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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Cancer Imaging and Image-directed Interventions
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1545407

Multimodal Ultrasound: A Non-invasive Method for Identifying Dedifferentiation of Papillary Thyroid Carcinoma During Active Surveillance

Provisionally accepted
Qian-Yi Dou Qian-Yi Dou 1Huan-Ling Guo Huan-Ling Guo 1Wan-Bing Qiu Wan-Bing Qiu 2Ming Xu Ming Xu 1Shu-Ling Chen Shu-Ling Chen 1Xiao-Er Zhang Xiao-Er Zhang 1Xiao-Yan Xie Xiao-Yan Xie 1Jin-Yu Liang Jin-Yu Liang 1*
  • 1 Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
  • 2 Department of Medical Ultrasonics, Shenzhen People’s Hospital., Shenzhen, Guangdong, China

The final, formatted version of the article will be published soon.

    Objectives: To assess the diagnostic accuracy of multimodal ultrasound in differentiating anaplastic thyroid carcinoma (ATC) from papillary thyroid carcinoma (PTC) and to evaluate its capability in detecting thyroid carcinoma (TC) aggressiveness.Methods: Sixty nude mice were randomly assigned to ATC and PTC groups and injected subcutaneously with KHM-5M and TPC-1 cell lines, respectively. Tumors were analyzed using Bmode ultrasound (B-US), Color Doppler flow imaging (CDFI), elastography, and contrast-enhanced ultrasound (CEUS). A logistic model integrating multimodal ultrasound data was constructed, and Ki-67 and CD31 expressions in tumor tissues were analyzed immunohistochemically. Correlations between ultrasound features and aggressiveness markers were investigated.The ATC group exhibited significantly higher strain-elastography scores (p=0.009) and Adler grades in CDFI (p=0.045). CEUS revealed a higher frequency of heterogeneous enhancement (95.2% vs. 48.1%, p<0.001) and perfusion defects (90.5% vs. 63.0%, p<0.001) in ATC. Model area under the curve (AUC) values for distinguishing ATC from PTC were 0.963 for (B-US + CEUS), 0.926 for CEUS, 0.729 for elastography, 0.663 for CDFI, and 0.675 for B-US. The multimodal ultrasound model demonstrated significant correlations with Ki-67 (p<0.001) and microvessel density (MVD) (p<0.001).Multimodal ultrasound showing high efficacy with an AUC of 0.963 for B-US and CEUS combined in distinguishing ATC from PTC and exhibited strong associations with Ki-67 and MVD. Incorporating multimodal ultrasound, with an emphasis on CEUS, into active surveillance strategies for PTC is recommended. By providing detailed insights into tumor vascularity and aggressiveness, multimodal ultrasound could play a crucial role in early detection and treatment decision-making, improving patient outcomes.

    Keywords: Papillary thyroid carcinoma, anaplastic thyroid carcinoma, Multimodal ultrasound, active surveillance, aggressiveness

    Received: 14 Dec 2024; Accepted: 31 Jan 2025.

    Copyright: © 2025 Dou, Guo, Qiu, Xu, Chen, Zhang, Xie and Liang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Jin-Yu Liang, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

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