Is Doppler ultrasound of additional value to gray-scale ultrasound in differentiating malignant and benign thyroid nodules?

Pedro Weslley Rosario,Michelle Aparecida Ribeiro Borges,Maria Regina Calsolari,Alexandre Lemos Da Silva

doi:10.1590/2359-3997000000014

Pedro Weslley Rosario, Michelle Aparecida Ribeiro Borges + Show 2 more

Open Access

https://doi.org/10.1590/2359-3997000000014

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Abstract

The objective of this study was to evaluate whether Doppler ultrasound (DUS) is of additional value to gray-scale ultrasound (GSUS) in predicting the benign or malignant nature of thyroid nodules. A total of 1,502 solid thyroid nodules ≥ 10 mm were evaluated. Suspicious vascularity (predominantly or exclusively central blood flow) was observed in only 5% of the nodules. This finding showed 96% specificity, but only 15% sensitivity. GSUS alone showed sensitivity and specificity of 88.7% and 68.2%, respectively, which did not improve with the addition of DUS (sensitivity of 89.4% and specificity of 66.4%). In non-suspicious nodules on GSUS, the type of vascularity on DUS did not modify the risk of malignancy, which was low. In suspicious nodules on GSUS, suspicious vascularity on DUS increased the risk of malignancy, but non-suspicious vascularity did not reduce this risk. DUS provided no additional value to GSUS in predicting the benign or malignant nature of thyroid nodules.

Highlights

The current indications for fine-needle aspiration (FNA) of thyroid nodules < 10 mm are highly selective [1,2,3,4,5,6,7]
In addition to the controversy regarding the use of Doppler US for the differentiation of benign and malignant nodules, there is no consensus which type of vascularity would be considered suspicious of malignancy
The objective of the present study was to determine whether Doppler US is of additional diagnostic value to gray-scale ultrasound (GSUS) in predicting the nature of solid thyroid nodules ≥ 10 mm

Summary

Introduction

The current indications for fine-needle aspiration (FNA) of thyroid nodules < 10 mm are highly selective [1,2,3,4,5,6,7]. In addition to the controversy regarding the use of Doppler US for the differentiation of benign and malignant nodules, there is no consensus which type of vascularity would be considered suspicious of malignancy. Some organization such as the American Thyroid Association [2], American Association of Clinical Endocrinologists and European Thyroid Association [12], European Society for Medical Oncology [5], and National Comprehensive Cancer Network [7] consider “increased intranodal vascularity” as suspicious, without requiring that vascularity is predominantly or exclusively intranodal. Others such as the Society of Radiologists in Ultrasound [1], French Society of Endocrinology [13], and Brazilian Society of Endocrinology [6] propose only “predominantly or exclusively central” blood flow to be defined as suspicious

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