Application of Ultrasonography in the Diagnosis and Management of Papillary Thyroid Microcarcinoma

doi:10.37015/AUDT.2020.200001

Abstract

Abstract:

Thyroid carcinoma is the most common malignant tumor of the endocrine system. Nearly 90% of thyroid carcinomas are papillary type, of which many are thyroid papillary microcarcinoma (PTMC) with a maximum diameter≤1 cm. Highresolution ultrasound imaging plays an important role in evaluating PTMC and guiding biopsy for pathology as well as appropriate treatment. This review paper discusses the ultrasonography features of PTMC and explores the clinical value of ultrasonography with gene testing in the diagnosis and management of PTMC.

Key words: Thyroid; Papillary thyroid microcarcinoma; Ultrasonography; Gene; Diagnosis; Treatment

Kun Huang, MD, Ji-Bin Liu, MD. Application of Ultrasonography in the Diagnosis and Management of Papillary Thyroid Microcarcinoma. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(4): 284-290.

References

[1]	Xu D, Lv X, Wang S, Dai W. Risk factors for predicting central lymph node metastasis in papillary thyroid microcarcinoma. Int J Clin Exp Pathol 2014; 7:6199-205.
[2]	Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the united states, 1988-2005. Cancer 2009; 115:3801-7.
[3]	Davies L, Welch HG. Increasing incidence of thyroid cancer in the united states, 1973-2002. JAMA 2006; 295:2164-7.
[4]	Lim YC, Choi EC, Yoon YH, Kim EH, Koo BS. Central lymph node metastases in unilateral papillary thyroid microcarcinoma. Br J Surg 2009; 96:253-7.
[5]	Mercante G, Frasoldati A, Pedroni C, Formisano D, Renna L, Piana S, et al. Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: Results of a study in 445 patients. Thyroid 2009; 19:707-16.
[6]	Lombardi CP, Bellantone R, De Crea C, Paladino NC, Fadda G, Salvatori M, et al. Papillary thyroid microcarcinoma: Extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goiter area. World J Surg 2010; 34:1214-21.
[7]	Xu YH, Song HJ, Qiu ZL, Luo QY. Brain metastases with exceptional features from papillary thyroid carcinoma: Report of three cases. Hell J Nucl Med 2011; 14:56-9.
[8]	Varsavsky M, Cortes Berdonces M, Alonso G, Garcia Martin A, Munoz Torres M. Metastatic adenopathy from a thyroid microcarcinoma: Final diagnosis of a presumed paraganglioma. Endocrinol Nutr 2011; 58:143-4.
[9]	Huang XP, Ye TT, Zhang L, Liu RF, Lai XJ, Wang L, et al. Sonographic features of papillary thyroid microcarcinoma predicting high-volume central neck lymph node metastasis. Surg Oncol 2018; 27:172-76.
[10]	Ferris RL, Baloch Z, Bernet V, Chen A, Fahey TJ, 3rd, Ganly I , et al. American thyroid association statement on surgical application of molecular profiling for thyroid nodules: Current impact on perioperative decision making. Thyroid 2015; 25:760-8.
[11]	Kwak JY, Kim EK, Chung WY, Moon HJ, Kim MJ, Choi JR. Association of brafv600e mutation with poor clinical prognostic factors and us features in korean patients with papillary thyroid microcarcinoma. Radiology 2009; 253:854-60.
[12]	Sobin LH. Histological typing of thyroid tumours. Histopathology 1990; 16:513.
[13]	Zhao Z, Zhao Z, Ma J, Jing S. Clinical significance of ultrasonography in the diagnosis of central clearing of papillary thyroid carcinoma. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 29:538-41.
[13]	[In Chinese]
[14]	Hou CJ, Wei R, Tang JL, Hu QH, He HF, Fan XM. Diagnostic value of ultrasound features and sex of fetuses in female patients with papillary thyroid microcarcinoma. Sci Rep 2018; 8:7510.
[15]	Ma HJ, Yang JC, Leng ZP, Chang Y, Kang H, Teng LH. Preoperative prediction of papillary thyroid microcarcinoma via multiparameter ultrasound. Acta Radiol 2017; 58:1303-11.
[16]	Huang K, Gao N, Zhai Q, Bian D, Wang D, Wang X. The anteroposterior diameter of nodules in the risk assessment of papillary thyroid microcarcinoma. Medicine (Baltimore) 2018; 97:e9712.
[17]	Y Wang, LY Gao, YX Jiang, H Pan, J Zhao, X Zhou, et al. Image features-based learning effectively improves inter-observer agreement for beginners in evaluating thyroid nodule with ultrasound. Advanced Ultrasound in Diagnosis and Therapy 2019; 3:1-5.
