Can ultrasound be used to predict malignancy in patients with a thyroid nodule and an indeterminate fine-needle aspiration biopsy?

Abstract

The purpose of this study was to evaluate whether ultrasonography is helpful in predicting malignancy in patients with a thyroid nodule and atypia/follicular lesion of undetermined significance (AFLUS). All patients with a preoperative ultrasound who underwent thyroidectomy for a nodule with AFLUS comprised the study population. A blinded review of gray-scale and color-Doppler sonographic images of the thyroid nodule was performed by an expert sonographer; results were compared with the original interpretation and were correlated with histopathology. All images were reviewed for hypoechogenicity, irregular margins, shape that was taller than wide, micro and macrocalcifications, absent halo, and intranodular hypervascularity. From 2010 to 2012, 61 patients underwent thyroidectomy for AFLUS with an ultrasound examination for review; 6 (10%) with cancer. Nodule shape that was taller than wide, was associated with cancer (P<.05). The original sonographer commented on an average of two of seven features important in assessment of a thyroid nodule. With the exception of nodule height greater than width, sonographic criteria were not helpful in deciding which patients with AFLUS should undergo thyroidectomy. Thyroidectomy is recommended in lieu of repeat biopsy for a nodule that is taller than wide. Standardized sonographic reporting should be implemented.