Differential Diagnostic Ultrasound Criteria of Papillary and Follicular Carcinomas: A Multivariate Analysis

Abstract

Purpose: The purpose of the study was to test the hypothesis that papillary thyroid carcinomas (PTCs) and follicular thyroid carcinomas (FTCs) appear with different ultrasound characteristics.

Material and Methods: 90 patients (70 females, 20 males) were included in the study in whom after thyroidectomy the diagnoses of PTCs or FTCs were established. 33 patients (25 females, 8 males) with the diagnosis of follicular adenoma were included in the study as controls (KONs). All patients had ultrasound examinations of the thyroid preoperatively. These ultrasound examinations were evaluated retrospectively with respect to the ultrasound characteristics: “size”, “shape”, “contour”, “structure”, “echogenicity” and “calcifications”.

Results: In PTCs, FTCs and KONs “size” was significantly different (PTCs: MW = 12.5 mm, SD = 8.1 mm – FTCs: MW = 35.4 mm, SD = 19.6 mm – KONs: MW = 22.7 mm, SD = 14.5 mm; p < 0.001 for PTCs vs. FTCs, p < 0.001 for PTCs vs. KONs, p = 0.013 for FTCs vs. KONs). Differences were also found with respect to “contour” and “echogenicity” among PTCs, FTCs and KONs (p ≤ 0.035). The parameters “size”, “contour”, “echogenicity” and “calcifications” correlated for PTCs, FTCs and KONs with a correlation coefficient r = 0.57 (p < 0.05, multivariate regressionanalysis).

Conclusions: PTCs and FTCs appear with different sonographic characteristics. Although there is some overlapping of the sonographic appearances of PTCs and FTCs, the knowledge of these differences should have some impact of the risk adapted further work up.

Key Points:

• In preoperative ultrasound examinations FTCs appear significantly larger than PTCs.

• The sonographically detected structure of FTCs can be classified as inhomogeneous predominantly, whilst PTCs are equally homogeneous or inhomogeneous.

• The knowledge of the different sonographic appearance of PTCs and FTCs is of importance within the context of risk-adapted further work-up.

Citation Format:

• Cordes M, Kondrat P, Uder M et al. Differential Diagnostic Ultrasound Criteria of Papillary and Follicular Carcinomas: A Multivariate Analysis. Fortschr Röntgenstr 2014; 186: 489 – 495

Zusammenfassung

Ziel: In der vorliegenden Arbeit sollte die Hypothese überprüft werden, dass sich papilläre Schilddrüsenkarzinome (PTCs) von follikulären Schilddrüsenkarzinomen (FTCs) bezüglich ihrer Ultraschallcharakteristika unterscheiden.

Material und Methoden: Untersucht wurden 90 Patienten (70 weiblich, 20 männlich), bei denen nach Thyreoidektomie histologisch die Diagnosen von PTCs oder FTCs gestellt wurde. Als Kontrollen (KONs) dienten 33 Patienten (25 weiblich, 8 männlich) mit einem follikulärem Adenom. Hochauflösende Ultraschalluntersuchungen erfolgten präoperativ mit Erfassung der Ultraschallcharakteristika: „Größe“, „Form“, „Kontur“, „Binnenstruktur“, „Echogenität“ und „Kalzifikationen“.

Ergebnisse: PTCs, FTCs und KONs unterschieden sich hinsichtlich „Größe“ (PTCs: MW = 12,5 mm, SD = 8,1 mm – FTCs: MW = 35,4 mm, SD = 19,6 mm – KONs: MW = 22,7 mm, SD = 14,5 mm; p < 0,001 für PTCs vs. FTCs, p < 0,001 für PTCs vs. KONs, p = 0,013 für FTCs vs. KONs). Auch im Hinblick auf „Kontur“ und „Echogenität“ konnten Unterschiede zwischen PTCs, FTCs und KONs gefunden werden (p ≤ 0,035). „Größe“, „Kontur“, „Echogenität“ und „Kalk“ ergaben für PTCs, FTCs und KONs einen Korrelationskoeffizienten r = 0,57 (p < 0,05, multiple Regressionsanalyse).

