Abstract
Purpose. To investigate the pathology and prognostic value of hyperechoic echo halo in cN0 papillary thyroid microcarcinoma (PTMC) and the relationship between age, gender, and the formation of abnormal hyperechoic echo halo and cervical lymph node metastasis. Data of 97 patients who underwent surgical treatment for the first time for single PTMC between April 2016 and March 2017 were analyzed retrospectively. The boundary status of the PTMC was determined preoperatively. Grayscale values of the nodular center, hyperechoic echo halo, and normal thyroid tissue were acquired with Adobe Photoshop CS6 software. The histopathology of the boundary and status of the cervical lymph node metastasis were analyzed. Formation of abnormal hyperechoic halo and cervical lymph node metastasis in relation to age and gender were explored. The abnormal hyperechoic halo mainly represents cancer cell infiltration with reactive hyperplasia of inflammatory cells and fibrous tissue. In the hyperechoic halo group, the grayscale values for the nodular center, hyperechoic echo halo, and normal thyroid tissue were 1552.6 ± 578.6, 5792.0 ± 747.6, and 3582.7 ± 759.0, respectively (P < 0.05). The cervical lymph node metastasis rate was significantly lower in patients with hyperechoic halo (15.0%) than in those without (41.6%; P < 0.05) and significantly higher in those aged <45 years (53.3%) than in those aged ≥45 years (28.4%; P < 0.05). There were no significant correlations between gender and cervical lymph node metastasis or between age, gender, and hyperechoic halo formation (P > 0.05). cN0 PTMC patients with abnormal hyperechoic halo and age >45 years have a significantly reduced risk of cervical lymph node metastasis and relatively good prognosis.
Highlights
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, accounting for 70–90% of welldifferentiated thyroid malignancies
Papillary thyroid microcarcinoma (PTMC) is a specific subgroup that is defined by the World Health Organization (WHO) as PTC with a maximum diameter of ≤1.0 cm
There have been an increasing number of patients undergoing total thyroidectomy, and while more aggressive therapy may be indicated for some cases, many may be overtreated [14]
Summary
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, accounting for 70–90% of welldifferentiated thyroid malignancies. Papillary thyroid microcarcinoma (PTMC) is a specific subgroup that is defined by the World Health Organization (WHO) as PTC with a maximum diameter of ≤1.0 cm. With the development of new sensitive devices and diagnostic procedures, the number of PTMC cases detected is increasing. With the continuous improvement of the resolution of ultrasonography, the detection rate of malignant thyroid nodules with abnormal hyperechoic halo has increased significantly. A large number of studies have reported the abnormal hyperechoic halo as one of the typical ultrasound signs in breast cancer, and the degree of malignancy of breast cancer with the above-mentioned sign is generally low [6]. Reports on thyroid nodules with abnormally high echoes are relatively rare, and comprehensive and systematic studies of these nodules are lacking
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