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Conventional sonographic phenotype of thyroid oncocytic neoplasms: a pathology-confirmed comparative study
Chuanyang Li1, Tingyu Zhu1, Xiaojuan Zheng2
1Center of Ultrasound Medicine, Zhoushan Hospital Affiliated to Wenzhou Medical University, No. 739 Dingshen Road, Dinghai District, Zhoushan, 316000, Zhejiang, China.
Purpose:
To describe the conventional sonographic features of oncocytic thyroid neoplasms (OTNs) and compare them with those of papillary thyroid carcinoma (PTC), nodular goiter (NG), and three follicular-pattern comparator groups: follicular adenoma (FA), follicular thyroid carcinoma (FTC), and follicular variant of papillary thyroid carcinoma (FVPTC).
Methods:
This retrospective study included 344 pathology-confirmed lesions: 41 OTNs, 110 PTCs, 90 NGs, 45 FAs, 24 FTCs, and 34 FVPTCs. Two radiologists independently re-reviewed stored preoperative ultrasound images while blinded to histopathologic diagnoses. Because the original reports did not consistently document C-TIRADS categories, they were reconstructed post hoc from feature-level descriptors. Feature-specific Firth logistic regression models adjusted for age, sex, and maximum lesion diameter, used size-matched sensitivity analyses; 1:1 matching with a 5-mm caliper.
Results:
OTNs were larger than PTC, NG, and FVPTC lesions (median maximum diameters: 25.0, 7.0, 9.0, and 10.0 mm, respectively; P < 0.001) but similar in size to FA and FTC lesions. They were commonly wider than tall (100.0%), had smooth margins (80.5%), were isoechoic (65.9%), and were hypervascular (70.7%). After adjustment, all six prespecified features were associated with OTN versus PTC. Compared with NG, smooth margins (aOR, 3.84; 95% CI, 1.30-13.14; P = 0.014) and is echogenicity (aOR, 3.36; 95% CI, 1.19-9.69; P = 0.022) remained associated with OTN. Compared with the pooled follicular-pattern comparator group (FA, FTC, and FVPTC), smooth margins and absence of focal echogenic foci remained associated with OTN (aORs, 3.71 and 2.55; P = 0.002 and 0.022, respectively), but these associations were attenuated after lesion-size matching.
Conclusions:
In this surgically selected cohort, OTNs showed several recurring conventional sonographic features, but their appearance overlapped substantially with follicular neoplasms and NG. Ultrasound may raise preoperative suspicion for an oncocytic phenotype but cannot distinguish oncocytic adenoma from oncocytic carcinoma.