Vous êtes sur la page 1sur 44

Ultrasound Findings of Papillary Thyroid Carcinoma Originating in the Isthmus: Comparison With Lobe-Originating Papillary Thyroid

Carcinoma
Soo Yeon Hahn1 Boo-Kyung Han Eun Young Ko Jung Hee Shin Eun Sook Ko
Hahn SY, Han BK, Ko EY, Shin

JOURNAL
Presented by : Meilani Sulaeman
1420221145
Supervisor : dr.Novita, Sp.Rad

ClCLERKSHIP DEPARTEMENT OF RADIOLOGY


AMBARAWA REGIONAL GENERAL HOSPITAL

Ultrasound Findings of Papillary Thyroid


Carcinoma Originating in the Isthmus:
Comparison With Lobe-Originating Papillary
Thyroid Carcinoma
Brownish-red, highly vascular gland
Location: ant neck at C5-T1,
overlays 2nd 4th tracheal rings
Avg width: 12-15 mm
Avg height: 50-60 mm
Avg weight: 25-30 g in adults

Batas lobus:
esofagus

Trake
a

M.
sternocleidormastoideu
M.
s
sternohyoideus
M.
sternothytoideus

V.
Jugularis
interna
A. Corotis communis
N.
vagus

anterior

posteolatera
medial

Vascular Anatomy
Arteri thyroidea superior
Arteri thyroidea inferior
Arteri thyroidea IMA
Vena thyroidea superior
Vena thyroidea inferior
Vena thyroidea media

VASCULARISATIO GLANDULAE THYREOIDEAE

CARTILAGO THYREOIDEA
A. CAROTIS EXTERNA
CAROTIS INTERNA
1. A. THYREOIDEA SUPERIOR
CARTILAGO CRICOIDEA

A.

ISTHMUS GLD. THYR.


GLANDULA THYREOIDEA
2. A. THYREOIDEA INFERIOR
3. A.THYREOIDEA IMA
A. CAROTIS COMM.SIN.
TRUNCUS THYREOCERVICALIS
A. SUBCLAVIA DEXTRA
A. SUBCLAVIA SIN.
A. ANONYMA ( A. INNOMINATA,
TRUNCUS BRACHIOCEPHALICA )

6/22/16 02:07:03 AM

ARCUS AORTAE

v. Thyroidea
suprior

v. Thyroidea
medialis

v.
Thyroidea
inferior

Structure

Under middle layer of deep cervical fascia (pretracheal)


thyroid inner true capsule thin and closely adherent to
the gland
capsule extensions within the gland form septae, dividing it
into lobes and lobules
lobules are composed of follicles = structural units of the
gland layer epithelium enclosing a colloid-filled cavity

Fundamentals of Diagnostic Radiology, 3rd


Edition

OBJECTIVE
According to previous reports, a small percentage of patients
present with masses confined to the isthmus, and the
incidence of papillary thyroid carcinoma (PTC) between 2.5%
and 9.2% [13]
However, PTCs arising in the isthmus are more likely to
invade adjacent tissues, such as the trachea and strap
muscles, than PTCs located in the other parts of the thyroid [1,
2, 4]
Therefore, the purpose of this study was to analyze the
ultrasound features and clinicopathologic characteristics
of PTCs originating in the isthmus and to evaluate how these
tumors differ from PTCs that originate in the lobes

Materials and Methods

Patients From the records of 2623 reviewed 58 cases of index tumors


diagnosed as classic PTC located in the isthmus after a total thyroidectomy
or lobectomy.

Among the 58 lesions, we excluded


Finally, 48 patients with 48 classic PTCs located in the isthmus were
included in the study group.
As a control group, 96 patients with classic PTC located in a lobe who
underwent total thyroidectomy with bilateral central lymph node dissection
during the same period were randomly selected and matched to the study
patients with respect to age, sex, and tumor size.

Imaging Methods
Ultrasound and ultrasound-guided fine-needle aspiration
(FNA) were performed using a 7- to 15-MHz linear-array
transducer (HDI 5000, Philips Healthcare) or a 5- to 12MHz linear array transducer (IU22, Philips Healthcare)
by one of six board-certified radiologists who were
aware of the clinical findings.
All ultrasound-guided FNA there were not any
differences in ultrasound-guided FNA techniques for
isthmus-originating masses and lobe originating
masses.

Data Collection and Analysis


The following ultrasound findings margin, shape, and internal echogenicity of
the mass and the presence of calcifications, cystic changes, and an ultrasound
finding suspicious for extrathyroidal extension
The margin was classified as being either circumscribed or not circumscribed
The shape was categorized as being wider-than-tall or taller-than-wide.
Internal echogenicity was classified as hyperechogenicity, isoechogenicity,
hypoechogenicity, marked hypoechogenicity, or anechogenicity.
The presence or absence of calcifications and cystic changes was also
evaluated.
When the malignant mass had capsular abutment of more than 25% of its
perimeter on ultrasound, the mass was classified as having ultrasound finding
suspicious for extrathyroidal extension [13, 14].

First, divide the thyroid gland into the isthmus and


lobes (Fig. 1) on the transverse scan.

