Predictive factors for extrathyroidal extension of papillary thyroid carcinoma based on preoperative sonography.
OBJECTIVE
The purpose of this study was to evaluate the diagnostic performance and predictive factors of extrathyroidal extension of papillary thyroid carcinoma based on preoperative sonography.


METHODS
Preoperative sonography was performed for 568 patients who underwent surgery for papillary thyroid cancer between May 2009 and December 2010. Patients' T stages based on preoperative sonography were compared with their T stages based on pathologic examination, and we statistically analyzed the discriminatory performance of sonography. Among the 568 patients enrolled in this study, we selected 320 patients in whom extrathyroidal extension was suspected on sonography. We analyzed several predictive factors for extrathyroidal extension.


RESULTS
Two hundred seventy-five of the 568 patients were proven to have pathologic extrathyroidal extension of papillary thyroid cancer after surgery (75.9% diagnostic accuracy, 83.3% sensitivity, 68.9% specificity, 71.6% positive predictive value, and 81.5% negative predictive value). Of 320 patients with sonographically suspected extrathyroidal extension, a larger lesion size (P < .001) and a higher lymph node stage on sonography (P = .004) were the best predictors of extrathyroidal extension among the features that we measured. There were no significant differences in terms of the lesion site or thyroid parenchymal background echogenicity. Thyroid capsular protrusion had a higher predictive value than the abutting ratio (P = .001). However, increasing the abutting ratio enabled the prediction of extrathyroidal extension on sonography (P = .009).


CONCLUSIONS
Preoperative sonography is a helpful tool for predicting pathologic extrathyroidal extension of papillary thyroid cancer. In particular, clinicians should focus on the lesion size, nodal stage, and abutment or capsular protrusion of the lesion while performing sonography because these are the most useful predictive factors for extrathyroidal extension.
Department of Radiology, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, Korea. ksj1567@hanmail.net.
Chang Yoon
CY
Lee
Soo Jin
SJ
Kim
Kyung Ran
KR
Ko
Ki-Wook
KW
Chung
Joo-Hyuk
JH
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D002291:Carcinoma, Papillary; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011300:Preoperative Care / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography / Q000706:statistics & numerical data*; D055815:Young Adult
extrathyroidal extension; general ultrasound; predictive factor; preoperative sonography; thyroid cancer