Ultrasound Features Of Thyroid Nodules Research Articles

JOURNAL CLUB: Retrospective Evaluation of Ultrasound Features of Thyroid Nodules to Assess Malignancy Risk: A Step Toward TIRADS.

The aim of this retrospective study was to develop a thyroid nodule scoring system for malignancy potential to better select nodules for ultrasound (US)-guided fine needle aspiration (FNA). US-guided FNA was performed on 2375 thyroid nodules in successive patients. Cytologic or histopathologic confirmation of disease state in 2002 lesions showed that 148 were malignant. We developed an extended scoring system to provide more decision levels than standard scoring by including weak (macrocalcification, eggshell calcification, hypoechogenicity, solid consistency) as well as strong indicators of malignancy (microcalcification, hypoechogenicity, lobulated or ill-defined margins, taller-than-wide shape, suspicious lymph nodes) and by including contraindications (hyperechogenicity, comet-tail artifact, complete halo, cystic or microcystic). ROC analysis was used to compare detection accuracy and decision thresholds resulting from standard scoring using five major features with extended scoring. Although an accuracy advantage was found for the extended scoring over standard scoring, we discount this finding because our scoring involved a preliminary analysis. However, the extended scoring offers more reporting options for certainty of malignancy: standard scoring gave four potential thresholds for reporting; extended scoring gave nine. The most useful of the additional thresholds captured nearly 88% of malignancies but resulted in only 28% of patients without malignancy undergoing biopsy. Our extended Thyroid Imaging Reporting and Data System scoring provides more operating points to support treatment decisions. A simplified decision rule-biopsy every nodule with at least two weak features or one strong feature-preserves the most useful of the new decision thresholds from extended scoring.

Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies.

Background: Thyroid nodules are a common finding in the general population, and their detection is increasing with the widespread use of ultrasound (US). Thyroid cancer is found in 5–15% of cases depending on sex, age, and exposure to other risk factors. Some US parameters have been associated with increased risk of malignancy. However, no characteristic seems sufficiently reliable in isolation to diagnose malignancy. The objective of this meta-analysis was to evaluate the diagnostic performance of US features for thyroid malignancy in patients with unselected thyroid nodules and nodules with indeterminate fine-needle aspiration (FNA) cytology.Methods: Electronic databases were reviewed for studies published prior to July 2012 that evaluated US features of thyroid nodules and reported postoperative histopathologic diagnosis. A manual search of references of review and key articles, and previous meta-analyses was also performed. A separate meta-analysis was performed including only nodules with indeterminate cytology. Analyzed features were solid structure, hypoechogenicity, irregular margins, absence of halo, microcalcifications, central vascularization, solitary nodule, heterogeneity, taller than wide shape, and absence of elasticity.Results: Fifty-two observational studies (12,786 nodules) were included. Nine studies included nodules with indeterminate cytology as a separate category, comprising 1851 nodules. In unselected nodules, all US features were significantly associated with malignancy with an odds ratio varying from 1.78 to 35.7, and microcalcifications, irregular margins, and a taller than wide shape had high specificities (Sp; 87.8%, 83.1%, 96.6%) and positive likelihood ratios (LHR; 3.26, 2.99, 8.07). Absence of elasticity was the single feature with the best diagnostic performance (sensitivity 87.9%, Sp 86.2%, and positive LHR 6.39). The presence of central vascularization was the most specific US feature in nodules with indeterminate cytology (Sp 96% and positive LHR 2.13).Conclusions: US features in isolation do not provide reliable information to select nodules that should have a FNA performed. A combination of US characteristics with higher likelihood ratios and consequently with higher post-test probabilities of malignancy—microcalcifications, or a taller than wide shape, or irregular margins, or absence of elasticity—will probably identify nodules with an increased risk for malignancy. Further studies are required to standardize elastography techniques and evaluate outcomes, especially in nodules with an indeterminate cytology.

Thyroid nodule ultrasound: technical advances and future horizons.

