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Abstract
Purpose
To assess the diagnostic accuracy of real-time ultrasound (US) for perithyroidal invasion of thyroid malignancy.
Materials and Methods
From January 2009 to December 2009, real-time US was performed on malignant thyroid nodules (largest diameter ≥ 10 mm) located in the isthmus or attached to the adjacent tracheal wall, by a single radiologist who prospectively determined the presence or absence of perithyroidal invasion.
Results
Of the 60 malignant thyroid nodules examined, intraglandular location (n = 0), capsular attachment with clear perithyroidal fat (n = 15), perithyroidal fat infiltration without tracheal invasion (n = 43), and tracheal invasion (n = 2) were prospectively determined. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of real-time US diagnosis for perithyroidal invasion were 80%, 90%, 94.1%, 69.2% and 83.3%, respectively when the pathological result was used as reference standard. Real-time US accuracies for intraglandular location, capsular attachment with clear perithyroidal fat, perithyroidal fat infiltration without tracheal invasion, and tracheal invasion were 76.6%, 53.3%, 51.7%, and 85.0%, respectively.
Figures and Tables
Fig. 1
A solid thyroid nodule in the medial aspect of left lower lobe of a 61-year-old woman (true positive, 1.4 × 1.7 × 2.0 cm).
A, B. Transverse and longitudinal gray-scale US images show perithyroidal invasion with loss of tracheal wall layering (arrows), and it was prospectively determined as probably tracheal invasion. After thyroid surgery, the nodule was confirmed to be a papillary thyroid microcarcinoma with tracheal wall invasion.
Fig. 2
A solid thyroid nodule in the left isthmus of a 68-year-old woman (false positive, 1.2 × 1.3 × 1.9 cm).
A, B. Transverse and longitudinal gray-scale US images show perithyroidal invasion with loss of tracheal wall layering (arrows), and it was prospectively determined as probably tracheal invasion. After thyroid surgery, the nodule was confirmed to be a papillary thyroid microcarcinoma without tracheal invasion.
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