ETA2024 Poster Presentations Diagnosis of thyroid cancer-2 (11 abstracts)
Predicting extrathyroidal extension (ETE) of differentiated thyroid carcinoma (DTC) preoperatively by using ultrasonography (US)
Adile Begum Bahcecioglu 1 , Fatma Avcı Merdin 2 , Ozge Bas Aksu 3 , Serpil Dizbay Sak 4 , Neşe Ersöz Gülçelik 5 , Sevim Gullu 6 & Murat Faik Erdoğan 2
1University of Health Sciences, Gülhane Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey; 2Ankara University School of Medicine, Endocrinology and Metabolism, Turkey; 3Ankara University, Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey; 4Ankara University School of Medicine, Pathology, Turkey; 5University of Health Sciences, Gulhane Training and Research Hospital, Endocrinology and Metabolism, Turkey; 6Ankara University Faculty of Medicine, Faculty of Medicine, Endocrinology and Metabolic Disorders, Ankara, Turkey
Objective: Neck US is essential in the preoperative endocrinological evaluation of malignant thyroid nodules and determining surgical approach. Extrathyroidal extension (ETE) in DTC is a significant risk factor for recurrence. Our study aim is to assess ultrasonographic features predicting minor ETE.
Method: In our two-center prospective study, we recorded US videos of DTC nodules adjacent to the capsule, with no thyroid parenchyma between the capsule. Experienced sonographers evaluated these videos for ETE-related sonographic characteristics (ERSC) blindly to pathology results. The relationship between these features and ETE presence was evaluated.
Results: Mean age of the study group was 45±14 years, mean nodule diameter was 14.3 ± 9.7 mm. ETE was found in 17 out of 140 DTC nodules (12%)., Eighty-nine percent of nodules were papillary thyroid carcinoma (PTC), with 76% of these being classic subtype PTC. Six nodules had non-invasive follicular thyroid neoplasm with papillary-like nuclear features, six had invasive encapsulated follicular variant papillary carcinoma, and three had follicular carcinoma. The frequencies of ERSC and their association with ETE presence are detailed in Table 1.
| ETE-related sonographic characteristics | ETE positive nodules (n = 17) | ETE negative nodules (n = 123) | P | PPV | NPV | Sensitive % | Specificity % | Diagnostic Accuracy % |
| Capsular disruption | 13 (77%) | 5 (4%) | <0.001 | 72% | 97% | 77% | 96% | 94% |
| Contour bulging | 11 (65%) | 38 (31%) | 0.006 | 22% | 93% | 65% | 70% | 69% |
| Nodule vascularity extending beyond the thyroid capsule | 3 (18%) | 1 (0.8%) | <0.001 | 75% | 90% | 18% | 99% | 89% |
| Ratio of contact area with adjacent capsule (contact diameter/nodule diameter) | <12.5%: 0 12.5-25% : 8 (47%) 25-37.5%: 6 (35%) >50%: 3 (18%) | <12.5%: 19 (14%) 12.5-25% : 63 (51%) 25-37.5%: 36 (29%) >50%: 5 (4%) | 0.0053 | 18%* | 92%* | 18%* | 96%* | %86* |
| Replacement of adjacent strap muscle | 9 (53%) | 1 (0.8%) | <0.001 | 90% | 94% | 53% | 99% | 94% |
| ETE: extrathyroidal extension, PPV: positive predictive value, NPV: negative predictive value *results of the ratio of the contact area with the adjacent capsule being >50%. | ||||||||
Conclusion: It has been determined that the features with the highest PPV for detecting ETE during US, are replacement of adjacent anterior neck muscles and vascularity of nodules extending beyond the thyroid capsule. The ratio of contact area with the adjacent capsule and contour bulging are the features with the lowest PPV. The highest NPV and the highest diagnostic accuracy were observed in capsular discontinuity and replacement of adjacent anterior neck muscles.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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