Korean Journal of Radiology

  • 제21권10호
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  • Pages.1187-1195
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  • 2020
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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Sonographic Assessment of the Extent of Extrathyroidal Extension in Thyroid Cancer

  • Sae Rom Chung (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jung Hwan Baek (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Young Jun Choi (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Tae-Yon Sung (Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Dong Eun Song (Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Tae Yong Kim (Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jeong Hyun Lee (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • 투고 : 2019.12.31
  • 심사 : 2020.03.24
  • 발행 : 2020.10.01
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초록

Objective: This study aimed to determine the sonographic features suggestive of extrathyroidal extension (ETE) of thyroid cancers. Materials and Methods: We retrospectively reviewed the sonographic images of 1656 consecutive patients who had undergone thyroidectomy in 2017. The diagnostic performance of sonographic features suggestive of ETE was evaluated using operation and histopathologic reports. Sonographic features for gross ETE to the strap muscle and minor ETE were assessed for thyroid cancer abutting the anterolateral thyroid capsule. Sonographic features for tracheal invasion were assessed according to whether the angle between the tumor and the trachea was an acute, right, or obtuse angle. Sonographic features for recurrent laryngeal nerve (RLN) invasion were assessed based on the association between the tumor and tracheoesophageal groove (TEG) as preserved normal tissue, abutting or protruding into the TEG. Results: ETE was observed in 783 patients (47.3%), including 123 patients with gross ETE (7.4% [strap muscle, n = 97; RLN, n = 24; and trachea, n = 14]) and 660 patients with minor ETE (39.9%). Regarding the diagnosis of gross and minor ETE to the strap muscle, sonographic features of replacement of the strap muscle and capsular disruption showed the highest positive predictive value (75.9% and 58.5%, respectively). Thyroid cancer forming an obtuse angle with the trachea had the highest sensitivity for the diagnosis of tracheal invasion (85.7%), and thyroid cancer protrusion into the TEG showed the highest sensitivity for the diagnosis of RLN (83.3%). Conclusion: Sonography is considered beneficial in the diagnosis of ETE to the strap muscle, trachea, and RLN. Assessment of ETE is important for the accurate staging of thyroid cancer, which in turn determines the extent of surgery or whether active surveillance is appropriate or not.