[18]	JJ Liu, LP Liu, YJ Zhang, YF Zhao, YH Hao, TT Li, et al. Analysis of characteristics microvessel density of thyroid malignant and benign nodules on contrast-enhanced ultrasonography. Advanced Ultrasound in Diagnosis and Therapy 2018; 2:167-72.
[19]	Zhan J, Ding H. Application of contrast-enhanced ultrasound for evaluation of thyroid nodules. Ultrasonography 2018; 37:288-97.
[20]	Ma JJ, Ding H, Xu BH, Xu C, Song LJ, Huang BJ, et al. Diagnostic performances of various gray-scale, color doppler, and contrast-enhanced ultrasonography findings in predicting malignant thyroid nodules. Thyroid 2014; 24:355-63.
[21]	Chen L, Chen L, Liu J, Nong L, Zhang H. The association among quantitative contrast-enhanced ultrasonography features, thyroid imaging reporting and data system and braf v600e mutation status in patients with papillary thyroid microcarcinoma. Ultrasound Q 2019; 35:228-32.
[22]	Liu Q, Cheng J, Li J, Gao X, Li H. The diagnostic accuracy of contrast-enhanced ultrasound for the differentiation of benign and malignant thyroid nodules: A prisma compliant meta-analysis. Medicine (Baltimore) 2018; 97:e13325.
[23]	Yu D, Han Y, Chen T. Contrast-enhanced ultrasound for differentiation of benign and malignant thyroid lesions: Meta-analysis. Otolaryngol Head Neck Surg 2014; 151:909-15.
[24]	Zhang B, Jiang YX, Liu JB, Yang M, Dai Q, Zhu QL, et al. Utility of contrast-enhanced ultrasound for evaluation of thyroid nodules. Thyroid 2010; 20:51-7.
[25]	Hong YR, Yan CX, Mo GQ, Luo ZY, Zhang Y, Wang Y, et al. Conventional us, elastography, and contrast enhanced us features of papillary thyroid microcarcinoma predict central compartment lymph node metastases. Sci Rep 2015; 5:7748.
[26]	Chen HY, Liu WY, Zhu H, Jiang DW, Wang DH, Chen Y, et al. Diagnostic value of contrast-enhanced ultrasound in papillary thyroid microcarcinoma. Exp Ther Med 2016; 11:1555-62.
[27]	Xing M, Westra WH, Tufano RP, Cohen Y, Rosenbaum E, Rhoden KJ, et al. Braf mutation predicts a poorer clinical prognosis for papillary thyroid cancer. J Clin Endocrinol Metab 2005; 90:6373-9.
[28]	Min HS, Lee C, Jung KC. Correlation of immunohistochemical markers and braf mutation status with histological variants of papillary thyroid carcinoma in the korean population. J Korean Med Sci 2013; 28:534-41.
[29]	Davies H, Bignell GR, Cox C, Stephens P, Edkins S, Clegg S, et al. Mutations of the braf gene in human cancer. Nature 2002; 417:949-54.
[30]	DeLuca AM, Srinivas A, Alani RM. Braf kinase in melanoma development and progression. Expert Rev Mol Med 2008; 10:e6.
[31]	Kim TH, Park YJ, Lim JA, Ahn HY, Lee EK, Lee YJ, et al. The association of the braf(v600e) mutation with prognostic factors and poor clinical outcome in papillary thyroid cancer: A meta-analysis. Cancer 2012; 118:1764-73.
[32]	Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised american thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19:1167-214.
[33]	Yoon JH, Kim EK, Moon HJ, Kwak JY. Is follow-up braf(v600e) mutation analysis helpful in the differential diagnosis of thyroid nodules with negative results on initial analysis? PLoS One 2013; 8:e58592.
[34]	Chen B, Zhang Z, Wang K, Shang M, Zhao S, Ding W, et al. Association of brafv600e mutation with ultrasonographic features and clinicopathologic characteristics of papillary thyroid microcarcinoma: A retrospective study of 116 cases. Clin Hemorheol Microcirc 2019; 73:545-52.
[35]	Kim SJ, Myong JP, Jee HG, Chai YJ, Choi JY, Min HS, et al. Combined effect of hashimoto's thyroiditis and braf(v600e) mutation status on aggressiveness in papillary thyroid cancer. Head Neck 2016; 38:95-101.
[36]	Zheng X, Peng C, Gao M, Zhi J, Hou X, Zhao J, et al. Risk factors for cervical lymph node metastasis in papillary thyroid microcarcinoma: A study of 1,587 patients. Cancer Biol Med 2019; 16:121-30.
