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Prediction of extrathyroidal extension using ultrasonography and computed tomography.

Lee DY, Kwon TK, Sung MW, Kim KH, Hah JH - Int J Endocrinol (2014)

Bottom Line: Methods.Results.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, Republic of Korea.

ABSTRACT
Objectives. The aim of the present study was to evaluate the value of high-resolution ultrasound (US) and computed tomography (CT) scan for preoperative prediction of the extrathyroidal extension (ETE). Methods. We analyzed the medical records of 377 patients with papillary thyroid carcinoma (PTC) with preoperative US and CT scan to calculate the sensitivity, specificity, and positive and negative predictive values of characteristics imaging features (such as contact and disruption of thyroid capsule) for the presence of ETE in postoperative pathologic examination. We also evaluated the diagnostic power for several combinations of US and CT findings. Results. ETE was present in 174 (46.2%) based on pathologic reports. The frequency of ETE was greater in the patients with greater degrees of tumor contact and disruption of capsule, as revealed by both US and CT scans (positive predictive value of 72.2% and 81.8%, resp.). Considering positive predictive values and AUC of US and CT categories, separately or combined, a combination of US and CT findings was most accurate for predicting ETE (83.0%, 0.744). Conclusions. This study suggests that ETE can be predicted most accurately by a combination of categories based on the findings of US and CT scans.

No MeSH data available.


Related in: MedlinePlus

44-year-old woman with papillary thyroid carcinoma without extrathyroidal extension. On contrast to the US finding which shows the tumor closely attached to the capsule, CT findings revealed the complete parenchymal envelop around the tumor.
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fig3: 44-year-old woman with papillary thyroid carcinoma without extrathyroidal extension. On contrast to the US finding which shows the tumor closely attached to the capsule, CT findings revealed the complete parenchymal envelop around the tumor.

Mentions: Although US usually provides critical information in managing the patients with PTC, the US is a subjective and examiner-dependent inconsistent study and shows only 2-dimensional images. Regarding ETE, as observed in previous studies and our data, diagnostic performance is not improved despite technical support and development of US had increased. To overcome these disadvantages, US using shear wave elastography or magnetic resonance imaging has been tried [16, 17]. However, several techniques using US still cannot perfectly assess the ETE preoperatively. Our data showed that the combination of two imaging methods might increase PPV of ETE. CT scan can overcome the disadvantages of US, such as 2-dimensional image and examiner dependency. Moreover, CT scan can provide information of the tumor status in neutral position; in contrast, the US probe could compress the patient's neck and may slightly distort the normal parenchyma around tumor. The thyroid gland is a compressible organ; therefore, external compression, by the probe of the US, can make the thyroid parenchyma thinner, especially when the thyroid is pressed between the malignant tumor and strap muscles. The distorted, thinner thyroid can misinform the physician about the actual proximity of the tumor and thyroid capsule. As shown in Figure 3, false positive findings occurring by US alone could be decreased if evaluated in combination with information from CT scans.


Prediction of extrathyroidal extension using ultrasonography and computed tomography.

Lee DY, Kwon TK, Sung MW, Kim KH, Hah JH - Int J Endocrinol (2014)

44-year-old woman with papillary thyroid carcinoma without extrathyroidal extension. On contrast to the US finding which shows the tumor closely attached to the capsule, CT findings revealed the complete parenchymal envelop around the tumor.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4265702&req=5

fig3: 44-year-old woman with papillary thyroid carcinoma without extrathyroidal extension. On contrast to the US finding which shows the tumor closely attached to the capsule, CT findings revealed the complete parenchymal envelop around the tumor.
Mentions: Although US usually provides critical information in managing the patients with PTC, the US is a subjective and examiner-dependent inconsistent study and shows only 2-dimensional images. Regarding ETE, as observed in previous studies and our data, diagnostic performance is not improved despite technical support and development of US had increased. To overcome these disadvantages, US using shear wave elastography or magnetic resonance imaging has been tried [16, 17]. However, several techniques using US still cannot perfectly assess the ETE preoperatively. Our data showed that the combination of two imaging methods might increase PPV of ETE. CT scan can overcome the disadvantages of US, such as 2-dimensional image and examiner dependency. Moreover, CT scan can provide information of the tumor status in neutral position; in contrast, the US probe could compress the patient's neck and may slightly distort the normal parenchyma around tumor. The thyroid gland is a compressible organ; therefore, external compression, by the probe of the US, can make the thyroid parenchyma thinner, especially when the thyroid is pressed between the malignant tumor and strap muscles. The distorted, thinner thyroid can misinform the physician about the actual proximity of the tumor and thyroid capsule. As shown in Figure 3, false positive findings occurring by US alone could be decreased if evaluated in combination with information from CT scans.

Bottom Line: Methods.Results.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, Republic of Korea.

ABSTRACT
Objectives. The aim of the present study was to evaluate the value of high-resolution ultrasound (US) and computed tomography (CT) scan for preoperative prediction of the extrathyroidal extension (ETE). Methods. We analyzed the medical records of 377 patients with papillary thyroid carcinoma (PTC) with preoperative US and CT scan to calculate the sensitivity, specificity, and positive and negative predictive values of characteristics imaging features (such as contact and disruption of thyroid capsule) for the presence of ETE in postoperative pathologic examination. We also evaluated the diagnostic power for several combinations of US and CT findings. Results. ETE was present in 174 (46.2%) based on pathologic reports. The frequency of ETE was greater in the patients with greater degrees of tumor contact and disruption of capsule, as revealed by both US and CT scans (positive predictive value of 72.2% and 81.8%, resp.). Considering positive predictive values and AUC of US and CT categories, separately or combined, a combination of US and CT findings was most accurate for predicting ETE (83.0%, 0.744). Conclusions. This study suggests that ETE can be predicted most accurately by a combination of categories based on the findings of US and CT scans.

No MeSH data available.


Related in: MedlinePlus