Ultrasound-guided thyroid nodule biopsy in esophageal cancer patients with thyroid nodules for surgical decision-making clinical value

Abstract

BACKGROUND

Esophageal cancer is a highly malignant digestive tract tumor with severe consequences, and radical surgery remains its primary treatment modality. Precise preoperative assessment is crucial for identifying suitable candidates for surgery. Some esophageal cancer patients present with concomitant thyroid masses, whose nature directly determines treatment strategy selection. Current conventional imaging methods offer limited specificity for the differential diagnosis of thyroid masses. Ultrasound-guided fine-needle aspiration biopsy (US-FNAB), as a minimally invasive diagnostic technique, can provide cytological evidence; however, its decision-guidance value in this specific patient population remains unclear.

AIM

To investigate the clinical use of US-FNAB in the esophagectomy decision-making process for patients with thyroid lesions and esophageal cancer.

METHODS

This retrospective cohort study included 120 patients with thyroid nodules and esophageal cancer treated between May 2023 and May 2025. They were divided into surgical (n = 85) and non-surgical (n = 35) groups based on esophagectomy status. Clinical data, ultrasound features, fine-needle aspiration biopsy, and pathology results were compared. Binary logistic regression identified independent factors influencing surgical decisions.

RESULTS

No statistically significant differences were found between the two groups in baseline characteristics including age, sex, body mass index, and comorbidities (P > 0.05). However, the non-surgical group had a significantly higher proportion of stage IV esophageal cancer (51.43% vs surgical group, P < 0.05) and thyroid nodules with malignant ultrasound features (e.g., solid composition, hypoechoicity; P < 0.05). Suspected or confirmed thyroid malignancy was also more frequent in the non-surgical group (48.57% vs 7.06%, P < 0.05). Multivariate analysis identified US-FNAB results and esophageal cancer stage as factors influencing non-operative management. Using pathology as the gold standard, US-FNAB showed 90.00% sensitivity, 95.00% specificity, and 94.20% accuracy for diagnosing thyroid malignancy (P < 0.05).

CONCLUSION

US-FNAB guides treatment decisions in esophageal cancer patients with thyroid lesions, avoiding unnecessary surgery for metastases and adjusting plans for combination therapy.

Keywords: Esophageal cancer; Thyroid nodules; Surgical decision-making; Ultrasound-guided thyroid nodule biopsy; Diagnostic value

Core Tip: In a study examining treatment decisions for patients with esophageal cancer and thyroid masses, we confirmed that after adjusting for multiple factors in esophageal cancer clinical staging, malignant results from thyroid nodule fine-needle aspiration biopsy remain an independent predictor influencing esophageal resection. This finding demonstrates that ultrasound-guided fine-needle aspiration biopsy can participate in the surgical decision-making pathway by clarifying the nature of thyroid lesions preoperatively. This study supports establishing a standardized pathway within a multidisciplinary diagnostic and treatment framework, encompassing “imaging screening-needle biopsy confirmation-integrated decision-making”, to enhance the precision of therapeutic strategies.