Abstract
To determine sonographic features of malignancy in partially cystic thyroid nodules and assess the diagnostic efficacy of these features for differentiating between benign and malignant lesions in the nodules with indeterminate cytology. From January 2016 to December 2017, a total of 91 patients with 94 partially cystic thyroid nodules who had undergone ultrasound-guided fine-needle aspiration biopsy and thyroid surgery in our hospital were included in this study. The sonographic features of the thyroid nodules were analyzed to identify the predictive features of malignancy and assess the diagnostic efficacy of these features. The features of hypoechogenicity, microcalcification, composition, and an eccentric solid component with an acute angle had statistically significant associations with malignant nodule (p<005) by univariable analysis. Binary logistic regression analysis showed that microcalcification and hypoechogenicity were significantly associated with malignancy. Using the combination of microcalcification, hypoechogenicity, and a solid component comprising of greater than or equal to 50% of the total volume, the diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 97.6%, 32.7%, 53.9%, and 94.4%, respectively. In these nodules with indeterminate cytology, this combination also exhibited a high sensitivity of 92.3% and an NPV of 83.3%. This study demonstrated that microcalcification and hypoechogenicity were independently associated with malignancy in partially cystic thyroid nodules. The combination of microcalcification, hypoechogenicity, and a solid portion that is greater than or equal to 50% of the total volume will help guide clinical decisions in mixed cystic solid nodules.
Highlights
Thyroid nodules are a common clinical problem, occurring in 19-68% of the healthy population [1,2]
Patients who met the following criteria were included in this study: [1] each nodule consisted of a solid and cystic component; [2] the patients underwent US-guided fine-needle aspiration biopsy (FNAB) based on the 2015 American Thyroid Association (ATA) guidelines or at the patients’ request, and [3] the histopathologic result of each nodule was confirmed after surgery
The 2015 American Thyroid Association (ATA) guidelines have addressed the clinical management of partially cystic thyroid nodules based on a small number of studies [6]
Summary
Thyroid nodules are a common clinical problem, occurring in 19-68% of the healthy population [1,2]. US features including hypoechogenicity, a tallerthan-wide shape, the presence of microcalcifications, and lobulated/irregular margin are widely applied to differentiate benign from malignant nodules in solid thyroid nodules [6,11,12,13,14]. Sonographic features as predictors for risk of malignancy in PCTNs are different from that of solid nodules [7].
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