients with papillary thyroid carcinoma received operative treatment in 2017 were retrospectively analyzed. Recorded and analyzed the ultrasonic risk assessment and postoperative grading of clinic risk assessment, to evaluate coherence and correlation between them.Results There were 400 lesions with an average size of (12.8±8.5) mm. Among 400 lesions, diameter of 214 lesions less than 10 mm, diameter of 178 lesions were between 10 mm and 40 mm, and diameter of 8 lesions were larger than 40 mm. A total of 242 cases had lymph node metastasis and 309 cases had capsule invasion. Clinical and ultrasoud risk assessment was performed on 400 lesions. There were 224 lesions with low risk of clinical risk stratification vs. 111 lesions with low ultrasonic risk, 148 lesions with intermediate risk of clinical risk stratification vs. 270 lesions with intermediate ultrasonic risk, and 28 lesions with high risk of clinical risk stratification vs. 19 lesions with high ultrasonic risk. The consistency of postoperative recurrence risk stratification and preoperative ultrasound recurrence risk stratification was moderate (κ=0.414, P<0.01). In addition, the consistency between ultrasound examination and clinical lymph node metastasis was poor (κ=0.291, P<0.05), and the consistency of invasion of the capsule was moderate (κ=0.402, P<0.05).Conclusion Pre- operative evaluation of recurrence risk grading before thyroid ultrasound, focusing on individualized preoperative assessment, the assessment is more detailed and detailed, and is helpful for follow-up treatment and early screening for recurrence risk.

Citation： HE Yushuang, MA Buyun, PENG Yulan, ZHOU Jiehong. Risk assessment of thyroid papillary carcinoma with ultrasound. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(12): 1476-1481. doi: 10.7507/1007-9424.201807003 Copy

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2.	Papini E, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab, 2002, 87(5): 1941-1946.
3.	Lin JD, Hsueh C, Chao TC. Long-term follow-up of the therapeutic outcomes for papillary thyroid carcinoma with distant metastasis. Medicine (Baltimore), 2015, 94(26): 1058-1063.
4.	Witt RL. What is the best treatment of incidental papillary thyroid microcarcinoma? Laryngoscope, 2016, 126(10): 2203-2204.
5.	Hughes DT, Miller BS, Cohen MS, et al. Outcomes of total thyroidectomy with therapeutic central and lateral neck dissection with a single dose of radioiodine in the treatment of regionally advanced papillary thyroid cancer and effects on serum thyroglobulin. Ann Surg Oncol, 2014, 21(5): 1647-1652.
6.	Lee CW, Roh JL, Gong G, et al. Risk factors for recurrence of papillary thyroid carcinoma with clinically node-positive lateral neck. Ann Surg Oncol, 2015, 22(1): 117-124.
7.	Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg, 2003, 237(3): 399-407.
8.	Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg, 2007, 245(4): 604-610.
9.	Ito Y, Miyauchi A. Lateral and mediastinal lymph node dissection in differentiated thyroid carcinoma: indications, benefits, and risks. World J Surg, 2007, 31(5): 905-915.
10.	Haugen BR. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: What is new and what has changed? Cancer, 2017, 123(3): 372-381.
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13.	Frangos S, Iakovou IP, Marlowe RJ, et al. Acknowledging gray areas: 2015 vs. 2009 American Thyroid Association differentiated thyroid cancer guidelines on ablating putatively low-intermediate-risk patients. Eur J Nucl Med Mol Imaging, 2017, 44(2): 185-189.
14.	程若川. 2015 年版较 2009 年版 ATA 指南对甲状腺乳头状癌的手术治疗变化及解读. 中国普外基础与临床杂志, 2016, 23(10): 1166-1168.
15.	Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg, 2014, 140(4): 317-322.
16.	Hay ID, Thompson GB, Grant CS, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940-1999): temporal trends in initial therapy and long-term outcome in 2 444 consecutively treated patients. World J Surg, 2002, 26(8): 879-885.
17.	Wong KP, Lang BH. The role of prophylactic central neck dissection in differentiated thyroid carcinoma: issues and controversies. J Oncol, 2011, 2011: 127929.
18.	Sippel RS, Chen H. Controversies in the surgical management of newly diagnosed and recurrent/residual thyroid cancer. Thyroid, 2009, 19(12): 1373-1380.
19.	兰霞斌, 张浩. 《2015美国甲状腺协会成人甲状腺结节与分化型甲状腺癌诊治指南》外科治疗更新解读. 中华外科杂志, 2016, 54(3): 172-176.
20.	高明. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17): 1249-1272.
21.	Hegde A, Gopinathan A, Abu Bakar R, et al. A method in the madness in ultrasound evaluation of thyroid nodules. Singapore Med J, 2012, 53(11): 766-773.
22.	Riemann B, Krämer JA, Schmid KW, et al. Risk stratification of patients with locally aggressive differentiated thyroid cancer. Results of the MSDS trial. Nuklearmedizin, 2010, 49(3): 79-84.
23.	Goldstein NS, Czako P, Neill JS. Metastatic minimally invasive (encapsulated) follicular and Hurthle cell thyroid carcinoma: a study of 34 patients. Mod Pathol, 2000, 13(2): 123-130.
24.	Ito Y, Kudo T, Takamura Y, et al. Lymph node recurrence in patients with N1b papillary thyroid carcinoma who underwent unilateral therapeutic modified radical neck dissection. World J Surg, 2012, 36(3): 593-597.
25.	Momesso DP, Tuttle RM. Update on differentiated thyroid cancer staging. Endocrinol Metab Clin North Am, 2014, 43(2): 401-421.
26.	刘晓莉, 孙辉. 甲状腺乳头状微小癌的术后管理及动态风险评估. 中华内分泌外科杂志, 2016, 10(4): 265-268.

