Preoperative Ultrasonographic Features of Papillary Thyroid Carcinoma Predict Biological Behavior

Background: Although ultrasound (US) features of papillary thyroid carcinoma (PTC) are well established, little is known regarding biological behavior according US features. We investigated whether there was a difference in biological behavior between PTCs that did and did not meet malignant US criteria. Patients and Methods: We retrospectively reviewed clinical records and histological and US findings of the index tumors in 488 patients who underwent surgery for PTC. Benign-looking PTC (B-PTC) was defined as showing none of the accepted US criteria for malignancy. Malignant-looking PTCs (M-PTCs) and B-PTCs were compared in terms of patients' age, sex, tumor size, histological subtype, multifocality, lymph node (LN) metastasis, extrathyroidal extension, stage, recurrence, and distant metastasis. Results: B-PTCs accounted for 74 (15%) of all 488 PTCs. Mean tumor size was not significantly different between the groups, with 1.10 cm for M-PTC and 1.11 cm for B-PTC (P = .947). Univariate and multivariate analysis indicated that M-PTC more frequently had LN metastasis, extrathyroidal extension, and a higher stage than B-PTC (all P < .05). The results were significant in tumors >= 1.0 cm, whereas there were no significant differences in tumors < 1 cm. As the number of malignant US features increased, multifocality, extrathyroidal extension, LN metastasis, and a higher stage were more likely. Conclusion: PTCs that did not meet malignant US criteria had better prognostic indicators than PTCs that met US criteria. Therefore, US features at the time of diagnosis can serve as a useful tool for predicting biological behavior in PTC. (J Clin Endocrinol Metab 98: 1476-1482, 2013)