{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:45:36Z","timestamp":1782283536994,"version":"3.54.5"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>To compare the sonographic features of papillary thyroid carcinoma (PTC) between classic and aggressive PTC subtypes to determine whether multimodal ultrasound (US) can aid in differentiating particular subtypes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The retrospective cohort study included patients with histologically proven PTCs according to the World Health Organization classification of thyroid neoplasms between December 2022 and October 2024. Imaging findings were evaluated using the International Expert Consensus on US Lexicon for Thyroid Nodules. Associations between US features and intrinsic subtypes were assessed by the \u03c7<jats:sup>2<\/jats:sup> or Fisher\u2019s exact test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 295 patients with 320 nodules (74 males with 81 nodules and 221 females with 239 nodules) were included. There were 279 classic PTC (87.2%), 26 tall cell (8.1%), 11 hobnail (3.4%), one columnar cell (0.3%), one solid (0.3%), and two diffuse sclerosing subtypes (0.6%). Regarding US features, direction of growth, extrathyroidal extension (ETE), calcifications, and color Doppler flow imaging significantly differed among the PTC subtypes. Tall cell subtype PTCs exhibited the highest prevalence of taller-than-wide shapes (<jats:italic>p<\/jats:italic>&amp;lt;0.001) and the absence of echogenic foci (<jats:italic>p<\/jats:italic>=0.047). ETE was not observed in hobnail subtype PTCs (<jats:italic>p<\/jats:italic> =0.008). The vascularity of classic and tall cell subtype PTCs usually presented as absent or rim blood signals, while the hobnail subtype commonly had vessels inside the nodule (<jats:italic>p<\/jats:italic>=0.017). All subtypes of PTC demonstrated similarly high stiffness values on SWE. The mean Emax, Emean, and Emin were 64.6 \u00b1 38.2 kPa, 45.1 \u00b1 29.6 kPa, and 27.7 \u00b1 20.7 kPa, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There were significant differences and several trends in the US characteristics of different intrinsic subtypes, providing imaging diagnostic criteria to assist in managing individuals with PTC.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1674109","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T05:51:58Z","timestamp":1759297918000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Multimodal ultrasound features for distinguishing classic and aggressive subtypes of papillary thyroid carcinoma"],"prefix":"10.3389","volume":"16","author":[{"given":"Bixue","family":"Deng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhuang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiamin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayi","family":"Hong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofeng","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongzhen","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"B1","article-title":"Thyroid cancer incidence and mortality trends in the United States: 2000\u20132018","volume":"32","author":"Megwalu UC, Moon PK","year":"2022","journal-title":"Thyroid"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1530\/erc-22-0293","article-title":"The 2022 who classification of thyroid tumors: novel concepts in nomenclature and grading","volume":"30","author":"Christofer Juhlin","year":"2023","journal-title":"Endocrine-related Cancer"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2022.3875","article-title":"Expanded parameters in active surveillance for low-risk papillary thyroid carcinoma: A nonrandomized controlled trial","volume":"8","author":"Ho","year":"2022","journal-title":"JAMA Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1186\/s13000-019-0924-z","article-title":"Causes of misdiagnoses by thyroid fine-needle aspiration cytology (Fnac): our experience and a systematic review","volume":"15","author":"Zhu","year":"2020","journal-title":"Diagn Pathol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.31884","article-title":"Thyroid cancer \u201cEpidemic\u201d Also occurs in low- and middle-income countries","volume":"144","author":"Lortet-Tieulent","year":"2019","journal-title":"Int J Cancer"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjorl.2020.05.024","article-title":"Grayscale, subjective color doppler, combined grayscale with subjective color doppler in predicting thyroid carcinoma: A retrospective analysis","volume":"88","author":"Wang","year":"2022","journal-title":"Braz J otorhinolaryngology"},{"key":"B7","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1186\/s12880-024-01354-w","article-title":"Application of color doppler ultrasound and us shear wave elastography with connective tissue growth factor in the risk assessment of papillary thyroid carcinoma","volume":"24","author":"Leng","year":"2024","journal-title":"BMC Med Imaging"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.1030143","article-title":"The spoke wheel color doppler blood flow signal is a specific sign of papillary thyroid carcinoma","volume":"13","author":"Xue","year":"2022","journal-title":"Front Endocrinol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-021-01570-z","article-title":"Evaluation of thyroid nodules by shear wave elastography: A review of current knowledge","volume":"44","author":"Swan","year":"2021","journal-title":"J endocrinological Invest"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.755273","article-title":"Real-time elastography: A web-based nomogram improves the preoperative prediction of central lymph node metastasis in Cn0 Ptc","volume":"11","author":"Huang","year":"2021","journal-title":"Front Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5572-x","article-title":"Shear-wave elastography for papillary thyroid carcinoma can improve prediction of cervical lymph node metastasis","volume":"23","author":"Park","year":"2016","journal-title":"Ann Surg Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2024.05.016","article-title":"Thyroid nodules: past, present, and future","volume":"31","author":"Parsa","year":"2025","journal-title":"Endocrine Pract"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1434787","article-title":"Comparison of ultrasound findings of papillary thyroid carcinoma subtypes based on the 2022 who classification of thyroid neoplasms","volume":"15","author":"Hekimsoy","year":"2024","journal-title":"Front Endocrinol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2018.00223","article-title":"Ultrasonographic features of papillary thyroid carcinomas according to their subtypes","volume":"9","author":"Baek","year":"2018","journal-title":"Front Endocrinol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1007\/s12022-011-9160-0","article-title":"Classical and follicular variant papillary thyroid carcinoma: comparison of