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Ultrasound Features of Thyroid Follicular Adenoma and Carcinoma
S240
Ultrasound in Medicine and Biology
T21-14-IN02 Ultrasound Features of Thyroid Follicular Adenoma and Carcinoma Hsin-Kai Wang, Yung-Hui Lin, Yi-Hong Chou Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan Objective: To review the ultrasound presentations of thyroid follicular neoplasm, and search for usable ultrasound features to distinguish the follicular carcinoma from follicular adenoma. Materials and methods: We retrospectively reviewed cases with the diagnosis of thyroid follicular adenoma and follicular carcinoma. 97 patients (29 men and 68 women; median age, 50 years) with follicular adenoma and 28 patients (6 men and 22 women; median age, 47.5 years) with follicular carcinoma were enrolled. Ultrasonographic studies were reviewed by 3 experienced radiologists for interpretation the features of echogenecity, echotexture, cystic change, intranodal vascularity, peripheral vascular ring, halo, and calcifications of these cases. Chi-square and Fisher’s exact test, and multiple logistic regression were used for analysis. A p value of less than 0.05 was considered as statistically significant. Results: Presence of calcification (9 [9.3 %] of follicular adenoma patients vs 9 [32.1 %] of follicular carcinoma patients; p 5 0.005), absence of halo (6 [6.2 %] of follicular adenoma patients vs 9 [32.1] % of follicular carcinoma patients; p 5 0.001), and absence of cystic change (61 [62.9 %] of follicular adenoma patients vs 25 [89.9 %] of follicular carcinoma patients; p 5 0.008) were more frequently associated with follicular carcinoma than with follicular adenoma. No significant difference in the age, gender, location of tumor, volume and size of tumor, intranodal vascularity, peripheral vascular ring, echotexure, and echogenecity of tumor between follicular carcinoma and follicular adenoma. Conclusion: The ultrasound features of the thyroid follicular adenoma or carcinoma are generally similar, but presence of calcification, absence of halo, and absence of cystic change favor a follicular carcinoma. T21-14-IN03 Core-Needle Biopsy for Thyroid Jung Hwan Baek Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea In clinical obstetric ultrasound, the ALARA (As Low as Reasonably Achievable) principle is what should guide the end-user in his/her daily practice. Ultrasound is a form of energy that will cause effects in every tissue it traverses (bioeffects), most likely via two mechanisms: thermal and non-thermal. These effects are not necessarily harmful if certain rules, such as ALARA, are followed. ALARA is based on two very different approaches: some risk/benefit analysis of how much acoustic energy is tolerable to obtain diagnostic information and the precautionary principle which states that benefit must be proven before certain actions are executed. When comparing images obtained at various acoustic output levels, as docu- mented by on-screen thermal (TI) and mechanical (MI) index, it is evident that excellent clinical information may be obtained at very low outputs. Knowledge of clinical end-users continues to be sorely lacking both in the USA ad throughout the world. T21-14-IN04 Application of Contrast-Enhanced Ultrasonography in the Evaluation of the Invasiveness of Papillary Thyroid Carcinoma Kun Yan, Qiuli Cui, Ke Ding Department of Ultrasound, Key Laboratory of the Ministry of Education for Carcinogenesis and Translational Research, Peking University Cancer Hospital &Institute, Beijing 100142, China
Volume 43, Number S1, 2017 Objective: To study the enhanced patterns of papillary thyroid carcinoma (PTC) on contrast-enhanced ultrasound(CEUS).To explore the relationship between the characteristics of enhancement and the invasiveness of papillary thyroid carcinoma. Methods: One hundred and fifty-eightPTCs in 136 patients selected for thyroid surgery underwent conventionalultrasound andcontrastenhanced ultrasound. The enhanced patterns were analyzed. To explore the risk factors of extrathyroidal extension and cervical lymph node metastasis. Results: Univariate analysis showed that extrathyroidal extension was associated with PTC nodules size, contour bulging, contact with thyroid capsule observed by CEUS, centripetal enhancement and IMAX$1. In multivariate analysis, contact with thyroid capsule observed by CEUS, centripetal enhancement and IMAX$1 had a significant effect on extrathyroidal extension. An age of ,45 years, multinodes, size(.1.1cm), vascularity, IMAX$1were significantly with lymph node metastasis in patients with PTC. Conclusion: The preoperative PTC nodes characteristics on contrast enhanced ultrasound with extrathyroidal extension and cervical lymph node metastasis may serve as preoperative supplementary markers for the optimal surgery extent. Key words: contrast-enhanced ultrasound; Papillary thyroid carcinoma; tumor invasiveness
