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Thyroid Cancers with Benign-Looking Sonographic Features Have Different Lymph Node Metastatic Risk and Histologic Subtypes According to Nodule Size
- 作者:Dong Yeob Shin (1) (2)
Young Ki Lee (1) Kwang Joon Kim (1) (3) Kyeong Hye Park (1) (3) Sena Hwang (1) (4) Se Hee Park (1) Eun-Kyung Kim (5) Hyeong Ju Kwon (6) Eun Jig Lee (1)
- 关键词:Thyroid cancers ; Papillary thyroid carcinoma ; Lymph node metastasis ; Ultrasonography ; Microcarcinoma
- 刊名:Endocrine Pathology
- 出版年:2014
- 出版时间:December 2014
- 年:2014
- 卷:25
- 期:4
- 页码:378-384
- 全文大小:608 KB
- 参考文献:1. Lee SW, Lee HJ, Kim HJ, et al. Combined categorical reporting systems of US and cytology findings for thyroid nodules: guidance on repeat fine-needle aspiration cytology. Radiology 266:956-3, 2013. doi:10.1148/radiol.12112710 . CrossRef
2. Kwak JY, Jung I, Baek JH, et al. Image reporting and characterization system for ultrasound features of thyroid nodules: multicentric Korean retrospective study. Korean J Radiol 14:110-, 2013. doi:10.3348/kjr.2013.14.1.110 . CrossRef 3. Gharib H, Papini E, Valcavi R, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 12:63-02, 2006. CrossRef 4. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167-14, 2009. doi:10.1089/thy.2009.0110 . CrossRef 5. Frates MC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 237:794-00, 2005. doi:10.1148/radiol.2373050220 . CrossRef 6. Gharib H, Papini E, Paschke R, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and EuropeanThyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract 16 Suppl 1:1-3, 2010. doi:10.4158/10024.GL . 7. Yu XM, Wan Y, Sippel RS, Chen H. Should all papillary thyroid microcarcinomas be aggressively treated? An analysis of 18,445 cases. Ann Surg 254:653-0, 2011. doi:10.1097/SLA.0b013e318230036d . CrossRef 8. Hay ID, Grant CS, van Heerden JA, Goellner JR, Ebersold JR, Bergstralh EJ. Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery 112:1139-6; discussion 46-, 1992. 9. Baudin E, Travagli JP, Ropers J, et al. Microcarcinoma of the thyroid gland: the Gustave-Roussy Institute experience. Cancer 83:553-, 1998. CrossRef 10. Sugitani I, Fujimoto Y. Symptomatic versus asymptomatic papillary thyroid microcarcinoma: a retrospective analysis of surgical outcome and prognostic factors. Endocr J 46:209-6, 1999. CrossRef 11. Noguchi S, Yamashita H, Murakami N, Nakayama I, Toda M, Kawamoto H. Small carcinomas of the thyroid. A long-term follow-up of 867 patients. Arch Surg 131:187-1, 1996. CrossRef 12. Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery 104:947-3, 1988. 13. Nam SY, Shin JH, Han BK, et al. Preoperative ultrasonographic features of papillary thyroid carcinoma predict biological behavior. J Clin Endocrinol Metab 98:1476-2, 2013. doi:10.1210/jc.2012-4072 . CrossRef 14. Kim EK, Park CS, Chung WY, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 178:687-1, 2002. doi:10.2214/ajr.178.3.1780687 . CrossRef 15. Watters DA, Ahuja AT, Evans RM, et al. Role of ultrasound in the management of thyroid nodules. Am J Surg 164:654-, 1992. - 作者单位:Dong Yeob Shin (1) (2)
Young Ki Lee (1) Kwang Joon Kim (1) (3) Kyeong Hye Park (1) (3) Sena Hwang (1) (4) Se Hee Park (1) Eun-Kyung Kim (5) Hyeong Ju Kwon (6) Eun Jig Lee (1)
1. Division of Endocrinology and Metabolism, Departments of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea 2. Department of Medicine, The Graduate School, Yonsei University College of Medicine, Seoul, South Korea 3. Severance Executive Healthcare Clinic, Yonsei University Health System, Seoul, South Korea 4. International Health Care Center, Severance Hospital, Yonsei University Health System, Seoul, South Korea 5. Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea 6. Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea
- ISSN:1559-0097
文摘
A decision to perform fine needle aspiration (FNA) on thyroid nodules mainly depends on sonographic features. We investigated if lymph node metastasis (LNM) risk differed by tumor size of thyroid cancers without suspicious sonographic features. Three hundred sixty patients with thyroid cancers with benign looking sonographic features were grouped by nodule size on ultrasonography (US) (?or >1?cm). The clinicopathologic parameters were compared between the groups. A multivariate analysis was performed to discover the independent factors predicting the presence of LNM. The nodules greater than 10?mm on US (n--57) demonstrated a larger tumor size on histology (17.9?±-4.5 vs. 5.6?±-.4?mm, P--.001), a lower frequency of classical papillary thyroid carcinoma (PTC) (58.6 vs. 87.2?%, P--.001), and a higher frequency of follicular variant PTC and follicular thyroid carcinoma (19.7 and 17.8?% vs. 9.4 and 1.5?%, respectively, P--.01). In subgroup analysis of 269 patients with classical PTC, the larger nodule size on US was associated with a higher prevalence of LNM (28.3 vs. 14.7?%, P--.007). A multivariate analysis revealed that classical PTC, extrathyroidal extension, and the US nodule size >10?mm were independent predictive factors of LNM after adjusting for age, sex, TSH level, and multifocality. Thyroid cancers larger than 10?mm with benign US features are more likely to be nonclassical PTC than those with smaller diameters. The larger ones also have an increased risk of LNM in classical PTC. These cases require a more aggressive approach to FNA.
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