Taller-than-wide Thyroid Nodules With Microcalcifications Are at High Risk of Malignancy

Correlation between EpCAM expression and cervical lymph node metastasis in papillary thyroid carcinoma: a study integrating ultrasonographic features

OBJECTIVES

The epithelial cell adhesion molecule (EpCAM) is a transmembrane glycoprotein that is overexpressed in various epithelial tumors and has been associated with tumor aggressiveness and unfavorable prognosis. This study aimed to explore the association between ultrasonic characteristics and EpCAM expression in papillary thyroid carcinoma (PTC), as well as the value in predicting the risk of cervical lymph node metastasis (CLNM).

METHODS

Participants with suspected thyroid cancer underwent conventional and contrast-enhanced ultrasonography (CEUS) before surgery. Age, sex, and nodule features in ultrasound were recorded. Participants were classified based on the presence of CLNM. EpCAM expression was detected using immunohistochemistry. The risk predictors of CLNM were evaluated by using univariate and multivariate Cox model.

RESULTS

The final dataset included 53 participants, of whom 27(50.94%) had CLNM, while 26(49.06%) did not. The EpCAM-positive area (p < 0.001), score (p < 0.001), and nuclear expression (p = 0.027) were significantly different between the CLNM and non-CLNM groups. Receiver operating characteristic curve analysis showed that EpCAM score with 4.5 had sensitivity and specificity of 85.2% and 76.9%, respectively, for diagnosing CLNM. Multivariate logistic regression results showed that overexpression EpCAM (score ≧ 4.5) [OR:46.54, p = 0.007], tumor size ≧ 1.05 cm [OR:14.21,p = 0.01] and extrathyroidal extension (ETE) on CEUS [OR:113.33, p = 0.01] were independent risk factors of CLNM. Overexpression of EpCAM (62.07%, 18/29) correlated with ETE of PTC confirmed by postoperative pathology (p = 0.01, 0.027). No significant difference in PTC histological variants was detected based on EpCAM expression (p = 0.05).

CONCLUSIONS

EpCAM overexpression demonstrated a significant association with ETE and CLNM in PTC. The integration of ultrasonography with EpCAM expression profiling offers A promising multiparameter diagnostic model to enhance predictive accuracy. Further studies evaluating EpCAM expression in fine-needle aspiration biopsy (FNAB) samples are required to determine its possible preoperative predictive value.

Thyroid Nodule Sphericity Metrics Discriminate Benign and Malignant Follicular and Oncocytic Neoplasms

Background: We investigated if thyroid nodule taller-than-wide (TTW) feature and sphericity metrics are helpful in separating benign neoplastic thyroid nodules (follicular and oncocytic adenomas) from follicular thyroid carcinomas (FTC) and oncocytic thyroid carcinomas (OCA). Methods: This is a retrospective study of TTW sonographic feature as reported by radiologists and nodule sphericity metrics at two academic health systems. Surgical pathology reports for benign and malignant follicular and oncocytic neoplasms, non-neoplastic nodules (hyperplastic and adenomatoid), and classic papillary thyroid cancers (PTC) were extracted from enterprise data warehouses. We independently reviewed each ultrasound and recorded nodule dimensions to identify nodules that were TTW and determine if the proportion of TTW nodules is different in benign and malignant thyroid nodules of various histologies. We also evaluated the sphericity index and sphericity ratio, two quantitative measures of how close the 3D shape of the nodule is to a sphere. Results: In total, 1110 nodules were analyzed: 209 non-neoplastic nodules (hyperplastic and adenomatoid), 398 benign neoplasms (follicular and oncocytic adenomas), and 503 malignant neoplasms (FTC, OCA, PTC, and follicular variant-PTC [FV-PTC]) and noninvasive follicular thyroid neoplasm with papillary-like features (NIFTP). There was no statistical difference for the TTW feature when follicular and oncocytic adenomas were compared with FV-PTC, OCA, FTC, and NIFTP (χ2, p = 0.08, sensitivity of 28% [confidence interval 23-24%]), when follicular adenoma was compared with FTC (χ2, p = 0.64) or when oncocytic adenoma was compared with OCA (χ2, p = 0.08). Benign and malignant neoplasms were more likely than non-neoplastic nodules to be TTW (χ2, p = 0.02). In contrast, the sphericity index and sphericity ratio were significantly different in most comparisons of benign and malignant nodules (Wilcoxon, p < 0.03) except for oncocytic tumors. Conclusions: TTW shape has limited utility in distinguishing benign follicular and oncocytic neoplasms from malignancy. This sonographic feature was more common among all benign and malignant neoplasms when they were compared as a group to non-neoplastic nodules, which suggests this sonographic feature is an indicator of neoplastic growth (benign or malignant) but not cancer. Alternative methods, such as measures of sphericity, are needed to distinguish benign and malignant oncocytic and follicular neoplasms.

