Diagnostic Accuracy of Preoperative Radiologic Findings in Papillary Thyroid Microcarcinoma: Discrepancies with the Postoperative Pathologic Diagnosis and Implications for Clinical Outcomes

Ying Li ¹, Seul Ki Kwon ^1,2, Hoonsung Choi ³

⁰Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Endocrinology and Metabolism (Seoul, Korea) +

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May 27, 2024

View abstract on PubMed

Summary

Preoperative imaging underestimated papillary thyroid microcarcinoma (PTMC) tumor size in many cases, with some exceeding 1 cm post-surgery. This size increase is linked to aggressive factors and higher metastasis risk.

Area Of Science

Endocrinology
Oncology
Radiology

Background

Papillary thyroid microcarcinoma (PTMC) diagnosis relies on preoperative imaging.
Accurate prediction of tumor characteristics and outcomes is crucial for risk stratification.

Purpose Of The Study

To evaluate the diagnostic accuracy of preoperative radiologic findings in predicting PTMC tumor characteristics and clinical outcomes.
To assess discrepancies between preoperative imaging and postoperative pathology across all PTMC risk groups.

Main Methods

Analysis of 939 PTMC patients (low-risk and non-low-risk) undergoing surgery.
Preoperative ultrasonography for tumor size and lymph node metastasis (LNM) evaluation.
Comparison of imaging findings with postoperative pathologic results.

Main Results

Agreement between radiological and pathological tumor size was ~60%.
Tumor size increased postoperatively in 24.3% of cases; 10.8% exceeded 1 cm.
Postoperative tumor size >1 cm correlated with aggressive factors (multiplicity, extrathyroidal extension, LNM) and distant metastasis risk.
LNM was newly diagnosed postoperatively in 30.1% of patients, with distinct clinical characteristics.

Conclusions

A subset of PTMCs show size increases post-surgery, potentially exceeding 1 cm.
These cases warrant special attention due to associations with adverse outcomes, including elevated distant metastasis risk.
Preoperative imaging may underestimate PTMC tumor size and LNM status, impacting risk assessment.

Keywords:

Discrepancy Lymph node metastasis Papillary thyroid microcarcinoma Radiologic diagnosis Tumor size