Gustave Roussy, Département d'Imagerie, Médicale, Service de Médecine Nucléaire et Cancérologie Endocrinienne, Villejuif, France.
Gustave Roussy, Département d'Imagerie Médicale, Villejuif, France.
Eur J Endocrinol. 2021 May 21;185(1):13-22. doi: 10.1530/EJE-21-0091.
The presence of extrathyroidal extension (ETE) is generally considered as an indication for total thyroidectomy for differentiated thyroid cancer. The accuracy of neck ultrasound for the diagnosis of ETE is controversial. The aim of this study was to assess the diagnostic accuracy of preoperative ultrasound evaluation of ETE.
The retrospective and observational study of consecutive patients operated between 2016 and 2019 for cytologically suspicious or indeterminate thyroid nodules were analyzed. US images obtained preoperatively were retrospectively reviewed to identify signs of minimal or gross ETE. Histology was considered as the golden standard for diagnosis of ETE. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of US were evaluated.
A cohort of 305 patients (75% females, median age 48 years) with 378 nodules (median size 18 mm) was studied. Seventy-five percent of the nodules (n = 228) were malignant on histology and ETE was present in 106 cases (28%): 83 minimal ETE and 23 gross ETE. Suspicion of minimal ETE on preoperative ultrasound was found in 50 (13%) with a sensitivity of 30%, a specificity of 93%, a PPV of 62% and an NPV of 78%, with an accuracy of 76%. Gross ETE on ultrasound was found in 19 (5%) nodules with a sensitivity of 78%, a specificity of 99.7% a PPV of 94.7% an NPV of 98.6% and an accuracy of 98%.
Preoperative US is very specific and accurate in diagnosing gross ETE which impacts the extent of initial surgery for thyroid cancers.
甲状腺外侵犯（ETE）的存在通常被认为是分化型甲状腺癌行甲状腺全切除术的指征。颈部超声对 ETE 的诊断准确性存在争议。本研究旨在评估术前超声评估 ETE 的诊断准确性。
回顾性分析 2016 年至 2019 年间连续行手术治疗的细胞学可疑或不确定甲状腺结节患者。回顾性分析术前获得的超声图像，以识别微小或大体 ETE 的征象。组织学被认为是 ETE 诊断的金标准。评估了超声的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）及准确性。
共纳入 305 例（75%为女性，中位年龄 48 岁）患者的 378 个结节（中位大小 18mm）。75%的结节（n=228）经组织学证实为恶性，106 例（28%）存在 ETE：83 例微小 ETE 和 23 例大体 ETE。术前超声怀疑存在微小 ETE 的患者有 50 例（13%），其敏感性为 30%，特异性为 93%，PPV 为 62%，NPV 为 78%，准确性为 76%。超声发现大体 ETE 结节 19 个（5%），其敏感性为 78%，特异性为 99.7%，PPV 为 94.7%，NPV 为 98.6%，准确性为 98%。
术前超声对大体 ETE 的诊断非常特异和准确，这会影响甲状腺癌初始手术的范围。