clinical, ultrasonographical, cytological, and histopathological features in 444 patients","volume":"22","author":"Ozdemir","year":"2011","journal-title":"Endocrine Pathol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"493","DOI":"10.14366\/usg.21200","article-title":"What is the difference between the tall cell variant and the classic type of papillary thyroid carcinoma on ultrasonography","volume":"41","author":"Kim","year":"2022","journal-title":"Ultrasonography (Seoul Korea)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e231481","DOI":"10.1148\/radiol.231481","article-title":"International expert consensus on us lexicon for thyroid nodules","volume":"309","author":"Durante","year":"2023","journal-title":"Radiology"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-020-02441-y","article-title":"2020 Chinese guidelines for ultrasound Malignancy risk stratification of thyroid nodules: the C-Tirads","volume":"70","author":"Zhou","year":"2020","journal-title":"Endocrine"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2005.02.003","article-title":"Thyroid nodules: evaluation with power doppler and duplex doppler ultrasound","volume":"132","author":"Chammas","year":"2005","journal-title":"Otolaryngology\u2013head Neck Surg"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-019-07444-2","article-title":"Papillary thyroid cancers with focal tall cell change are as aggressive as tall cell variants and should not be considered as low-risk disease","volume":"26","author":"Bongers","year":"2019","journal-title":"Ann Surg Oncol"},{"key":"B21","volume-title":"Mathematical Methods of Statistics","author":"Cram\u00e9r","year":"1999"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.4097\/kjae.2016.69.6.555","article-title":"Alternatives to P value: confidence interval and effect size","volume":"69","author":"Lee","year":"2016","journal-title":"Korean J anesthesiology"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2017.12.008","article-title":"Histogram analysis of greyscale sonograms to differentiate between the subtypes of follicular variant of papillary thyroid cancer","volume":"73","author":"Kwon","year":"2018","journal-title":"Clin Radiol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1093\/bjr\/tqae103","article-title":"Predicting tall-cell subtype of papillary thyroid carcinomas independently with preoperative multimodal ultrasound","volume":"97","author":"Ye","year":"2024","journal-title":"Br J Radiol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-024-03854-9","article-title":"Analyzing the correlation between low proportion of hobnail features in papillary thyroid carcinoma and clinical aggressiveness risk","volume":"86","author":"Liu","year":"2024","journal-title":"Endocrine"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-020-01391-1","article-title":"Papillary thyroid cancer-aggressive variants and impact on management: A narrative review","volume":"37","author":"Coca-Pelaz","year":"2020","journal-title":"Adv Ther"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1967\/s002449910552","article-title":"Impact of tall cell variant histology on predicting relapse and changing the management of papillary thyroid carcinoma patients","volume":"20","author":"Gunalp","year":"2017","journal-title":"Hellenic J Nucl Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1089\/thy.2022.0534","article-title":"Papillary thyroid carcinomas with tall cell features: an intermediate entity between classic and tall cell subtypes","volume":"33","author":"Bikas","year":"2023","journal-title":"Thyroid: Off J Am Thyroid Assoc"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad313","article-title":"Cytological and ultrasound features of thyroid nodules correlate with histotypes and variants of thyroid carcinoma","volume":"108","author":"Sgr\u00f2","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2008.0082","article-title":"Microcalcifications and psammoma bodies in thyroid tumors","volume":"18","author":"Triggiani","year":"2008","journal-title":"Thyroid"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpba.2020.113534","article-title":"On the chemical composition of psammoma bodies microcalcifications in thyroid cancer tissues","volume":"190","author":"De Santis","year":"2020","journal-title":"J Pharm Biomed Anal"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2021.09.014","article-title":"The relationship between ultrasound microcalcifications and psammoma bodies in thyroid tumours: A single-institution retrospective study","volume":"77","author":"O\u2019Connor","year":"2022","journal-title":"Clin Radiol"},{"key":"B34","volume-title":"Who Classification of Tumours of Endocrine Organs","year":"2017"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2008.0271","article-title":"Thyroid papillary carcinoma with micropapillary and hobnail growth pattern: A histological variant with intermediate Malignancy","volume":"19","author":"Motosugi","year":"2009","journal-title":"Thyroid"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2012.06.003","article-title":"Papillary thyroid carcinoma with hobnail features: histopathologic criteria to predict aggressive behavior","volume":"44","author":"Asioli","year":"2013","journal-title":"Hum Pathol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3322\/caac.21820","article-title":"Cancer statistics, 2024","volume":"74","author":"Siegel","year":"2024","journal-title":"CA: A Cancer Journal for Clinicians"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.EJ20-0248","article-title":"Case report: exceptionally rapid growth character of hobnail variant of papillary thyroid carcinoma: A report of four cases","volume":"67","author":"Ito","year":"2020","journal-title":"Endocrine J"},{"key":"B39","doi-asserted-by":"publisher","first-page":"89","DOI":"10.7863\/ultra.16.03043","article-title":"Most thyroid cancers detected by sonography lack intranodular vascularity on color doppler imaging: review of the literature and sonographic-pathologic correlations for 698 thyroid neoplasms","volume":"36","author":"Yang","year":"2017","journal-title":"J ultrasound Med"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2024.0586","article-title":"Multimodality ultrasound utilizing microvascular flow imaging and shear wave elastography to guide fine-needle aspiration of thyroid lesions: A prospective study validating pattern-based microvascular classification","volume":"35","author":"Chen","year":"2025","journal-title":"Thyroid"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1674109\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T05:51:59Z","timestamp":1759297919000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1674109\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":40,"alternative-id":["10.3389\/fendo.2025.1674109"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1674109","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]},"article-number":"1674109"}}