Kang Buseon, Yu Hyeong Won, Kong Yoon, Lee Ja Kyung, Choi June Young, Na Hee Young, Park So Yeon, Kim Min Joo, Moon Jae Hoon, Cha Wonjae, Jeong Woo-Jin, Lee Won Woo, Lim Hunjong, Choi Sang Il
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Ann Surg Treat Res. 2025 Jul;109(1):35-43. doi: 10.4174/astr.2025.109.1.35. Epub 2025 Jul 2.
Diffuse sclerosing variant papillary thyroid carcinoma (DSV-PTC) is a rare and aggressive subtype of PTC. Preoperative diagnosis is challenging owing to the overlapping of imaging characteristics with those of other thyroid conditions. This study aimed to evaluate the accuracy of preoperative ultrasound (US) in predicting DSV-PTC and to identify significant diagnostic factors.
This retrospective study analyzed 34 patients who were preoperatively suspected of having DSV-PTC based on US findings and later underwent thyroidectomy. Patients were divided into 2 groups based on the final histopathological diagnosis: DSV-PTC and non-DSV-PTC. Demographic, radiological, and pathological characteristics were also compared.
Only 32.4% of patients initially suspected of having DSV-PTC were confirmed postoperatively. Among the US features, the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) score 5 was significantly associated with DSV-PTC (P = 0.038), whereas other radiological factors, including echogenicity and microcalcifications, were not. The histopathological features, such as tumor size, and mutations, vascular invasion, and lymph node metastasis, showed no significant differences between the groups.
Preoperative US has limited accuracy (32.4%) in diagnosing DSV-PTC. Because of the aggressive treatment recommendations based on preoperative suspicion, clinicians should carefully consider the limitations of imaging. Further studies incorporating fine-needle aspiration or core needle biopsy are required to improve diagnostic accuracy.
弥漫性硬化型乳头状甲状腺癌（DSV-PTC）是一种罕见且侵袭性强的PTC亚型。由于其影像学特征与其他甲状腺疾病重叠，术前诊断具有挑战性。本研究旨在评估术前超声（US）预测DSV-PTC的准确性，并确定重要的诊断因素。
本回顾性研究分析了34例根据US检查结果术前怀疑患有DSV-PTC且随后接受甲状腺切除术的患者。根据最终组织病理学诊断将患者分为两组：DSV-PTC组和非DSV-PTC组。还比较了人口统计学、放射学和病理学特征。
最初怀疑患有DSV-PTC的患者中，术后仅32.4%得到确诊。在US特征中，韩国甲状腺影像报告和数据系统（K-TIRADS）5类评分与DSV-PTC显著相关（P = 0.038），而其他放射学因素，包括回声性和微钙化，则无相关性。两组间肿瘤大小、突变、血管侵犯和淋巴结转移等组织病理学特征无显著差异。
术前US诊断DSV-PTC的准确性有限（32.4%）。由于基于术前怀疑会推荐积极的治疗方案，临床医生应仔细考虑影像学检查的局限性。需要进一步开展纳入细针穿刺或粗针活检的研究以提高诊断准确性。
