Abstract
Contrast-enhanced ultrasound (CEUS) can be used to evaluate microcirculation in cancers, which in turn is associated with the biologic features and ultimately patient prognosis. We conducted a retrospective analysis to examine potential association between CEUS parameters and prognosis in patients with papillary thyroid cancer (PTC). The analysis included 306 patients who underwent CEUS prior to thyroidectomy at our center during a period from 2012 to 2019. Subjects with excellent response (ER) were compared to the non-ER group (including indeterminate response, biochemical incomplete response and structural incomplete response). During the median follow-up of 34 months, ER was observed in 195 (63.7%) subjects. The remaining 111 (36.3%) patients developed non-ER events, with distant metastasis in five (1.6%) cases. In a multivariate COX regression, non-ER event was associated with the male sex (OR = 1.83, 95%CI: 1.21–2.76) and blood-rich enhancement in CEUS (OR = 1.69, 95%CI: 1.04–2.75). Based on this finding, we developed a predictive model: high risk for developing non-ER events was defined as having both risk factors; low risk was defined as having none or only one risk. In receiver operating characteristic (ROC) analysis, the area under the curve was 0.59 (95%CI: 0.52–0.66). The sensitivity and specificity were 17.1 and 95.4%, respectively. The positive and negative predictive values were 67.9 and 66.9%, respectively. In conclusion, blood-rich enhancement in CEUS is associated with non-ER events after thyroidectomy in patients with PTC.
Highlights
Papillary thyroid cancer (PTC) accounts for 85% of differentiated thyroid cancers [1]
Factors that are known to be associated with poor prognosis include older age (>55 years), male sex, larger tumor size, extrathyroid extension, and distant metastasis [9, 10]
Treatment response was categorized based on the 2015 American Thyroid Association (ATA) guidelines to: excellent response (ER), indeterminate response (IDR), biochemical incomplete response (BIR), and structural incomplete response (SIR)
Summary
Papillary thyroid cancer (PTC) accounts for 85% of differentiated thyroid cancers [1]. Recurrence rate is up to 30% [2,3,4], with distant metastasis at about 1% [5]. Surgery can improve patient prognosis, but may lead to a number of complications, including hypoparathyroidism and recurrent laryngeal nerve injury [6]. Factors that are known to be associated with poor prognosis include older age (>55 years), male sex, larger tumor size, extrathyroid extension, and distant metastasis [9, 10]. A previous study suggested an association between hyper-iso enhancement of CEUS and central lymph node metastasis in PTC [13]. CEUS has been used to predict the prognosis in patients with other diseases, including hepatic cirrhosis and pancreatic carcinoma [15, 16]
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