Clinical study of ultrasonic evaluation of T/N staging of differentiated thyroid carcinoma using AJCC 8th staging criteria

Yu Liang; Xingxiang Huang; Zhe Song; Yang Yang; Ju Lei; Mei Ren; Li Tan; Hui Zhang

doi:10.1371/journal.pone.0269994

Clinical study of ultrasonic evaluation of T/N staging of differentiated thyroid carcinoma using AJCC 8th staging criteria

PLoS One. 2022 Jun 16;17(6):e0269994. doi: 10.1371/journal.pone.0269994. eCollection 2022.

Authors

Yu Liang¹, Xingxiang Huang², Zhe Song³, Yang Yang¹, Ju Lei⁴, Mei Ren⁴, Li Tan¹, Hui Zhang¹

Affiliations

¹ Department of Ultrasound, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
² School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
³ Department of Thyroid Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
⁴ North Sichuan Medical College, Nanchong, Sichuan, China.

Abstract

Objective: To explore the value of ultrasound in evaluating T/N staging of differentiated thyroid carcinoma (DTC).

Methods: The clinical data of 1206 patients with DTC in our hospital from January 2018 to December 2020 were retrospectively analyzed. Cervical ultrasound was performed before surgery, and the standard ultrasound images of thyroid nodules and cervical lymph nodes I to VII were retained. According to the 8th TNM staging guidelines of AJCC DTC, the T/N stages were assessed by preoperative ultrasonic data. Then, the sensitivity, specificity, negative predicted value, positive predicted value (PPV), and diagnostic value of ultrasound T/N staging were assessed using postoperative pathological staging as the reference.

Results: Ultrasonic T-stage had good consistency to pathological T stage in T4a and T4b tumors (kappa value>0.75), and moderate consistency to pathological T stage in T1, T2 and T3a tumors (kappa value between 0.4 and 0.75). ultrasonic T-stage had a sensitivity higher than 66%, except in T3b assessment (13/44, 29.5%, 95%CI: 16.1%-43.0%). All ultrasonic T-stage had specificity higher than 93%, except in T1b assessment (734/889, 82.6%, 95%CI: 80.1%-85.1%). The PPV of ultrasonic T1a to T4b was 94.3% (494/524), 61.0% (242/397), 54.4% (87/160), 34.3% (12/35), 20.3% (13/64), 100% (22/22) and 100% (4/4), respectively. The diagnostic accuracy values were 83% in T1a, 81% in T1b, 91% in T2, 98% in T3a, 93% in T3b, 99% in T4a and 100% in T4b. Nltrasonic N-stage had poor consistency to pathological N stage in any N stages (kappa value<0.3). The PPV of ultrasonic N0, N1, N1a and N1b was 61.0% (542/889), 55.2% (37/67), 48.2% (53/110), and 24.3% (34/140), respectively.

Conclusion: Ultrasound has a good consistency and high accuracy in assessing the T-stage of DTC. However, the consistency and accuracy were poor in N-staging. It has a certain reference value in reducing excessive surgical treatment of DTC.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenocarcinoma* / pathology
Humans
Lymph Nodes / pathology
Neoplasm Staging
Prognosis
Retrospective Studies
Thyroid Neoplasms* / pathology
Ultrasonics

Grants and funding

This work was supported by Key R & D projects of the Science and Technology Department of Sichuan Province, China (Grant NO. 2020YFS0406). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.