[37]	Pyo JS, Sohn JH, Kang G. Detection of tumor multifocality is important for prediction of tumor recurrence in papillary thyroid microcarcinoma: A retrospective study and meta-analysis. J Pathol Transl Med 2016; 50:278-86.
[38]	Jeon MJ, Chung MS, Kwon H, Kim M, Park S, Baek JH, et al. Features of papillary thyroid microcarcinoma associated with lateral cervical lymph node metastasis. Clin Endocrinol (Oxf) 2017; 86:845-51.
[39]	Zhang X, Zhang L, Xue S, Wang P, Chen G. Predictive factors of lateral lymph node metastasis in solitary papillary thyroid microcarcinoma without gross extrathyroidal extension. Asian J Surg 2019; 42:563-70.
[40]	Back K, Kim JS, Kim JH, Choe JH. Superior located papillary thyroid microcarcinoma is a risk factor for lateral lymph node metastasis. Ann Surg Oncol 2019; 26:3992-4001.
[41]	Kim MH, Bae JS, Lim DJ, Lee H, Jeon SR, Park GS, et al. Quantification of braf v600e alleles predicts papillary thyroid cancer progression. Endocr Relat Cancer 2014; 21:891-902.
[42]	Guo L, Ma YQ, Yao Y, Wu M, Deng ZH, Zhu FW, et al. Role of ultrasonographic features and quantified brafv600e mutation in lymph node metastasis in chinese patients with papillary thyroid carcinoma. Sci Rep 2019; 9:75.
[43]	Xing M, Alzahrani AS, Carson KA, Viola D, Elisei R, Bendlova B, et al. Association between braf v600e mutation and mortality in patients with papillary thyroid cancer. JAMA 2013; 309:1493-501.
[44]	Miccoli P, Basolo F. Braf mutation status in papillary thyroid carcinoma: Significance for surgical strategy. Langenbecks Arch Surg 2014; 399:225-8.
[45]	Hay ID, Hutchinson ME, Gonzalez-Losada T, McIver B, Reinalda ME, Grant CS, et al. Papillary thyroid microcarcinoma: A study of 900 cases observed in a 60-year period. Surgery 2008; 144 980-987.
[46]	Baudin E, Travagli JP, Ropers J, Mancusi F, Bruno-Bossio G, Caillou B, et al. Microcarcinoma of the thyroid gland: The gustave-roussy institute experience. Cancer 1998; 83:553-9.
[47]	Tuttle RM, Tala H, Shah J, Leboeuf R, Ghossein R, Gonen M, et al. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: Using response to therapy variables to modify the initial risk estimates predicted by the new american thyroid association staging system. Thyroid 2010; 20:1341-9.
[48]	Pelttari H, Laitinen K, Schalin-Jantti C, Valimaki MJ. Long-term outcome of 495 tnm stage I or II patients with differentiated thyroid carcinoma followed up with neck ultrasonography and thyroglobulin measurements on t4 treatment. Clin Endocrinol (Oxf) 2008; 69:323-31.
[49]	Yoon JH, Kim JY, Moon HJ, Youk JH, Son EJ, Kim EK, et al. Contribution of computed tomography to ultrasound in predicting lateral lymph node metastasis in patients with papillary thyroid carcinoma. Ann Surg Oncol 2011; 18:1734-41.
[50]	Nixon IJ, Ganly I, Patel SG, Palmer FL, Whitcher MM, Tuttle RM, et al. Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy. Surgery 2012; 151:571-9.
[51]	Durante C, Attard M, Torlontano M, Ronga G, Monzani F, Costante G, et al. Identification and optimal postsurgical follow-up of patients with very low-risk papillary thyroid microcarcinomas. J Clin Endocrinol Metab 2010; 95:4882-8.
[52]	Pedrazzini L, Baroli A, Marzoli L, Guglielmi R, Papini E. Cancer recurrence in papillary thyroid microcarcinoma: A multivariate analysis on 231 patients with a 12-year follow-up. Minerva Endocrinol 2013; 38:269-79.
[53]	Ito Y, Miyauchi A, Kihara M, Higashiyama T, Kobayashi K, Miya A. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid 2014; 24:27-34.
[54]	Ito Y, Miyauchi A, Inoue H, Fukushima M, Kihara M, Higashiyama T, et al. An observational trial for papillary thyroid microcarcinoma in japanese patients. World J Surg 2010; 34:28-35.
[55]	Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994; 97:418-28.
[56]	Shin DY, Kim KJ, Chang S, Kim H, Hwang S, Kim W, et al. Follicular variant of papillary thyroid carcinoma with b-type raf(v600e) showing higher frequency of suspicious sonographic features and multifocality. Head Neck 2015; 37:1590-5.
[57]	Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: Frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg 2003; 237:399-407.