Assessing Diagnostic Value of Combining Ultrasound and MRI in Extrathyroidal Extension of Papillary Thyroid Carcinoma

Abstract

Shudong Hu,1,2,* Heng Zhang,1,2,* Yanqi Zhong,3,* Enock Adjei Agyekum,2,* Zongqiong Sun,1 Yuxi Ge,1 Jie Li,4 Weiqiang Dou,5 Junlin He,6 Hong Xiang,7 Yuandong Wang,8 Xiaoqin Qian,2 Xian Wang2 1Department of Radiology, Affiliated Hospital, Jiangnan University, Wuxi, People’s Republic of China; 2Department of Ultrasound, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, People’s Republic of China; 3School of Medicine, Jiangnan University, Wuxi, People’s Republic of China; 4Department of Interventional Radiology, Affiliated Hospital, Jiangnan University, Wuxi, People’s Republic of China; 5GE Healthcare, MR Research China, Beijing, People’s Republic of China; 6Department of Radiology, Tinglin Hospital of Jinshan District, Shanghai, People’s Republic of China; 7Department of Pediatric, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China; 8Department of Radiotherapy, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xian Wang; Xiaoqin Qian, Tel +86 13952808812 ; +86 13813186750, Email wangxian8812@126.com; yz_tyz1030@126.comPurpose: To explore the separate diagnostic value of preoperative ultrasound (US), magnetic resonance imaging (MRI), and the combination of US and MRI in extrathyroidal extension (ETE) of papillary thyroid carcinoma (PTC).Materials and Methods: This retrospective study was approved by the Affiliated People’s Hospital of Jiangsu University review board. A total of 158 PTC patients with ETE received preoperative US and MRI examination and underwent surgery between May 2014 and December 2018 in Affiliated People’s Hospital of Jiangsu University. For each case, the US and MRI features of ETE were retrospectively and independently investigated by two radiologists. The clinical assessment for each case was implemented, respectively, using US imaging only, MRI only, and a combination of both modalities at three different time points with one-month intervals.Results: The diagnostic accuracies of US, MRI, and the combined set for T3 (minimal ETE) were 91.7% (88/96), 74.0% (71/96), and 97.9% (94/96), respectively, indicating a significantly different performance (P < 0.001). The diagnostic accuracies for T4 (extensive ETE) were 62.9% (39/62), 87.1% (54/62), and 93.5% (58/62), respectively. The difference between the three methods for T4 was statistically significant (P = 0.000). The diagnostic accuracies for overall ETE were 80.4% (127/158), 79.1% (125/158), and 96.2% (152/158), respectively. The difference between the three methods for ETE was statistically significant (P = 0.001).Conclusion: This study suggests that ETE can be predicted most accurately by the combination of preoperative US and MRI.Keywords: thyroid cancer, ultrasonography, magnetic resonance imaging, neoplasm staging