MTC ultrasound
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Research published in the Asian Journal of Surgery showed that high-frequency ultrasound and the Thyroid Imaging Reporting and Data System (TI-RADS™) effectively evaluated patients with medullary thyroid carcinoma (MTC).

MTC is more malignant than other segregated thyroid cancers because it is highly aggressive, has a poor diagnosis, and is unresponsive to conventional chemotherapy or radiotherapy treatments. Therefore, early diagnosis and comprehensive preoperative assessments are essential.

According to the authors, “this is the first study which determines the sonographic risk factors linked with aggressive behavior in MCTs, using TI-RADS as the primary assessment method.”

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The researchers conducted a retrospective analysis, selecting 127 patients from the database. Patients with MTC and preoperative sonographic images, comprising 47 male and 80 female patients (mean age, 51.8 ± 15.4 years old, range, 6-82 years), were included in the cohort. Two radiologists evaluated the clinical records and ultrasonic images, and all cases were scored retrospectively according to the TI-RADS. 

Logistic regression analysis was carried out to identify the risk factors for aggressive behaviors of MTCs. Kaplan-Meier and log-rank tests were also used to determine survival proportions between different groups.

Female patients with MTCs outnumbered their male counterparts (1.7:1). According to a multivariable analysis, male sex was a specific risk factor for both metastasis (OR =4.471, P =.01) and perithyroidal invasion (OR =4.674, P =.004).

On sonograms, the standard MTCs were visible as hypoechoic (96.9%) and solid nodules (94.5%). 

The patient’s gender, margin of the nodule, and focality of the nodule were independent risk factors for metastasis, whereas, for perithyroidal invasion, sex of the patient and margin of the nodule were individual risk factors. Kaplan-Meier analysis showed that survival proportions differed between groups with or without perithyroidal extension (P =.002) but not between groups with or without metastasis (P =.473).

A kappa test was used to maintain uniformity between the reviewers. The consistency between the 2 assessors was relatively high (K value, 0.797-0.988).

The analysis demonstrated that high-frequency ultrasound and TI-RADS were useful methods for preoperative diagnosis of MTC. The patient’s gender and nodule margin were common risk factors for both metastasis and perithyroidal invasion, and the focality of the tumor was an additional independent risk factor for metastasis.


Ning C-p, Kim E-K. Sonographic risk factors of aggressive behaviors in medullary thyroid carcinomas.Asian J Surg. Published online Jun 11, 2021. doi:10.1016/j.asjsur.2021.05.036.