Preoperative Ultrasonographic Staging of Papillary Thyroid Carcinoma With the Eighth American Joint Committee on Cancer Tumor-Node-Metastasis Staging System.

Objective: The purpose of this study was to evaluate the performance of preoperative ultrasonography (US) in the staging of papillary thyroid carcinoma (PTC) according to the eighth AJCC TNM classification system, to determine the effect of the preoperative US staging in the management of PTC.

Patients And Methods: Preoperative US was performed by 2 highly trained sonographers in 665 consecutive patients with PTC, and the T and N categories were determined preoperatively. The accuracy of preoperative US in clinical staging was evaluated based on the histopathological specimens according to the eighth AJCC TNM classification. Further analysis was performed to identify the high-risk factors of N1b stage.

Results: Overall accuracy of preoperative US for T stage was 92.5% (615/665). The accuracy of sonographic evaluation for T was high except for the T4a. Overall accuracy of preoperative US for N stage was 59% (426/655). The accuracies of sonographic evaluation for N0, N1a, and N1b were 81.8% (274/335), 33.3% (70/250), and 87.5% (70/80), respectively. Of 250 N1a patients, 164 (65.6%) were underestimated by US. Univariate and multivariate analyses showed that larger tumor diameter, multifocality, and higher T stage significantly increase the risk of N1b stage (P < 0.01).

Conclusions: Preoperative US was useful for the evaluation in staging of PTC, but some limitations still existed. For higher-risk patients of N1b (larger tumor size, multifocality, and higher T stage), preoperative US examination for lateral neck region should be further emphasized, and prophylactic lateral nodal dissection should be determined based on both preoperative imaging results and intraoperative evaluation.