Schlussfolgerungen: Hinsichtlich ihres sonografischen Erscheinungsbildes gibt es Unterschiede zwischen PTCs und FTCs. Wenngleich große Überlappungen vorkommen können, erscheint die Kenntnis der Unterschiede im sonografischen Erscheinungsbild für eine risikoadaptierte Abklärungsdiagnostik von Bedeutung.

Key words

thyroid carcinoma - papillary thyroid carcinoma - follicular thyroid carcinoma - ultrasound

• References

• 1 Robert Koch Institut (ed.) Krebs in Deutschland 2005/2006. Häufigkeiten und Trends. Berlin: Westkreuz Druckerei; 2010
• 2 Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 2006; 295: 2164-2167
• 3 Hegedüs L. Thyroid ultrasound. Endocrinol Metab Clin North Am 2001; 30: 339-360
• 4 Solbiati L, Volterrani L, Rizzatto G et al. The thyroid gland with low uptake lesions: evaluation by ultrasound. Radiology 1985; 155: 187-191
• 5 Kim DW, Kim SH, Jung SJ. Successful sonography-guided fine-needle aspiration Biopsy of a 1-millimeter-diameter papillary thyroid microcarcinoma. AJNR 2010; 31: 1082-1084
• 6 Frates MC, Benson CB, Charboneau JW et al. Management of thyroid nodules detected at US: Society of Radiologists in US consensus conference statement. Radiology 2005; 237: 794-800
• 7 Moon WJ, Jung SL, Lee JH et al. Benign and malignant thyroid nodules: US differentiation-multicenter retrospective study. Radiology 2008; 247: 762-770
• 8 Hamburger JL. Diagnosis of thyroid nodules by fine needle biopsy: use and abuse. Journ Clin Endocrinology Metab 1994; 79: 335-339
• 9 Sugino K, Ito K, Nagahama M et al. Diagnostic accuracy of fine needle aspiration biopsy cytology and ultrasonography in patients with thyroid nodules diagnosed as benign or indeterminate before thyroidectomy. Endocr J 2013; 60: 375-382
• 10 Yeung MJ, Serpell JW. Management of the solitary thyroid nodule. The Oncologist 2008; 13: 105-112
• 11 Aschebrook-Kilfoy B, Grogan R, Ward M et al. Follicular thyroid cancer incidence patterns in the United States, 1980–2009. Thyroid 2013; 23: 1015-1021
• 12 Verburg FA, Mäder U, Luster M et al. Histology does not influence prognosis in differentiated thyroid carcinoma when accounting for age, tumour diameter, invasive growth and metastases. Europ Journ of Endocrinology 2009; 160: 619-624
• 13 Surveillance, Epidemiology and End Results (SEER) Program. Public – use database (1973–2009). Cancer Statistics Branch 2011; 1: 27
• 14 Greco A, Borrello MG, Miranda C et al. Molecular pathology of differentiated thyroid cancer. Q J Nucl Med Mol Imaging 2009; 53: 440-454
• 15 Zhu C, Zheng T, Kilfoy B et al. A birth cohort analysis of the incidence of papillary thyroid cancer in the United States 1973–2004. Thyroid 2009; 19: 1061-1066
• 16 Kamran SC, Marqusee E, Kim MI et al. Thyroid nodule size and prediction of cancer. J Clin Endrocrinol Metab 2013; 89: 564-570
• 17 Krause K, Prawitt S, Eszlinger M et al. Dissecting molecular events in thyroid neoplasia provides evidence for distinct evolution of follicular thyroid adenoma and carcinoma. Am Journ Path 2011; 179: 3066-3073
• 18 Eze O, Starker L, Carling T. The role of alterations in papillary thyroid carcinogenesis. Journ of Thyroid Res 2011; 2011: 895470
• 19 Popowicz B, Klencki M, Lewinski A et al. The usefulness of sonographic features in selection of thyroid nodules for biopsy in relation to the nodule’s size. Europ Journ of Endocrinology 2009; 161: 103-111
• 20 Horvath E, Majlis S, Rossi R et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab 2009; 90: 1748-1751
• 21 Watkinson JC. Fifteen years’ experience in thyroid surgery. Ann R Coll Surg Engl 2010; 92: 541-547
• 22 Paschke R. Abklärung des euthyreoten Schilddrüsenknotens: wann punktieren? Stellenwert der Sonographie. Dtsch Med Wochenschr 2009; 134: 2498-2503