Can preoperative ultrasound predict extrathyroidal extension of differentiated thyroid cancer?

in European Journal of Endocrinology
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  • 1 L Lamartina, Department of Endocrine Oncology and Nuclear Medicine, Gustave Roussy, Villejuif, France
  • 2 S Bidault, Département d’Imagerie médicale, Gustave Roussy, Villejuif, France
  • 3 J Hadoux, Department of Endocrine Oncology and Nuclear Medicine, Gustave Roussy, Villejuif, France
  • 4 J Guerlain, Département de Chirurgie, Gustave Roussy, Villejuif, France
  • 5 E Girard, Département d’Imagerie médicale, Gustave Roussy, Villejuif, France
  • 6 I Breuskin, Surgery, Gustave Roussy, Villejuif, France
  • 7 M Attard, Département d’Imagerie médicale, Gustave Roussy, Villejuif, France
  • 8 V Suciu, Département de Biologie et Pathologie Médicales, Gustave Roussy, Villejuif, France
  • 9 E Baudin, Nuclear Medicine and Endocrine Oncology, Gustave Roussy Cancer Center, Villejuif, France
  • 10 A Al Ghuzlan, Médecine Nucléaire et Cancérologie Endocrinienne, Gustave Roussy, Villejuif, France
  • 11 S Leboulleux, médecine nucléaire et cancérologie endocrinienne, Institut Gustave Roussy, Villejuif, France
  • 12 D Hartl, Surgery, Gustave Roussy, Villejuif, France

Correspondence: Livia Lamartina, Email: livia.lamartina@gustaveroussy.fr

Objective

The presence of extrathyroidal extension (ETE) is generally considered an indication for total thyroidectomy for differentiated thyroid cancer. The accuracy of neck ultrasound for the diagnosis of ETE is controversial. The aim of this study was to assess the diagnostic accuracy of preoperative ultrasound evaluation of ETE.

Methods

Retrospective and observational study of consecutive patients operated between 2016 and 2019 for cytologically suspicious or indeterminate thyroid nodules. US images obtained preoperatively were retrospectively reviewed to identify signs of minimal or gross ETE. Histology was considered the gold standard for diagnosis of ETE. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of US were evaluated.

Results

A cohort of 305 patients (75% females, median age 48 years) with 378 nodules (median size 18 mm) was studied. Seventy-five percent of the nodules (n=228) were malignant on histology and ETE was present in 106 cases (28%): 83 minimal ETE and 23 gross ETE. Suspicion of minimal ETE on preoperative ultrasound was found in 50 (13%) with a sensitivity of 30%, a specificity of 93%, a PPV 62% and a NPV of 78%, with an accuracy of 76%. Gross ETE on ultrasound was found in 19 (5%) nodules with a sensitivity of 78%, a specificity of 99.7% a PPV 94.7% an NPV of 98.6% and an accuracy of 98%.

Conclusions

Preoperative US is very specific and accurate in diagnosing gross ETE which impacts the extent of initial surgery for thyroid cancers.

 

     European Society of Endocrinology