T21-14-IN05 Ultrasound-Guided Radiofrequency Ablation of Low-Risk Papillary Thyroid Microcarcinoma: a Prospective Study Yukun Luo, Mingbo Zhang General Hospital of Chinese PLA, Beijing, China Introduction: Low risk papillary thyroid microcarcinoma (PTMC) has a high incidence and a good prognosis. Surgical operation to all PTMC has been questioned as over treatment and active surveillance is recommended as an alternative. However, some patients have heavy mental burden and minimally invasive treatment could be used to eliminate PTMC and reduce the tumor related risk of growth and metastasis. The objective of this study was to evaluate the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) of low-risk PTMC on a large scale of patients with over 1 year follow-up. Methods / Case Presentation: 421 patients with 440 low risk PTMC were included in this study. US and contrastenhanced ultrasound (CEUS) examinations were performed before ablation. RFA was performed using the movingshot technique. The ablation area exceeded the tumor edge to prevent marginal residue and recurrence. Patients were followed at 1, 3, 6, and 12 months and every six months thereafter. US and CEUS examinations were used to evaluate the ablation area and cervical lymph nodes. Results / Discussion: The mean volume reduction ratio (VRR) was 0.5860.09, 0.7960.07, 0.8760.05, 0.9460.04, and 0.9660.01 at 1, 3, 6, 12, and 18 months after RFA, respectively. Of all the nodules, 172 (39.1%) resolved in six months, and 415 (94.3%) resolved in 12 months. No residual lesion was detected in ablation area. 82 patients were followed up for more than 3 years and the rest patients were followed up for at least 1 year. During follow up, 4 patients had biopsy proved recurrent PTMC in other parts of thyroid tissue, which had diameter of 2mm-3mm and received a second RFA. 5 patients had suspicious thyroid lesions less than 2mm and continued follow up. 4 patients had biopsy proved cervical lymph node metastasis and received RFA of the lymph nodes. No distant metastasis was detected in these patients. And no major complications were encountered.
Ultrasound in Medicine and Biology
T21-14-IN02 Ultrasound Features of Thyroid Follicular Adenoma and Carcinoma Hsin-Kai Wang, Yung-Hui Lin, Yi-Hong Chou Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan Objective: To review the ultrasound presentations of thyroid follicular neoplasm, and search for usable ultrasound features to distinguish the follicular carcinoma from follicular adenoma. Materials and methods: We retrospectively reviewed cases with the diagnosis of thyroid follicular adenoma and follicular carcinoma. 97 patients (29 men and 68 women; median age, 50 years) with follicular adenoma and 28 patients (6 men and 22 women; median age, 47.5 years) with follicular carcinoma were enrolled. Ultrasonographic studies were reviewed by 3 experienced radiologists for interpretation the features of echogenecity, echotexture, cystic change, intranodal vascularity, peripheral vascular ring, halo, and calcifications of these cases. Chi-square and Fisher’s exact test, and multiple logistic regression were used for analysis. A p value of less than 0.05 was considered as statistically significant. Results: Presence of calcification (9 [9.3 %] of follicular adenoma patients vs 9 [32.1 %] of follicular carcinoma patients; p 5 0.005), absence of halo (6 [6.2 %] of follicular adenoma patients vs 9 [32.1] % of follicular carcinoma patients; p 5 0.001), and absence of cystic change (61 [62.9 %] of follicular adenoma patients vs 25 [89.9 %] of follicular carcinoma patients; p 5 0.008) were more frequently associated with follicular carcinoma than with follicular adenoma. No significant difference in the age, gender, location of tumor, volume and size of tumor, intranodal vascularity, peripheral vascular ring, echotexure, and echogenecity of tumor between follicular carcinoma and follicular adenoma. Conclusion: The ultrasound features of the thyroid follicular adenoma or carcinoma are generally similar, but presence of calcification, absence of halo, and absence of cystic change favor a follicular carcinoma. T21-14-IN03 Core-Needle Biopsy for Thyroid Jung Hwan Baek Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea In clinical obstetric ultrasound, the ALARA (As Low as Reasonably Achievable) principle is what should guide the end-user in his/her