Yao Xiang-Yun, Li Xin, Mei Fang, Yu Bo, Song Shi-Bing, Cui Li-Gang, Tan Shi
Department of Ultrasound, Peking University Third Hospital, Beijing, China.
Department of General Surgery, Peking University Third Hospital, Beijing, China.
Cancer Med. 2025 Sep;14(17):e71190. doi: 10.1002/cam4.71190.
The surgical indications for follicular thyroid neoplasms (FTNs) remain controversial due to challenges in the preoperative follicular thyroid carcinoma (FTC) diagnosis. We aimed to explore the sonographic features of the FTN capsule and establish a prediction model for diagnosing FTC without high-risk features.
This prospective cohort study enrolled consecutive adult patients with FTN. Patients presenting with extrathyroidal extension or extracapsular angioinvasion on preoperative imaging were excluded. Intraoperative ultrasound (US)-guided incisions were conducted in 20 patients during thyroidectomy. Sonographic features of FTN capsules were identified and validated through comparison with US, macroscopic, and microscopic pathology images from the same US-selected section. Invaded capsules were categorized based on pathological indicators of capsular invasion. The diagnostic performance of the US capsule-based model and US risk stratification systems (American College of Radiology Thyroid Imaging Reporting and Data System [ACR-TIRADS] and Ultrasound Follicular Thyroid Imaging Reporting and Data System [F-TIRADS]) were compared.
Seventy-four patients with unifocal lesions and 14 patients with multifocal lesions were enrolled and pathologically diagnosed with follicular thyroid adenoma (n = 67) and FTC (n = 35). As widely invasive FTC was initially excluded, there were 34 minimally invasive subtypes and 1 encapsulated angioinvasive subtype. The areas under the curves for the US capsule-based model, ACR-TIRADS, and F-TIRADS were 0.839 (95% confidence interval [CI], 0.753-0.904), 0.852 (95% CI, 0.768-0.914), and 0.840 (95% CI, 0.755-0.905), respectively. No significant differences were observed in the areas under the curves, sensitivity, or accuracy of the US capsule-based model, ACR-TIRADS, and F-TIRADS. The specificities of the US capsule-based model and F-TIRADS were higher than that of the ACR-TIRADS (88.1% and 80.60%, respectively, vs. 44.8%, p < 0.05).
Careful US scanning enables clear FTN capsule visualization, providing a straightforward, specific method for diagnosing FTC and guiding completion thyroidectomy by detecting intracapsular angioinvasion in patients with FTC.
由于术前诊断滤泡状甲状腺癌（FTC）存在挑战，滤泡状甲状腺肿瘤（FTN）的手术指征仍存在争议。我们旨在探讨FTN包膜的超声特征，并建立一个用于诊断无高危特征FTC的预测模型。
这项前瞻性队列研究纳入了连续的成年FTN患者。排除术前影像学检查显示甲状腺外侵犯或包膜外血管侵犯的患者。20例患者在甲状腺切除术中接受了术中超声（US）引导下的切口。通过与同一US选择区域的US、宏观和微观病理图像进行比较，确定并验证了FTN包膜的超声特征。根据包膜侵犯的病理指标对侵犯的包膜进行分类。比较了基于US包膜的模型和US风险分层系统（美国放射学会甲状腺影像报告和数据系统[ACR-TIRADS]和超声滤泡状甲状腺影像报告和数据系统[F-TIRADS]）的诊断性能。
纳入了74例单发病灶患者和14例多发病灶患者，病理诊断为滤泡状甲状腺腺瘤（n = 67）和FTC（n = 35）。由于最初排除了广泛浸润性FTC，有34例微浸润亚型和1例包膜内血管浸润亚型。基于US包膜的模型、ACR-TIRADS和F-TIRADS的曲线下面积分别为0.839（95%置信区间[CI]，0.753 - 0.904）、0.852（95%CI，0.768 - 0.914）和0.840（95%CI，0.755 - 0.905）。基于US包膜的模型、ACR-TIRADS和F-TIRADS的曲线下面积、敏感性或准确性方面未观察到显著差异。基于US包膜的模型和F-TIRADS的特异性高于ACR-TIRADS（分别为88.1%和80.60%，而ACR-TIRADS为44.8%，p < 0.05）。
仔细的US扫描能够清晰显示FTN包膜，为诊断FTC提供一种直接、特异的方法，并通过检测FTC患者的包膜内血管浸润来指导甲状腺全切术。
