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Common and Uncommon Sonographic Features of Papillary Thyroid Carcinoma

Departments of Radiology (B.K.C., T.S.D., R.B.J.) and Nuclear Medicine (I.R.M.), Stanford University School of Medicine, Stanford, California USA; and Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania USA (R.J.W.).

Address correspondence and reprint requests to Bryan K. Chan, MD, Department of Radiology, H-1307, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305. E-mail: xone{at}stanford.edu.

Objective. To determine the relative frequency of various sonographic findings in papillary carcinoma of the thyroid. Methods. We retrospectively analyzed the sonographic features in 55 patients with proven papillary carcinoma of the thyroid. Sonographic features analyzed were echo texture, cystic change, margin, contour, presence of a peripheral halo, vascularity, and calcification pattern. Features were classified as common (35% of cases) or uncommon (<10% of cases). Combinations of features were also analyzed. Results. Common sonographic features of papillary carcinoma included hypoechoic texture (86%), microcalcifications (42%) or no calcifications (47%), well-defined margins (47%), and intrinsic hypervascularity (69%). Uncommon features included hyperechoic or mixed echo texture, cystic elements, irregular margins, hypovascularity, and coarse or peripheral calcifications. Of the 29 lesions that had calcifications, 20 (69%) had microcalcifications; 5 (17%) had coarse calcifications; and 1 had peripheral calcifications. In total, 54% of cases had at least 1 uncommon feature, and 11% had 2 or more uncommon features. Cystic carcinomas were rare and accounted for only 6% of lesions; all had hypervascular solid components. No carcinomas in our series were completely avascular. Conclusions. There is a broad spectrum of sonographic findings in papillary carcinoma of the thyroid. Half of the lesions in this series had at least 1 uncommon sonographic feature.

Key Words: head and neck neoplasms, sonography • sonography, Doppler studies • sonography, power Doppler studies • thyroid, biopsy • thyroid, neoplasms • thyroid, sonography

Abbreviations: FNA, fine-needle aspiration

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