Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillance
Abstract Active surveillance (AS) of small, low-risk papillary thyroid cancers (PTCs) is increasingly studied in prospective observational studies. Ultrasound is the primary imaging modality for case selection. While researchers have put forward selection criteria for PTCs based on size, absence of...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2021-09-01
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| Series: | Insights into Imaging |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13244-021-01072-9 |
| _version_ | 1819082214789349376 |
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| author | Sangeet Ghai Ciara O’Brien David P. Goldstein Anna M. Sawka the Canadian Thyroid Cancer Active Surveillance Study Group |
| author_facet | Sangeet Ghai Ciara O’Brien David P. Goldstein Anna M. Sawka the Canadian Thyroid Cancer Active Surveillance Study Group |
| author_sort | Sangeet Ghai |
| collection | DOAJ |
| description | Abstract Active surveillance (AS) of small, low-risk papillary thyroid cancers (PTCs) is increasingly studied in prospective observational studies. Ultrasound is the primary imaging modality for case selection. While researchers have put forward selection criteria for PTCs based on size, absence of suspicious lymph nodes and tumor location, there are limited reported data highlighting inherent ultrasound limitations and guidelines for case selection and follow-up. We report our experience including imaging limitations encountered in the ongoing AS prospective observational study for PTCs measuring < 2 cm at our institute. We define disease progression as an increase in size of > 3 mm in the largest dimension of nodule or evidence of metastatic disease or extrathyroidal extension. Accurate, consistent and reproducible measurements of PTCs are essential in risk stratifying patients for the option of AS or disease progression. Interobserver discrepancy, shadowing from coarse calcification and background parenchyma heterogeneity or thyroiditis can limit accurate PTC size assessment and therefore hinder patient eligibility evaluation or AS follow-up. Following the ACR Thyroid Imaging, Reporting and Data System (TI-RADS) protocol of three-axes technique to measure a thyroid nodule enables reproducibility of measurements. In patients with multi-nodular goiter, accurate identification and labeling of the PTC is important to avoid mistaking with adjacent benign nodules at follow-up. Ultrasound assessment for extrathyroid extension of PTC, and relationship of PTC to trachea and the anatomic course of the recurrent laryngeal nerve are important considerations in evaluation for AS eligibility. |
| first_indexed | 2024-12-21T20:13:07Z |
| format | Article |
| id | doaj.art-36af8335b2eb43b6921f025d7c2888a1 |
| institution | Directory Open Access Journal |
| issn | 1869-4101 |
| language | English |
| last_indexed | 2024-12-21T20:13:07Z |
| publishDate | 2021-09-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Insights into Imaging |
| spelling | doaj.art-36af8335b2eb43b6921f025d7c2888a12022-12-21T18:51:42ZengSpringerOpenInsights into Imaging1869-41012021-09-0112111210.1186/s13244-021-01072-9Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillanceSangeet Ghai0Ciara O’Brien1David P. Goldstein2Anna M. Sawka3the Canadian Thyroid Cancer Active Surveillance Study GroupJoint Department of Medical Imaging, University Health Network – Mount Sinai Hospital – Women’s College Hospital, University of TorontoJoint Department of Medical Imaging, University Health Network – Mount Sinai Hospital – Women’s College Hospital, University of TorontoPrincess Margaret Cancer Centre, Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network and University of TorontoDivision of Endocrinology, Department of Medicine, University Health Network and University of TorontoAbstract Active surveillance (AS) of small, low-risk papillary thyroid cancers (PTCs) is increasingly studied in prospective observational studies. Ultrasound is the primary imaging modality for case selection. While researchers have put forward selection criteria for PTCs based on size, absence of suspicious lymph nodes and tumor location, there are limited reported data highlighting inherent ultrasound limitations and guidelines for case selection and follow-up. We report our experience including imaging limitations encountered in the ongoing AS prospective observational study for PTCs measuring < 2 cm at our institute. We define disease progression as an increase in size of > 3 mm in the largest dimension of nodule or evidence of metastatic disease or extrathyroidal extension. Accurate, consistent and reproducible measurements of PTCs are essential in risk stratifying patients for the option of AS or disease progression. Interobserver discrepancy, shadowing from coarse calcification and background parenchyma heterogeneity or thyroiditis can limit accurate PTC size assessment and therefore hinder patient eligibility evaluation or AS follow-up. Following the ACR Thyroid Imaging, Reporting and Data System (TI-RADS) protocol of three-axes technique to measure a thyroid nodule enables reproducibility of measurements. In patients with multi-nodular goiter, accurate identification and labeling of the PTC is important to avoid mistaking with adjacent benign nodules at follow-up. Ultrasound assessment for extrathyroid extension of PTC, and relationship of PTC to trachea and the anatomic course of the recurrent laryngeal nerve are important considerations in evaluation for AS eligibility.https://doi.org/10.1186/s13244-021-01072-9Watchful waitingPapillary cancerThyroid glandUltrasonographyManagement |
| spellingShingle | Sangeet Ghai Ciara O’Brien David P. Goldstein Anna M. Sawka the Canadian Thyroid Cancer Active Surveillance Study Group Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillance Insights into Imaging Watchful waiting Papillary cancer Thyroid gland Ultrasonography Management |
| title | Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillance |
| title_full | Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillance |
| title_fullStr | Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillance |
| title_full_unstemmed | Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillance |
| title_short | Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillance |
| title_sort | ultrasound in active surveillance for low risk papillary thyroid cancer imaging considerations in case selection and disease surveillance |
| topic | Watchful waiting Papillary cancer Thyroid gland Ultrasonography Management |
| url | https://doi.org/10.1186/s13244-021-01072-9 |
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