Abstract
IntroductionA discussion in literature about a standardized decision support tool for the management of thyroid nodules remains.ObjectiveThe purpose of this study was to create a statistical prediction model for thyroid nodules management.MethodsTwo hundred and four benign and 57 malignant thyroid nodules were selected for a retrospective study. The variables age, gender and ultrasonographic features were examined using univariate and multivariate models. A statistical formula was used to calculate the risk of cancer of each case.ResultsIn multivariate analysis, irregular shape, absence of halo, lower mean age, homogeneous echotexture, microcalcifications and solid content were associated with cancer. After applying the formula, 20 cases (7.6%) with a calculated risk for malignancy ≤3.0% were found, all of them benign. Setting the calculated risk in ≥80%, 21 (8.0%) cases were selected, and in 85.7% of them cancer was confirmed in histopathology. Internal accuracy of the prediction formula was 92.5%.ConclusionsThe prediction formula reached high accuracy and may be an alternative to other decision support tools for thyroid nodule management.
Highlights
The incidence of thyroid cancer has been rising around the world.1---3 Despite the high prevalence of thyroid nodules (19---67% on ultrasonography --- US), most of them are benign
About 5---10% of diagnosed nodules are malignant, it is well known that this frequency may be higher when considering occasional diagnosis of small microcarcinomas.4---6
Malignancy was found after histopathological study in 57 (21.8%) resected nodules (55 papillary carcinoma and 2 follicular carcinoma)
Summary
The incidence of thyroid cancer has been rising around the world.1---3 Despite the high prevalence of thyroid nodules (19---67% on ultrasonography --- US), most of them are benign. About 5---10% of diagnosed nodules are malignant, it is well known that this frequency may be higher when considering occasional diagnosis of small microcarcinomas.4---6. The investigation of these lesions usually requires clinical and imaging examination of the neck, sometimes associated with fine-needle aspiration biopsy (FNAB). Among these imaging tests, US are a safe, cheap, noninvasive and nonradioactivity tool, able to detect and qualitatively evaluate the nodules. No US sign showed to be pathognomonic of malignancy, the combination of several characteristics may help determinate the malignancy risk of a nodule.7---9
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