Value of Contrast-Enhanced Ultrasound in Partially Cystic Papillary Thyroid Carcinomas.

Fengkai Fang,Zhang Qi,Xiaodu Li,Liyan Liao,Chengcheng Niu,Yi Gong,Fei Ye,Zhongkun Zuo

doi:10.3389/fendo.2021.783670

Abstract

Partially cystic papillary thyroid carcinomas (PCPTCs) are rarely reported papillary thyroid carcinomas (PTCs) and are usually misdiagnosed as benign nodules. The objective of this study was to provide the various sonographic characteristics of partially cystic thyroid nodules for differentiation between malignant and benign nodules, including those for conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). Twenty-three PCPTC patients and 37 nodular goiter patients were enrolled in this study. We evaluated the size, cystic percentage, solid echogenicity, calcification, vascularity, and CEUS parameters for each nodule. The final diagnosis of all patients was confirmed via surgery. Univariate analysis demonstrated that compared with benign nodular goiters, PCPTCs more frequently presented with calcification, hypoechogenicity of the solid part, hypoenhancement, heterogeneous enhancement, centrifugal perfusion, peak intensity index <1, time to peak index ≥1, and area under the curve index <1 on preoperative US and CEUS. Binary logistic regression analysis demonstrated that heterogeneous enhancement, centrifugal perfusion, and peak intensity index <1 are independent CEUS characteristics related to malignant PCPTCs and can be used for their differentiation from benign nodular goiters (all p < 0.05). Our study indicated that preoperative CEUS characteristics may serve as a useful tool to distinguish malignant PCPTCs from benign thyroid nodules.

Highlights

Thyroid carcinomas have a mostly solid composition, but those with predominant cystic changes (>50% of the nodule) can be observed in 2.5%–6.0% of all thyroid carcinoma cases [1, 2]
The univariate analysis indicated that the Partially cystic papillary thyroid carcinomas (PCPTCs) more frequently presented with calcification, hypoechogenicity of the solid part, hypoenhancement, heterogeneous enhancement, centrifugal perfusion, peak intensity (PI) index
The results indicated that enhancement uniformity (B = 4.080, OR = 59.166, 95% CI = 1.928–1,815.846, p = 0.020), centrifugal perfusion (B = 4.502, OR = 90.157, 95% CI = 4.443–1,829.637, p = 0.003), and PI index

Summary

Introduction

Thyroid carcinomas have a mostly solid composition, but those with predominant cystic changes (>50% of the nodule) can be observed in 2.5%–6.0% of all thyroid carcinoma cases [1, 2]. 213 partially cystic thyroid nodules in 196 patients who had consecutively undergone prospective sonographic diagnosis and ultrasonography-guided fine-needle aspiration biopsy (US-FNAB) were included, and the rate of malignancy for partially cystic thyroid nodules was 5.2% [3]. To our knowledge, there are few studies that have investigated sonographic features as predictors for the diagnosis of malignant partially cystic thyroid nodules. US-FNAB has a high rate of nondiagnostic and false-negative results for the diagnosis of partially cystic thyroid nodules [6]

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