Thyroid nodules are extremely common and the vast majority are non-malignant; therefore the accurate discrimination of a benign lesion from malignancy is challenging. Ultrasound (US) characterisation has become the key component of many thyroid nodule guidelines and is primarily based on the detection of key features by high-resolution US. The thyroid imager should be familiar with the strengths and limitations of this modality and understand the technical factors that create and alter the imaging characteristics. Specific advances in high-resolution US are discussed with reference to individual features of thyroid cancer and benign disease. Potential roles for three-dimensional thyroid ultrasound and computer-aided diagnosis are also considered. The second section provides an overview of current evidence regarding thyroid ultrasound elastography (USE). USE is a novel imaging technique that quantifies tissue elasticity (stiffness) non-invasively and has potential utility because cancers cause tissue stiffening. In recent years, there has been much research into the value of thyroid USE for distinguishing benign and malignant nodules. Preliminary findings from multiple pilot studies and meta-analyses are promising and suggest that USE can augment the anatomical detail provided by high-resolution US. However, a definite role remains controversial and is discussed.Teaching points • High-resolution US characterises thyroid nodules by demonstration of specific anatomical features • Technical advances heavily influence the key US features of thyroid nodules • Most papillary carcinomas appear stiffer than benign thyroid nodules on US elastography (USE) • Thyroid USE is controversial because of variation in the reported accuracies for malignancy • Combined grey-scale US/USE may lower the FNAC rate in benign nodules

The reliability of thyroid nodule ultrasound features and size to predict malignancy in fine needle aspiration specimens: Practical utility for the evaluating pathologist.

The prognostic impact of ultrasound features of thyroid nodules is debated. We explore the correlation between nodule size, echogenicity on US, and malignancy. We performed a retrospective review of thyroid nodules undergoing ultrasound guided FNA (US-FNA) at our institution between 01/2008-05/2013. In all, 2,403 nodules from 2,293 patients (age range 14-91, mean 54, median 56, M: F-1:3.2) underwent US-FNA. 766 nodules were resected, 337 were malignant (size range 0.4-8.7 cm, median 2 cm, mean 2.37 cm,) and 429 were benign (size range 0.5-9.7 cm, median 2.5 cm, mean 2.79 cm). The malignant diagnoses included: classical variant of PTC 77 (size range 0.5-5.5 cm, mean 1.5 cm), follicular variant of PTC 209 (size range 0.14-7.5 cm, mean 2.1 cm), tall cell variant of PTC 7 (size range 0.5-2.4 cm, mean1.4 cm), poorly differentiated carcinoma 5 (size range 5-8.7 cm, mean 6.42 cm), follicular carcinoma 27 (size range 0.5-7 cm, mean 3.03 cm), and oncocytic follicular carcinoma 9 cases (size range 1.4-7.2 cm, mean 3.2 cm). Of the malignant nodules with echogenicity reported on US, 93 were hypoechoic, 26 hyperechoic, 20 isoechoic, and 76 heteroechoic; increased vascularity on US was seen in 69/337 (20%). On US, 105 benign nodules were reported as hypoechoic, 35 hyperechoic, 43 isoechoic, and 100 as heterogeneous; increased vascularity on US was seen in 88/429 (20%). A malignant diagnosis was more common in thyroid nodules ≤1.0 cm. No differences were noted in the US-features of benign and malignant thyroid nodules.

Repeat FNA Is Unnecessary for Many Nodules with Initially Nondiagnostic Results

Background The reported diagnostic yield of thyroid FNA varies from 80% to 99%. A nondiagnostic thyroid FNA result is a common clinical challenge. Current guidelines recommend repeat FNA after a nondiagnostic result (1). A recent study (2) suggests that the incidence of malignancy at repeat FNA is lower than the malignancy rate for the initial biopsy. The purpose of this study was to identify demographic and ultrasound features of thyroid nodules that may be predictive of malignancy or benignity after initial nondiagnostic FNA results to clarify the role of repeat FNA, surgical excision, or serial ultrasound in these nodules.

Striving toward standardization of reporting of ultrasound features of thyroid nodules and lymph nodes: a multidisciplinary consensus statement.