1. Fagin JA, Mitsiades N. Molecular pathology of thyroid cancer: diagnostic and clinical implications. Best Pract Res Clin Endocrinol Metab, 2008, 22(6): 955-969.
2. Papini E, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab, 2002, 87(5): 1941-1946.
3. Lin JD, Hsueh C, Chao TC. Long-term follow-up of the therapeutic outcomes for papillary thyroid carcinoma with distant metastasis. Medicine (Baltimore), 2015, 94(26): 1058-1063.
4. Witt RL. What is the best treatment of incidental papillary thyroid microcarcinoma? Laryngoscope, 2016, 126(10): 2203-2204.
5. Hughes DT, Miller BS, Cohen MS, et al. Outcomes of total thyroidectomy with therapeutic central and lateral neck dissection with a single dose of radioiodine in the treatment of regionally advanced papillary thyroid cancer and effects on serum thyroglobulin. Ann Surg Oncol, 2014, 21(5): 1647-1652.
6. Lee CW, Roh JL, Gong G, et al. Risk factors for recurrence of papillary thyroid carcinoma with clinically node-positive lateral neck. Ann Surg Oncol, 2015, 22(1): 117-124.
7. Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg, 2003, 237(3): 399-407.
8. Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg, 2007, 245(4): 604-610.
9. Ito Y, Miyauchi A. Lateral and mediastinal lymph node dissection in differentiated thyroid carcinoma: indications, benefits, and risks. World J Surg, 2007, 31(5): 905-915.
10. Haugen BR. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: What is new and what has changed? Cancer, 2017, 123(3): 372-381.
11. 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.
12. 王伟. 介绍一种评价临床检验结果一致性的的新指标-Kappa 值. 天津医药, 1991, 19(10): 639-640.
13. Frangos S, Iakovou IP, Marlowe RJ, et al. Acknowledging gray areas: 2015 vs. 2009 American Thyroid Association differentiated thyroid cancer guidelines on ablating putatively low-intermediate-risk patients. Eur J Nucl Med Mol Imaging, 2017, 44(2): 185-189.
14. 程若川. 2015 年版较 2009 年版 ATA 指南对甲状腺乳头状癌的手术治疗变化及解读. 中国普外基础与临床杂志, 2016, 23(10): 1166-1168.
15. Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg, 2014, 140(4): 317-322.
16. Hay ID, Thompson GB, Grant CS, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940-1999): temporal trends in initial therapy and long-term outcome in 2 444 consecutively treated patients. World J Surg, 2002, 26(8): 879-885.
17. Wong KP, Lang BH. The role of prophylactic central neck dissection in differentiated thyroid carcinoma: issues and controversies. J Oncol, 2011, 2011: 127929.
18. Sippel RS, Chen H. Controversies in the surgical management of newly diagnosed and recurrent/residual thyroid cancer. Thyroid, 2009, 19(12): 1373-1380.
19. 兰霞斌, 张浩. 《2015美国甲状腺协会成人甲状腺结节与分化型甲状腺癌诊治指南》外科治疗更新解读. 中华外科杂志, 2016, 54(3): 172-176.
20. 高明. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17): 1249-1272.
21. Hegde A, Gopinathan A, Abu Bakar R, et al. A method in the madness in ultrasound evaluation of thyroid nodules. Singapore Med J, 2012, 53(11): 766-773.
22. Riemann B, Krämer JA, Schmid KW, et al. Risk stratification of patients with locally aggressive differentiated thyroid cancer. Results of the MSDS trial. Nuklearmedizin, 2010, 49(3): 79-84.
23. Goldstein NS, Czako P, Neill JS. Metastatic minimally invasive (encapsulated) follicular and Hurthle cell thyroid carcinoma: a study of 34 patients. Mod Pathol, 2000, 13(2): 123-130.
24. Ito Y, Kudo T, Takamura Y, et al. Lymph node recurrence in patients with N1b papillary thyroid carcinoma who underwent unilateral therapeutic modified radical neck dissection. World J Surg, 2012, 36(3): 593-597.
25. Momesso DP, Tuttle RM. Update on differentiated thyroid cancer staging. Endocrinol Metab Clin North Am, 2014, 43(2): 401-421.
26. 刘晓莉, 孙辉. 甲状腺乳头状微小癌的术后管理及动态风险评估. 中华内分泌外科杂志, 2016, 10(4): 265-268.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk assessment of thyroid papillary carcinoma with ultrasound

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