Histopathological Analysis of Thyroid Nodules with Taller-Than-Wide Shape in Adults

Background

The ultrasound examination (USE) feature of taller-than-wide (TTW) shape is highly specific but low sensitive in diagnosis of thyroid carcinoma. Relationships between other USE malignant features (such as irregular margin, ill-defined, markedly hypoechoic, and microcalcification) with histopathological features have been well investigated, while studies about the histopathologic features of TTW shape are rare.

Aim

The present study aimed to investigate the histopathological features of thyroid nodules with TTW shapes.

Methods

A total of 85 thyroid nodules with TTW were selected from 1680 consecutive patients who underwent thyroid resection. USE features of the nodules, including size, location, boundary, margin, composition, echogenicity, and calcification, were recorded according to the China Thyroid Imaging Reporting and Data System (C-TIRADS). Hypoechoic lesions were further categorized as mild, moderate or markedly hypoechoic lesions. The histological features of the specimens were evaluated according to the arrangement of follicular cells, presence of papillary structures or psammoma bodies, degree of fibrosis, and amount of lymphoid infiltration. Differences in the USE and histological features between benign and malignant nodules were compared.

Results

Among the 85 nodules, 72 (84.71%) were malignant, and 13 (15.29%) were benign. Only echogenicity showed a statistically significant difference between benign and malignant nodules (P=0.003). Apart from microfoci, papillary structures, and psammoma bodies, the degree of fibrosis was also significantly different between benign and malignant tumors (all P<0.05). Regression analysis showed a trend of decreasing nodule echogenicity with increasing fibrosis frequency (odds ratio [OR] = 4.500).

Conclusion

Extensive fibrosis is the most common histopathological feature of thyroid cancer and corresponds to hypoechogenicity in USE. TTW-shaped thyroid nodules are highly suggestive of malignancy, especially those with moderate or markedly hypoechogenicity.

Imprinted gene detection effectively improves the diagnostic accuracy for papillary thyroid carcinoma

BACKGROUND

Papillary thyroid carcinoma (PTC) is the most frequent histological type of thyroid carcinoma. Although an increasing number of diagnostic methods have recently been developed, the diagnosis of a few nodules is still unsatisfactory. Therefore, the present study aimed to develop and validate a comprehensive prediction model to optimize the diagnosis of PTC.

METHODS

A total of 152 thyroid nodules that were evaluated by postoperative pathological examination were included in the development and validation cohorts recruited from two centres between August 2019 and February 2022. Patient data, including general information, cytopathology, imprinted gene detection, and ultrasound features, were obtained to establish a prediction model for PTC. Multivariate logistic regression analysis with a bidirectional elimination approach was performed to identify the predictors and develop the model.

RESULTS

A comprehensive prediction model with predictors, such as component, microcalcification, imprinted gene detection, and cytopathology, was developed. The area under the curve (AUC), sensitivity, specificity, and accuracy of the developed model were 0.98, 97.0%, 89.5%, and 94.4%, respectively. The prediction model also showed satisfactory performance in both internal and external validations. Moreover, the novel method (imprinted gene detection) was demonstrated to play a role in improving the diagnosis of PTC.

