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Ultrasound features value in the diagnosis and prognosis of medullary thyroid carcinoma

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Abstract

Purpose

Ultrasound (US) is the most important imaging in the preoperative diagnosis of medullary thyroid carcinoma (MTC). MTC are easy to be misdiagnosed due to lacking typical malignant US features. This study investigated US features, clinical characteristics, prognosis, and detection methods, aimed to explore the association between US features and biological behavior, and improve early diagnosis of MTC.

Methods

A total of 189 MTC patients were enrolled in the study. Based on US features, 29 MTC were categorized as “indeterminate” (i-MTC) and 160 MTC were categorized as “malignant” (m-MTC) according to Thyroid Imaging, Reporting and Data System published by America College of Radiology (ACR TI-RADS). We compared US features, clinical characteristics and prognosis between both groups. We analyzed cytological categories of fine needle aspiration (FNA) within each i-MTC and m-MTC group according to the 2017 Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). We assessed the positive rate of FNA, frozen pathological examination, and preoperative serum calcitonin (Ctn) level in i-MTC and m-MTC groups.

Results

Preoperative US features were significantly different in shape, margin, composition, echogenicity, and calcifications between i-MTC and m-MTC (p < 0.05). I-MTC showed a hypoechoic solid or solid-cystic nodule lacking malignant US features. While m-MTC was presented as a solid nodule with obviously malignant US features. There were significant differences in lymph node dissection, extent of tumor, lymph node metastasis, and TNM stage and prognosis between i-MTC and m-MTC (p < 0.05). Compared to m-MTC, i-MTC underwent central neck dissection more frequently rather than lateral neck dissection at the time of the initial operation; i-MTC had less extrathyroidal invasion and lymph node metastasis, earlier stage, higher rate of biochemical cure, and lower rate of structural persistence/recurrence (p < 0.05). The 2017 TBSRTC of i-MTC and m-MTC was significantly different (p < 0.05). Preoperative serum Ctn level had a higher diagnostic sensitivity for both i-MTC and m-MTC when comparing to FNA and frozen pathological examination (p < 0.05).

Conclusions

US features were associated with biological characteristics and prognosis of MTC. I-MTC lack malignant US features, preformed less aggressiveness, and better prognosis. TBSRTC according to FNA combined with serum Ctn were helpful for the detection of i-MTC.

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Author information

Author notes

  1. These authors contributed equally: Jing Zhao, Fan Yang

Authors and Affiliations

  1. Department of Ultrasound Diagnosis and Treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China

    Jing Zhao, Fan Yang, Xi Wei, Yiran Mao, Jie Mu, Lihui Zhao, Xiaojie Xin & Sheng Zhang

  2. Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China

    Jing Zhao, Fan Yang, Xi Wei, Yiran Mao, Jie Mu, Lihui Zhao, Jianghua Wu, Xiaojie Xin & Sheng Zhang

  3. Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University, Tianjin, 300060, China

    Jing Zhao, Fan Yang, Xi Wei, Yiran Mao, Jie Mu, Lihui Zhao, Jianghua Wu, Xiaojie Xin & Sheng Zhang

  4. Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China

    Jianghua Wu

  5. Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, 300000, China

    Jian Tan

Authors
  1. Jing Zhao
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  2. Fan Yang
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Contributions

J.Z. and F.Y. participated in the study conception and design. L.H.Z., Y.M., and J.M. analyzed and interpreted the patient clinical data. X.J.X. analyzed the ultrasonographs. J.H.W. analyzed histological examination. S.Z. checked for statistical consistency. X.W. was the operator of FNA and reviewed the paper critically. J.Z. was a major contributor in writing the manuscript. X.W., J.Z., and J.T. were guarantors of the study, had full access to all data, and took responsibility for the integrity and accuracy of the data analysis. X.W. analyzed cytological categories of FNA according to TBSRTC in revision. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Sheng Zhang or Jian Tan.

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The authors declare that they have no conflict of interest.

Ethics

This research project was approved by the Ethics Committee of Tianjin Cancer Institute and Hospital. Written consents were obtained from each patient.

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Zhao, J., Yang, F., Wei, X. et al. Ultrasound features value in the diagnosis and prognosis of medullary thyroid carcinoma. Endocrine 72, 727–734 (2021). https://doi.org/10.1007/s12020-020-02510-2

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  • DOI: https://doi.org/10.1007/s12020-020-02510-2

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