J Korean Med Sci.  2016 Mar;31(3):397-402. 10.3346/jkms.2016.31.3.397.

Ultrasonographic Characteristics of the Follicular Variant Papillary Thyroid Cancer According to the Tumor Size

• Jeon EJ
• Jeong YJ
• Park SH
• Cho CH
• Shon HS
• Jung ED

• KMID: 2363500
• DOI: http://doi.org/10.3346/jkms.2016.31.3.397

Abstract

Follicular variant papillary thyroid cancer (FVPTC) is the second most common subtype after conventional PTC. We compared ultrasonographic (US) features of FVPTC to those of conventional PTC according to tumor size. We reviewed US findings, pathologic reports, and medical charts of 249 PTC patients with surgically proven disease (83 FVPTCs, 166 conventional PTCs) at our institution from January 2007 to December 2012. FVPTCs were divided into PTC-like and follicular neoplasm (FN)-like based on sonographic characteristics. PTC-like features were defined as having at least one malignant feature (taller-than-wide shape, infiltrative margin, marked hypoechogenicity, and micro-calcifications), whereas FN-like cancers showed oval solid features without malignant features. FVPTCs showed a higher rate of FN-like features than conventional PTCs. Of 166 conventional PTCs, 13 (7.8%) had FN-like features and 153 (92.2%) had PTC-like features, whereas of the 83 FVPTCs, 31 (37.3%) had FN-like features and 52 (62.7%) had PTC-like features. Macro-FVPTCs showed a higher rate of FN-like features than micro-FVPTCs (P < 0.001). Of 21 macro-FVPTCs, 18 (85.7%) had FN-like features and 3 (14.3%) had PTC-like features, whereas of the 62 micro-FVPTCs, 13 (21%) had FN-like features and 49 (79%) had PTC-like features. There were no differences in multifocality, extrathyroidal invasion, and lymph node metastasis between PTC-like FVPTCs and FN-like FVPTCs. FVPTCs showed fewer sonographic malignant features than conventional PTCs. In particular, FVPTCs larger than 1 cm had a more frequent benign sonographic appearance. Therefore, if fine-needle aspiration result is suspicious for PTC in a nodule larger than 1 cm with no suspicious US features, the possibility of FVPTC might be considered.

Keyword

Follicular Variant; Papillary; Thyroid Neoplasms

MeSH Terms

Adult
Carcinoma, Papillary, Follicular/*diagnostic imaging/pathology
Demography
Female
Humans
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Staging
Thyroid Neoplasms/*diagnostic imaging/pathology
*Ultrasonography

Figure

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  Fig. 1 Ultrasonographic findings of thyroid in a 35-year-old woman with FN-like follicular variant papillary thyroid cancer. The nodule shows no malignant suspicious US findings in transverse view (A) and longitudinal view (B).

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  Fig. 2 Ultrasonographic findings of thyroid in a 55-year-old woman with PTC-like follicular variant papillary thyroid cancer. The nodule shows marked hypoechogenicity and irregular infiltrated margin in transverse view (A) and longitudinal view (B).

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