CONCLUSION

The present study developed and validated a comprehensive prediction model for PTC, and a visualized nomogram based on the prediction model was provided for clinical application. The prediction model with imprinted gene detection effectively improves the diagnosis of PTCs that are undetermined by the current means.

Clinical value of dual-energy CT for predicting occult metastasis in central neck lymph nodes of papillary thyroid carcinoma

OBJECTIVES

To predict the probability of occult lymph node metastasis (OLNM) in the central cervical by analyzing the dual-energy computed tomography (DECT) parameters derived from papillary thyroid carcinoma (PTC).

METHODS

Data were retrospectively collected from patients with pathologically confirmed PTC who underwent arterial and venous phases of enhanced DECT with concurrent central neck lymph node dissection (CLND). Three clinical features, three shape-related features, and twenty-six DECT-derived parameters were measured. The univariate and multivariate analyses were applied to select the relevant parameters and develop the nomogram.

RESULTS

A total 140 cases with negative diagnosis of cervical central lymph node metastases by preoperative evaluation were included, among which 88 patients with metastasis (OLNM +) and 52 patients without metastasis (OLNM -) were finally confirmed by pathology. (1) Anteroposterior/transverse diameter ratio (A/T) derived from the PTC focus had significant difference between the OLNM + and OLNM - groups (p < 0.05). (2) In the arterial phase, iodine concentration (ICarterial), normalized iodine concentration (NICarterial), effective atomic number (Zeff-arterial), electron density (EDarterial), and slope of energy curve (karterial) from PTC focus showed significant difference (all p < 0.05) between the two groups. In the venous phase, only the CT value under the 40 keV (HU40keVvenous) had differences (p < 0.05). (3) The nomogram was produced to predict the probability of OLNM, and the AUC, sensitivity, and specificity in the training and test cohort were 0.830, 75.0%, 76.9%, and 0.829, 65.9%, 84.6%, respectively.

CONCLUSIONS

DECT parameters combined with shape-related feature derived from PTC might be used as predictors of OLNM in the central neck.

CLINICAL RELEVANCE STATEMENT

Preoperative imaging evaluation combining shape-related features and dual-energy CT parameters could serve as a reference to discern occult lymph node metastasis in central neck during the surgically planning of papillary thyroid carcinoma.

KEY POINTS

• Papillary thyroid carcinoma (PTC) patients may have occult lymph node metastasis (OLNM) in the central neck, which is extremely difficult to find by preoperative imaging examination. • Dual-energy CT quantitative evaluation has higher accuracy than conventional CT and can predicting OLNM in the central neck of PTC. • Dual-energy CT quantitative parameters and morphology of PTC can serve as a useful tool in predicting OLNM in the central neck, and as a guide for personalized treatment.

The diagnostic value of a new ultrasonographic method for the measurement of a taller-than-wide shape of benign and malignant thyroid nodules

PURPOSE

To evaluate the diagnostic value of a new ultrasonographic method in the measurement of thyroid nodules with a taller-than-wide (TTW) shape.

METHODS

A total of 982 thyroid nodules were analysed, 571 of which were malignant thyroid nodules and 411 of which were benign nodules. Nodules were divided into two groups by size: Group A (<1 cm, n = 627) and Group B (≥1 cm, n = 355). The angle between the maximum diameter of each nodule and the horizontal axis was measured by image analysis software. The best cut-off value for distinguishing between benign and malignant thyroid nodules and the diagnostic accuracy of the new ultrasonographic method in the measurement of TTW shapes were determined by receiver operating characteristic (ROC) curve analysis.