daily practice. Ultrasound is a form of energy that will cause effects in every tissue it traverses (bioeffects), most likely via two mechanisms: thermal and non-thermal. These effects are not necessarily harmful if certain rules, such as ALARA, are followed. ALARA is based on two very different approaches: some risk/benefit analysis of how much acoustic energy is tolerable to obtain diagnostic information and the precautionary principle which states that benefit must be proven before certain actions are executed. When comparing images obtained at various acoustic output levels, as docu- mented by on-screen thermal (TI) and mechanical (MI) index, it is evident that excellent clinical information may be obtained at very low outputs. Knowledge of clinical end-users continues to be sorely lacking both in the USA ad throughout the world. T21-14-IN04 Application of Contrast-Enhanced Ultrasonography in the Evaluation of the Invasiveness of Papillary Thyroid Carcinoma Kun Yan, Qiuli Cui, Ke Ding Department of Ultrasound, Key Laboratory of the Ministry of Education for Carcinogenesis and Translational Research, Peking University Cancer Hospital &Institute, Beijing 100142, China
Volume 43, Number S1, 2017 Objective: To study the enhanced patterns of papillary thyroid carcinoma (PTC) on contrast-enhanced ultrasound(CEUS).To explore the relationship between the characteristics of enhancement and the invasiveness of papillary thyroid carcinoma. Methods: One hundred and fifty-eightPTCs in 136 patients selected for thyroid surgery underwent conventionalultrasound andcontrastenhanced ultrasound. The enhanced patterns were analyzed. To explore the risk factors of extrathyroidal extension and cervical lymph node metastasis. Results: Univariate analysis showed that extrathyroidal extension was associated with PTC nodules size, contour bulging, contact with thyroid capsule observed by CEUS, centripetal enhancement and IMAX$1. In multivariate analysis, contact with thyroid capsule observed by CEUS, centripetal enhancement and IMAX$1 had a significant effect on extrathyroidal extension. An age of ,45 years, multinodes, size(.1.1cm), vascularity, IMAX$1were significantly with lymph node metastasis in patients with PTC. Conclusion: The preoperative PTC nodes characteristics on contrast enhanced ultrasound with extrathyroidal extension and cervical lymph node metastasis may serve as preoperative supplementary markers for the optimal surgery extent. Key words: contrast-enhanced ultrasound; Papillary thyroid carcinoma; tumor invasiveness
T21-14-IN05 Ultrasound-Guided Radiofrequency Ablation of Low-Risk Papillary Thyroid Microcarcinoma: a Prospective Study Yukun Luo, Mingbo Zhang General Hospital of Chinese PLA, Beijing, China Introduction: Low risk papillary thyroid microcarcinoma (PTMC) has a high incidence and a good prognosis. Surgical operation to all PTMC has been questioned as over treatment and active surveillance is recommended as an alternative. However, some patients have heavy mental burden and minimally invasive treatment could be used to eliminate PTMC and reduce the tumor related risk of growth and metastasis. The objective of this study was to evaluate the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) of low-risk PTMC on a large scale of patients with over 1 year follow-up. Methods / Case Presentation: 421 patients with 440 low risk PTMC were included in this study. US and contrastenhanced ultrasound (CEUS) examinations were performed before ablation. RFA was performed using the movingshot technique. The ablation area exceeded the tumor edge to prevent marginal residue and recurrence. Patients were followed at 1, 3, 6, and 12 months and every six months thereafter. US and CEUS examinations were used to evaluate the ablation area and cervical lymph nodes. Results / Discussion: The mean volume reduction ratio (VRR) was 0.5860.09, 0.7960.07, 0.8760.05, 0.9460.04, and 0.9660.01 at 1, 3, 6, 12, and 18 months after RFA, respectively. Of all the nodules, 172 (39.1%) resolved in six months, and 415 (94.3%) resolved in 12 months. No residual lesion was detected in ablation area. 82 patients were followed up for more than 3 years and the rest patients were followed up for at least 1 year. During follow up, 4 patients had biopsy proved recurrent PTMC in other parts of thyroid tissue, which had diameter of 2mm-3mm and received a second RFA. 5 patients had suspicious thyroid lesions less than 2mm and continued follow up. 4 patients had biopsy proved cervical lymph node metastasis and received RFA of the lymph nodes. No distant metastasis was detected in these patients. And no major complications were encountered.