The use of high-resolution ultrasound (US) imaging is a mainstay of the initial evaluation and long-term management of thyroid nodules and thyroid cancer. To fully capitalize on the diagnostic capabilities of a US examination in the context of thyroid disease, many clinicians consider it desirable to establish a universal format and standard of US reporting. The goals of this interdisciplinary consensus statement are twofold. First, to create a standardized set of US features to characterize thyroid nodules and cervical lymph nodes accurately, and second, to create a standardized system for tracking sequential changes in the US examination of thyroid nodules and cervical lymph nodes for the purpose of determining risk of malignancy. The Thyroid, Head and Neck Cancer (THANC) Foundation convened a panel of nine specialists from a variety of medical disciplines that are actively involved in the diagnosis and treatment of thyroid nodules and thyroid cancer. Consensus was achieved on the following topics: US evaluation of the thyroid gland, US evaluation of thyroid nodules, US evaluation of cervical lymph nodes, US-guided fine needle aspiration (FNA) of thyroid nodules, and US-guided FNA of cervical lymph nodes. We propose that this statement represents a consensus within a multidisciplinary team on the salient and essential elements of a comprehensive and clinically significant thyroid and neck US report with regards to content, terminology, and organization. This reporting protocol supplements previous US performance guidelines by not only capturing categories of findings that may have important clinical implications, but also delineating findings that are clinically relevant within those categories as specifically as possible. Additionally, we have included the specific features of diagnostic and therapeutic interventions that have not been previously addressed.

Epidemiological characteristics of thyroid nodules and risk factors for malignant nodules: a retrospective study from 6 304 surgical cases

Background The prevalence of thyroid nodules (TN) is increasing rapidly. This study analyzed the epidemiological and clinical characteristics of TN in surgically treated patients and identified the risk factors for malignant nodules (MN) to provide more understanding of the differential diagnosis of TN. Methods A total of 6 304 TN cases who underwent thyroid surgery were included in this retrospective study. The clinical data were collected to evaluate the clinical and epidemiological characteristics and related risk factors for MN. The nature of TN (benign nodules (BN) or MN), medical records, laboratory data, and imaging data were analyzed. The risk factors for MN were screened using Spearman's rank correlation analysis and nonconditional binary Logistic regression analysis. Results The number of surgically treated TN cases increased yearly. A total of 34.33% of cases were MN and 65.67% were BN. Up to 56.74% of these cases underwent unnecessary surgery. Among the MN cases, papillary thyroid carcinoma accounted for 94%, in which 46.71% coexisted with benign thyroid disease and 32.28% with multiple foci. Single-related factor analysis showed that age, employment, disease duration, history of breast nodules and/or hypertension, the levels of serum thyroid-stimulating hormone (TSH), thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPoAb), and ultrasound features of TN were related to MN. Stepwise nonconditional binary Logistic regression analysis showed that 13 factors may be the independent risk factors for MN, including <40 years old, previous history of breast nodules and/or hypertension, disease duration <1 month, employment, hypoechoic nodule, irregular nodules, nodule calcification, solid echo nodule, fuzzy boundary, rich blood flow within nodules, abnormal lymph nodes around the neck, nodule diameter <1 cm, and abnormally high TgAb. Conclusions Our results demonstrate a rapid increase in surgically treated TN cases and ratio of MN and indicate unnecessary surgeries in some cases. This study also suggest that age, duration of thyroid disease, history of breast disease and/or hypertension, the levels of serum TSH, TgAb, and TPoAb, and ultrasound features of TN are related to MN, and some of these factors may be the risk factors for MN.

Erratum: Image Reporting and Characterization System for Ultrasound Features of Thyroid Nodules: Multicentric Korean Retrospective Study

Erratum: Image Reporting and Characterization System for Ultrasound Features of Thyroid Nodules: Multicentric Korean Retrospective Study

Image Reporting and Characterization System for Ultrasound Features of Thyroid Nodules: Multicentric Korean Retrospective Study