RESULTS

The cut-off value for distinguishing benign and malignant thyroid nodules was 44.5 degrees. The area under the ROC curve (AUC) was 0.849 (95% CI: 0.822~0.875), and the sensitivity and specificity of the diagnosis of malignant thyroid nodules were 86.9% and 84.4%, respectively. Regarding the angle between the maximum diameter and the transverse axis of the thyroid nodules, an angle greater than 45 degrees was a significant indicator of a diagnosis of malignant thyroid nodules. The AUC for distinguishing malignant from benign thyroid nodules with the new ultrasonographic method in the measurement of TTW shapes was higher than that with the first method (FM) in the whole group, Group A and Group B (respectively, 0.849 vs. 0.812, 0.853 vs. 0.808, 0.852 vs. 0.828). The diagnostic sensitivity of a TTW shape measured by the new ultrasonographic method for predicting thyroid malignancy was significantly higher than that measured by the FM in the whole group, Group A and Group B (respectively, 0.858 vs. 0.760, 0.764 vs. 0.669, 0.890 vs. 0.815).

CONCLUSION

A TTW shape measured by our new ultrasonographic method showed superior performance for predicting thyroid malignancy.

The value of color Doppler ultrasound in the diagnosis of thyroid nodules: a systematic review and meta-analysis

BACKGROUND

This study aimed to analyze the value of color Doppler ultrasound in the diagnosis of thyroid nodules.

METHODS

We searched the PubMed, Web of Science, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) on using color Doppler ultrasound, thyroid nodules, thyroid tumors, and Doppler ultrasound to diagnose the thyroid nodules. The outcome indicators in the articles had to include the numbers of true positives (TP), false positives (FP), false negatives (FN), and true negatives (TN). Subsequently, the Jadad tool was adopted to evaluate the quality of the included articles, and Review Manager 5.3 software was used to conduct a meta-analysis of the experimental data.

RESULTS

A total of eight suitable articles were selected. The results showed that the estimated sensitivity and specificity of color Doppler ultrasound for the diagnostic of thyroid nodules were 0.46-0.89 and 0.00-1.00, respectively. The pooled estimate of sensitivity for the different articles was 0.71 [95% confidence interval (CI): 0.46-0.89], and the pooled estimate of specificity was 0.77 (95% CI: 0.00-1.00). The area under the summary receiver operating characteristic (SROC) curve (AUC) was 0.917, which was larger than 0.9, signifying high diagnostic accuracy. This suggests that color doppler ultrasound can realize the clinical diagnosis of thyroid nodules.

DISCUSSION

In summary, the results of this study could provide a clinical data for the promotion and application of color Doppler ultrasound in the clinical diagnosis of thyroid nodules, as well as further reliable data for follow-up clinical research on the diagnosis and treatment of thyroid nodules.

Ultrasound Echogenicity of Papillary Thyroid Cancer Is Affected by Tumor Growth Patterns and Tumor Fibrosis

BACKGROUND/AIM

The association between preoperative ultrasound (US) echogenicity and histopathological characteristics of papillary thyroid cancer (PTC) has been rarely investigated is not well characterized. This study evaluated a relationship between the clinical characteristics of PTC, histopathological phenomena including tumor growth patterns (TGPs) and tumor fibrosis (TF), and US echogenicity.

PATIENTS AND METHODS

In total, 170 patients with PTC (<2 cm) underwent total thyroidectomy with central neck dissection. Demographics, US echogenicity, tumor size, extra-thyroidal extension (ETE), lymph node metastasis (LNM) within the central and lateral neck, TGPs, and TF percentage were reviewed.

RESULTS

Patients with TGP II (encapsulated growth with partial pericapsular extension) and III (infiltrative growth) were more frequently burdened by ETE and lateral neck LNM compared to patients with TGP I (encapsulated growth with a well-defined cystic or solid characteristic). Older age was significantly deterministic of TGP III, and male gender and higher TF percentage were independent risk factors for lateral neck LNM. TGP III and TF were independent determining factors for marked hypoechogenicity on US.

CONCLUSION

PTC with TGP II and III and higher tumor fibrosis exhibited more aggressive clinicopathologic behaviors. TGP III and TF were determinants for marked hypoechogenicity.