Fig. 1Ultrasound image of thyroid of 37-year-old woman who was a


healthy volunteer. To divide thyroid gland into isthmus and lobe, we
defined lateral border of isthmus by drawing two imaginary lines
(arrows) perpendicular to skin surface from most lateral borders of
trachea.

Fig. 251-year-old woman with papillary thyroid carcinoma (PTC) originating in isthmus. A and B,
Transverse (A) and longitudinal (B) ultrasound images show 1.2-cm cystic mass with circumscribed margin,
wider-than-tall shape, broad abutment to anterior capsule (> 25%), and anterior capsular bulging. Analysis of
fine-needle aspiration cytologic examination result revealed PTC. After surgery, diagnosis was PTC arising in
isthmus without lymph node metastasis. According to pathologic report, no extrathyroidal extension was found
despite ultrasound finding suspicious for extrathyroidal extension

Results
The mean age at the time of
diagnosis of all 144 patients was 47.6
12.6 (SD) years (range, 2877
years).
The female-to-male ratio was 4.3:1.0
(81.3% vs 18.7%, respectively).
The mean tumor size was 1.2 0.7
cm (range, 0.33.7 cm).

RESULTS
According to the clinicopathologic analyses, the
incidence of extrathyroidal extension was
higher in the patients with a tumor originating
in the isthmus than in the control group (p =
0.026)
According to the imaging analyses, the tumors
originating in the isthmus more frequently had a
circumscribed margin (p = 0.030), a wider-thantall shape (p < 0.001), and the suspicion of
extrathyroidal extension (p < 0.001) than those
originating from the lobes.

CONCLUSION
The results of this study showed that PTCs
originating in the isthmus were more likely to
have extrathyroidal extension than those
originating from the lobes.
Therefore, careful ultrasound evaluation should
be performed on masses in the thyroid isthmus
even if ultrasound shows a circumscribed mass
with a wider-than-tall shape.

hypoechoge
nity

microcalcifica
tions

Poor
marginatio
n

Malignant. Longitudinal US image of papillary thyroid


carcinoma
in
42-year-old
woman
shows
marked
hypoechogenicity,
spiculated
margin,
microcalcifications, and taller-than-wide shape.

isoechogen
ity

Smooth
margin

Benign. Longitudinal US image of benign


nodule in 46-year-old woman shows ovoid
shape, isoechogenicity, and smooth
margin.

TERIMA KASIH

Five categories for US diagnosis of


solid thyroid nodules

D, Malignant features in a 45-year-old woman. A


longitudinal sonogram of a papillary thyroid carcinoma in
the left lobe shows an eccentric configuration with an acute
angle (arrows), macrolobulation, microcalcifications, and
hypoechogenicity.

A, Benign features in a 60-year-old woman. A


longitudinal sonogram of nodular hyperplasia in
the left lobe shows a concentric configuration
with a centrally located cystic component, a
smooth free margin, an ovoid shape, and
isoechogenicity.

B. Suspicious for malignancy. Longitudinal US image of


papillary thyroid carcinoma in 42-year-old woman shows
marked hypoechogenicity, smooth margin, and ovoid
shape.

C. Borderline. Transverse US image of nodular hyperplasia in 60-yearold woman shows macrocalcification in peripheral portion of nodule.
Patient underwent right lobectomy of thyroid, despite benign cytology
upon US-guided fine-needle aspiration, for pathologic confirmation.

D. Probably benign. Longitudinal US image of benign


nodule in 57-year-old woman shows isoechogenicity and
smooth margin.

B, Probably benign in a 50-year-old woman. A transverse


sonogram of nodular hyperplasia in the left lobe shows an
eccentric configuration with a blunt angle between the solid
component and the wall (arrows), a smooth free margin,
and isoechogenicity.

C, Suspicious for malignancy in a 28-year-old


woman. A longitudinal sonogram of a papillary
thyroid carcinoma in the left lobe shows an
eccentric configuration with an acute angle
between the solid component and the wall (arrows),
a microlobulation, and isoechogenicity.

Lymphatics

defined the lateral border of the isthmus by drawing two imaginary


lines perpendicular to the surface of the skin from the most lateral
points of the trachea
If the center of the thyroid mass was located between these two
imaginary lines, we classified it as a mass originating in the isthmus
even if its margin crossed these two imaginary lines
Taller than-wide shape was defined as a mass that was greater in its
anteroposterior dimension than its transverse dimension
When the echogenicity of the mass was similar to that of the
thyroid parenchyma, we classified it as isoechogenicity. Marked
hypoechogenicity was defined as decreased echogenicity compared
with the surrounding strap muscle

1. Bagaimana kita tau bahwa tiroid tersebut


hipoekogenik atau sebaliknya, adakah
perbandingannya?
2. Adakah kelebihan dari penelitian ini?
3. Tadi dijelaskan histologi dari kelenjar tiroid.
Secara histologis karsinoma tiroid papiler itu
berasal dari sel apa?
4. Mengapa yang tidak menjalani operasi
dieksklusikan?
5. Adakah perbedaan gambaran USG dari tumor
tiroid yang benign dan yg malignan?

Vous aimerez peut-être aussi