ObjectiveThe objective of this retrospective study was to develop and validate a simple diagnostic prediction model by using ultrasound (US) features of thyroid nodules obtained from multicenter retrospective data.Materials and MethodsPatient data were collected from 20 different institutions and the data included 2000 thyroid nodules from 1796 patients. For developing a diagnostic prediction model to estimate the malignant risk of thyroid nodules using suspicious malignant US features, we developed a training model in a subset of 1402 nodules from 1260 patients. Several suspicious malignant US features were evaluated to create the prediction model using a scoring tool. The scores for such US features were estimated by calculating odds ratios, and the risk score of malignancy for each thyroid nodule was defined as the sum of these individual scores. Later, we verified the usefulness of developed scoring system by applying into the remaining 598 nodules from 536 patients.ResultsAmong 2000 tumors, 1268 were benign and 732 were malignant. In our multiple regression analysis models, the following US features were statistically significant for malignant nodules when using the training data set: hypoechogenicity, marked hypoechogenicity, non-parallel orientation, microlobulated or spiculated margin, ill-defined margins, and microcalcifications. The malignancy rate was 7.3% in thyroid nodules that did not have suspicious-malignant features on US. Area under the receiver operating characteristic (ROC) curve was 0.867, which shows that the US risk score help predict thyroid malignancy well. In the test data set, the malignancy rates were 6.2% in thyroid nodules without malignant features on US. Area under the ROC curve of the test set was 0.872 when using the prediction model.ConclusionThe predictor model using suspicious malignant US features may be helpful in risk stratification of thyroid nodules.

Incidentally discovered thyroid nodules: incidence, and greyscale and colour Doppler pattern in an adult population screened by real-time compound spatial sonography

Our aim was to assess the incidence and ultrasound features of thyroid nodules in an adult population screened by means of high-resolution ultrasonography (HRUS) and to evaluate the contribution of real-time spatial compound sonography (CS) in terms of image quality. A total of 704 consecutive patients (400 women, 304 men) without thyroid disease underwent HRUS and CS examination of the thyroid gland. Number, size, location, echotexture and colour Doppler pattern of detected nodules were assessed. Two radiologists also assessed image quality of the two techniques. Seven hundred and eleven thyroid nodules (size range 0.18-4.1 cm; mean: 1.1 cm) were detected in 233 subjects (33.1%). Of these, 416 (58.5%) were found in 143 women whereas 295 (41.5%) were detected in 90 men. In both genders, the number of detected nodules increased with age, with the highest prevalence in the seventh decade (p<0.001). There were 461/711 (64.9%) thyroid nodules that were hypoechoic, and 449/711 (63.1%) had peripheral vascularity only (p<0.001). Fine-needle aspiration (FNA) revealed no malignancies. CS was graded better than HRUS in 621/711 (87.3%) cases (p<0.001). The prevalence of benign, small, hypoechoic thyroid nodules with peripheral vascularity was high in our series, thus suggesting a conservative approach. CS provided better image quality compared with HRUS.

Diagnostic Use of Ultrasonography in Patients with Nodular Thyroid Disease

To review the published reports pertaining to the diagnostic utility of ultrasonography for evaluation of thyroid nodules. Various roles for diagnostic thyroid ultrasonography and screening ultrasound studies of the thyroid are discussed, and ultrasound characteristics of thyroid nodules and their association with malignant potential are described. In two studies that correlated ultrasound findings with physical examination findings in patients with a solitary thyroid nodule detected by palpation, 16% of such patients had no corresponding nodule evident on ultrasonography, and 45% of such patients had an additional nodule detected by ultrasonography. Similarly, approximately 18% of patients with a palpable multinodular thyroid had no nodules larger than 1 cm in diameter on ultrasound studies. Thyroid nodules larger than 1 cm have been found by ultrasonography to be present in from 2 to almost 5% of the population with normal findings on examination of the thyroid. Use of screening ultrasound study of the thyroid has been suggested for patients with a history of childhood irradiation to the head and neck or a family history of thyroid cancer. Numerous investigations that have evaluated ultrasound features of thyroid nodules have suggested five characteristics as suggestive of malignant potential--hypoechogenicity, microcalcifications, irregular or microlobulated border, absent or irregular thick halo, and increased intranodular vascularity. Correlation of ultrasound and palpation findings will provide a comprehensive evaluation of nodular thyroid disease. Moreover, real-time ultrasonography facilitates characterization of features associated with an increased risk of a malignant lesion. High-resolution thyroid ultrasonography is a dynamic tool for endocrinologists.