Abstract
Simple SummaryThyroid nodules are a frequent clinical issue. Their incidence has increased mainly due to the widespread use of neck ultrasound scans. Most thyroid nodules are asymptomatic, incidentally discovered, and benign at cytology. Thyroid ultrasound is the most sensitive diagnostic tool to evaluate patients with nodular thyroid disease. It is therefore important to use the ultrasound features to select nodules that require a fine-needle aspiration cytology.Thyroid nodules are common in iodine deficient areas, in females, and in patients undergoing neck irradiation. High-resolution ultrasonography (US) is important for detecting and evaluating thyroid nodules. US is used to determine the size and features of thyroid nodules, as well as the presence of neck lymph node metastasis. It also facilitates guided fine-needle aspiration (US-FNA). The most consistent US malignancy features of thyroid nodules are spiculated margins, microcalcifications, a taller-than-wide shape, and marked hypoechogenicity. Increased nodular vascularization is not identified as a predictor of malignancy. Thyroid elastosonography (USE) is also used to characterize thyroid nodules. In fact, a low elasticity of nodules at USE has been related to a higher risk of malignancy. According to their US features, thyroid nodules can be stratified into three categories: low-, intermediate-, and high-risk nodules. US-FNA is suggested for intermediate and high-risk nodules.
Highlights
Thyroid nodules are detected in 50–65% of healthy individuals, the majority being asymptomatic and discovered incidentally [1,2]
The risk factors associated with a higher probability of malignancy include a history of neck irradiation, a family history of medullary thyroid carcinoma or multiple endocrine neoplasia (MEN2), age < 20 years or >60 years, male sex, rapid growth, a firm and hard consistency, and the presence of suspicious cervical lymph nodes [3,4,5,6,7,8]
Given that a carcinoma is harder than a normal thyroid parenchyma or a benign nodule, a high stiffness on US Elastosonography (USE) has been suggested as a good predictor of malignancy [68,69,70,71,72,73]
Summary
Thyroid nodules are detected in 50–65% of healthy individuals, the majority being asymptomatic and discovered incidentally [1,2]. Thyroid US has been considered as the cornerstone for the management of thyroid nodules, there is no clear consensus on nodule selection for US-guided FNA [11,12,13,14], on a standardized terminology for US features [15,16,17,18,19,20]. Due to their increased detection, thyroid nodules represent a clinical challenge [15,16,17,18,19,20]. Several endocrine societies have developed various US-based guidelines and recommendations for managing thyroid nodules [16,17,18,19,20,21,22]
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