Preoperative Staging of Differentiated Thyroid Carcinomas: Comparison of USG and CT with Intraoperative Findings and Histopathology

  • Thasneem Jainulabdeen
  • Balakrishnan Ramaswamy
  • K. Devaraja
  • Samir M. Paruthikunnan
  • Ajay M. BhandarkarEmail author
Original Article


To study the efficacy of USG and CECT in preoperative staging of differentiated thyroid carcinomas in comparison to the intraoperative and histopathological findings. A prospective, observational study was conducted in a tertiary care hospital over a period of one and a half years where USG and CECT of 23 subjects with histopathologically proven differentiated thyroid malignancy were analysed to study the characteristics of the primary tumour, lymphatic metastasis and evaluate the sensitivity and specificity of the radiological investigations in comparison to the intra-operative and histopathological findings. When compared with intraoperative and histopathological T-staging, USG had an accuracy of 69.5% and 73.9% and CECT had an accuracy of 78.2% and 73.9% respectively. The sensitivity and specificity of USG and CECT in determining a malignant nodule was 71.4% and 33.3% and 52.4% and 66.7% respectively. The N-staging according to the histopathological examination findings was in agreement with that of USG in 65.2% and CECT in 65.2% patients. The sensitivity and specificity of USG was 94.4% and 41.7% and that of CECT was 92.2% and 44.4% respectively in detecting lymphatic metastasis. The sensitivity and specificity of USG was 94.4% and 44.4% and that of CECT was 92.2% and 27.3% respectively in detecting lateral compartment lymphatic metastasis. USG identifies the characteristics of the malignant nodules better and CECT has a higher identifying central compartment lymphatic metastasis. CECT should be used as an adjunct to ultrasound to determine the extent of lymphatic metastasis and staging of disease.


Papillary carcinoma Follicular carcinoma Ultrasound Contrast enhanced CT scan TNM staging TIRADS 


Compliance with Ethical Standards

Conflict of interest


Ethical Clearance

Ethical Clearance has been obtained from the institutional ethics committee, Kasturba Medical College, Manipal.


  1. 1.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016) 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 26(1):1–133CrossRefGoogle Scholar
  2. 2.
    Kim N, Lavertu P (2003) Evaluation of a thyroid nodule. Otolaryngol Clin North Am 36(1):17–33CrossRefGoogle Scholar
  3. 3.
    Stulak JM, Grant CS, Farley DR, Thompson GB, van Heerden JA, Hay ID, Reading CC, Charboneau JW (2006) Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg 141(5):489–494 (discussion 494–496) CrossRefGoogle Scholar
  4. 4.
    Hagag P, Strauss S, Weiss M (1998) Role of ultrasound-guided fine-needle aspiration biopsy in evaluation of nonpalpable thyroid nodules. Thyroid 8(11):989–995CrossRefGoogle Scholar
  5. 5.
    Bomeli SR, LeBeau SO, Ferris RL (2010) Evaluation of a thyroid nodule. Otolaryngol Clin North Am 43(2):229–238CrossRefGoogle Scholar
  6. 6.
    Yoon DY, Lee JW, Chang SK, Choi CS, Yun EJ, Seo YL, Kim KH, Hwang HS (2007) Peripheral calcification in thyroid nodules: ultrasonographic features and prediction of malignancy. J Ultrasound Med 26(10):1349–1355 (quiz 1356–1357) CrossRefGoogle Scholar
  7. 7.
    Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, Dominguez M (2009) An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab 94(5):1748–1751CrossRefGoogle Scholar
  8. 8.
    Shimamoto K, Satake H, Sawaki A, Ishigaki T, Funahashi H, Imai T (1998) Preoperative staging of thyroid papillary carcinoma with ultrasonography. Eur J Radiol 29(1):4–10CrossRefGoogle Scholar
  9. 9.
    Park JS, Son K-R, Na DG, Kim E, Kim S (2009) Performance of preoperative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC/UICC TNM classification system. AJR Am J Roentgenol 192(1):66–72CrossRefGoogle Scholar
  10. 10.
    Ahn JE, Lee JH, Yi JS, Shong YK, Hong SJ, Lee DH, Choi CG, Kim SJ (2008) Diagnostic accuracy of CT and ultrasonography for evaluating metastatic cervical lymph nodes in patients with thyroid cancer. World J Surg 32(7):1552–1558CrossRefGoogle Scholar
  11. 11.
    Morgan JL, Serpell JW, Cheng MSP (2003) Fine-needle aspiration cytology of thyroid nodules: how useful is it? ANZ J Surg 73(7):480–483CrossRefGoogle Scholar
  12. 12.
    Horvath E, Silva CF, Majlis S, Rodriguez I, Skoknic V, Castro A, Rojas H, Niedmann JP, Madrid A, Capdeville F, Whittle C, Rossi R, Domínguez M, Tala H (2017) Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules. Eur Radiol 27(6):2619–2628CrossRefGoogle Scholar
  13. 13.
    Calcatera NA, Lutfi W, Suman P, Suss NR, Wang C-H, Prinz RA, Winchester DJ, Moo-Young TA (2018) Concordance of pre-operative clinical stage with pathologic stage in patients ≥ 45 years old with well-differentiated thyroid cancer. Endocr Pract 24(1):27–32CrossRefGoogle Scholar
  14. 14.
    Kim E, Park JS, Son K-R, Kim J-H, Jeon SJ, Na DG (2008) Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography. Thyroid 18(4):411–418CrossRefGoogle Scholar
  15. 15.
    Moon HJ, Kwak JY, Kim E-K, Kim MJ (2011) A taller-than-wide shape in thyroid nodules in transverse and longitudinal ultrasonographic planes and the prediction of malignancy. Thyroid 21(11):1249–1253CrossRefGoogle Scholar
  16. 16.
    Choi JS, Chung WY, Kwak JY, Moon HJ, Kim MJ, Kim E-K (2011) Staging of papillary thyroid carcinoma with ultrasonography: performance in a large series. Ann Surg Oncol 18(13):3572–3578CrossRefGoogle Scholar
  17. 17.
    Herh SJ, Kim E-K, Sung JM, Yoon JH, Moon HJ, Kwak JY (2014) Heterogeneous echogenicity of the thyroid parenchyma does not influence the detection of multi-focality in papillary thyroid carcinoma on preoperative ultrasound staging. Ultrasound Med Biol 40(5):884–889CrossRefGoogle Scholar
  18. 18.
    Lee DW, Ji YB, Sung ES, Park JS, Lee YJ, Park DW, Tae K (2013) Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma. Eur J Surg Oncol 39(2):191–196CrossRefGoogle Scholar
  19. 19.
    Choi JS, Kim J, Kwak JY, Kim MJ, Chang HS, Kim E-K (2009) Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol 193(3):871–878CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, ManipalManipal Academy of Higher EducationManipalIndia
  2. 2.Department of Radiodiagnosis and Imaging, Kasturba Medical College, ManipalManipal Academy of Higher EducationManipalIndia

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