Papillary thyroid cancer echocardiography or ultrasound
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
Neck ultrasound may be performed to detect papillary thyroid cancer.
Ultrasound
Ultrasound imaging is useful in the diagnosis and management of thyroid cancer. It is used for:[1]
- Evaluation of thyroid nodule characteristics
- Determination of nodule location during fine needle aspiration study
- Assessment of adjacent lymph node for the purpose of staging the cancer
- Post-surgical surveillance for early detection of tumor recurrence and/or nodal metastatic disease
In summary, ultrasound imaging findings suggestive of malignant thyroid nodule include:
- Microcalcification
- Peripheral, coarse calcification
- Solid, hypoechoic nodule
- Locally invaded nodule (more commonly seen in anaplastic thyroid cancer and primary thyroid lymphoma)
- High anteroposterior/width ratio
- Irregular nodular margin
- Adjacent suspicious lymph node with following features:
- Greater than 2 cm
- Presence of posterior acoustic shadowing
Additionally, ultrasound imaging has been observed to be useful in the diagnosis of non-palpable lymph node metastasis when used preoperatively.[2]
Key Ultrasound Findings in Papillary thyroid cancer
The ultrasound is a useful test to distinguish solid from cystic lesions and to identify calcifications.[3]
- The thyroid ultrasound is also very effective to discover microcarcinomas, which refer to very small carcinomas (<1 cm).Papillary carcinoma within the thyroid usually appears as a solitary mass usually with an irregular outline, located in the subcapsular region and demonstrating vascularity.[4] Small punctate regions of echogenicity representing microcalcifications (psammoma bodies) may be present.[5]
- Lymph node metastases have a tendency to completely cavitate (40%), and although usually multiple, in a minority of cases (6%) a single completely cystic node may be present. They tend to have septations, mural nodules, and relatively thick walls.[6]
- Very few radiologists would aspirate a lesion under 10 mm in diameter.
- A lesion that enlarges with follow up is a relatively strong indication for FNA of the lesion. In patients with pathological cervical nodes on ultrasound, any thyroid lesion should likely be aspirated.
- In every day ultrasound practice, papillary thyroid cancer most commonly has poorly defined margins and/or calcifications (which may be macrocalcifications). There is a poor correlation between blood flow and malignancy in practice. Aspiration of simple cysts of the thyroid lesions does not yield malignant cells and cysts can safely be followed up in the context of excluding malignancy.
- Ultrasound Examples of Papillary thyroid cancer
References
- ↑ Coquia, Stephanie F.; Chu, Linda C.; Hamper, Ulrike M. (2014). "The Role of Sonography in Thyroid Cancer". Radiologic Clinics of North America. 52 (6): 1283–1294. doi:10.1016/j.rcl.2014.07.007. ISSN 0033-8389.
- ↑ Stulak, John M. (2006). "Value of Preoperative Ultrasonography in the Surgical Management of Initial and Reoperative Papillary Thyroid Cancer". Archives of Surgery. 141 (5): 489. doi:10.1001/archsurg.141.5.489. ISSN 0004-0010.
- ↑ "Papillary Thyroid Carcinoma: An Overview". Archives of Pathology & Laboratory Medicine. 2006. Retrieved 2010-07-15.
- ↑ Lyshchik A, Drozd V, Demidchik Y, Reiners C (2005). "Diagnosis of thyroid cancer in children: value of gray-scale and power doppler US". Radiology. 235 (2): 604–13. doi:10.1148/radiol.2352031942. PMID 15770036.
- ↑ Kwak JY, Kim EK, Son EJ, Kim MJ, Oh KK, Kim JY; et al. (2007). "Papillary thyroid carcinoma manifested solely as microcalcifications on sonography". AJR Am J Roentgenol. 189 (1): 227–31. doi:10.2214/AJR.06.0750. PMID 17579175.
- ↑ Wunderbaldinger P, Harisinghani MG, Hahn PF, Daniels GH, Turetschek K, Simeone J; et al. (2002). "Cystic lymph node metastases in papillary thyroid carcinoma". AJR Am J Roentgenol. 178 (3): 693–7. doi:10.2214/ajr.178.3.1780693. PMID 11856700.
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Image courtesy of Dr Garth Kruger. Radiopaedia (original file ‘’here’’.Creative Commons BY-SA-NC