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참고문헌

  1. Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK, et al. AJCC cancer staging manual, 8th ed. New York: Springer, 2017
  2. Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 2004;136:1310-1322
  3. Randolph GW, Kamani D. The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy. Surgery 2006;139:357-362
  4. Shindo ML, Caruana SM, Kandil E, McCaffrey JC, Orloff LA, Porterfield JR, et al. Management of invasive well-differentiated thyroid cancer: an American Head and Neck Society consensus statement. AHNS consensus statement. Head Neck 2014;36:1379-1390
  5. Hu A, Clark J, Payne RJ, Eski S, Walfish PG, Freeman JL. Extrathyroidal extension in well-differentiated thyroid cancer: macroscopic vs microscopic as a predictor of outcome. Arch Otolaryngol Head Neck Surg 2007;133:644-649
  6. Ortiz S, Rodriguez JM, Soria T, Perez-Flores D, Pinero A, Moreno J, et al. Extrathyroid spread in papillary carcinoma of the thyroid: clinicopathological and prognostic study. Otolaryngol Head Neck Surg 2001;124:261-265
  7. Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, et al. AJCC cancer staging manual, 6th ed. New York: Springer, 2002
  8. Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, et al. Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J Surg 2006;30:780-786
  9. Kim JM, Lee YY, Choi CW, Lim SM, Lee SS, Cho SY, et al. The clinical importance of minimal extrathyroid extension on tumor recurrence in patients with papillary thyroid carcinoma. Endocrinol Metab 2010;25:340-346
  10. Jin BJ, Kim MK, Ji YB, Song CM, Park JH, Tae K. Characteristics and significance of minimal and maximal extrathyroidal extension in papillary thyroid carcinoma. Oral Oncol 2015;51:759-763
  11. Mete O, Rotstein L, Asa SL. Controversies in thyroid pathology: thyroid capsule invasion and extrathyroidal extension. Ann Surg Oncol 2010;17:386-391
  12. Rim JH, Chong S, Ryu HS, Chung BM, Ahn HS. Feasibility study of ultrasonographic criteria for microscopic and macroscopic extra-thyroidal extension based on thyroid capsular continuity and tumor contour in patients with papillary thyroid carcinomas. Ultrasound Med Biol 2016;42:2391-2400
  13. Ito Y, Miyauchi A, Oda H, Kobayashi K, Kihara M, Miya A. Revisiting low-risk thyroid papillary microcarcinomas resected without observation: was immediate surgery necessary? World J Surg 2016;40:523-528
  14. Arora N, Turbendian HK, Scognamiglio T, Wagner PL, Goldsmith SJ, Zarnegar R, et al. Extrathyroidal extension is not all equal: implications of macroscopic versus microscopic extent in papillary thyroid carcinoma. Surgery 2008;144:942-947; discussion 947-948
  15. Jung SP, Kim M, Choe JH, Kim JS, Nam SJ, Kim JH. Clinical implication of cancer adhesion in papillary thyroid carcinoma: clinicopathologic characteristics and prognosis analyzed with degree of extrathyroidal extension. World J Surg 2013;37:1606-1613
  16. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1-133
  17. Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014;81 Suppl 1:1-122
  18. National Comprehensive Cancer Network®. NCCN clinical practice guidelines in oncology (NCCN guidelines®). Thyroid carcinoma, Version 1. NCCN, 2017. Available at: http://www.klinikum.uni-muenchen.de/Schilddruesenzentrum/download/inhalt/Leitlinien/NCCN/thyroid_2017.pdf. Accessed August 5, 2019
  19. Kamaya A, Tahvildari AM, Patel BN, Willmann JK, Jeffrey RB, Desser TS. Sonographic detection of extracapsular extension in papillary thyroid cancer. J Ultrasound Med 2015;34:2225-2230
  20. Kim H, Kim JA, Son EJ, Youk JH, Chung TS, Park CS, et al. Preoperative prediction of the extrathyroidal extension of papillary thyroid carcinoma with ultrasonography versus MRI: a retrospective cohort study. Int J Surg 2014;12:544-548
  21. Kwak JY, Kim EK, Youk JH, Kim MJ, Son EJ, Choi SH, et al. Extrathyroid extension of well-differentiated papillary thyroid microcarcinoma on US. Thyroid 2008;18:609-614
  22. Moon SJ, Kim DW, Kim SJ, Ha TK, Park HK, Jung SJ. Ultrasound assessment of degrees of extrathyroidal extension in papillary thyroid microcarcinoma. Endocr Pract 2014;20:1037-1043
  23. Shin JH, Ha TK, Park HK, Ahn MS, Kim KH, Bae KB, et al. Implication of minimal extrathyroidal extension as a prognostic factor in papillary thyroid carcinoma. Int J Surg 2013;11:944-947
  24. Song E, Lee YM, Oh HS, Jeon MJ, Song DE, Kim TY, et al. A relook at the T stage of differentiated thyroid carcinoma with a focus on gross extrathyroidal extension. Thyroid 2019;29:202-208
  25. Sturniolo G, D'Alia C, Tonante A, Gagliano E, Taranto F, Lo Schiavo MG. The recurrent laryngeal nerve related to thyroid surgery. Am J Surg 1999;177:485-488
  26. Miyauchi A, Ito Y. Conservative surveillance management of low-risk papillary thyroid microcarcinoma. Endocrinol Metab Clin North Am 2019;48:215-226
  27. Brito JP, Ito Y, Miyauchi A, Tuttle RM. A clinical framework to facilitate risk stratification when considering an active surveillance alternative to immediate biopsy and surgery in papillary microcarcinoma. Thyroid 2016;26:144-149