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Abstract
Purpose
Follicular neoplasms (FNs) such as follicular adenoma and carcinoma (FTC), nodular hyperplasia (NH) and follicular variant of papillary carcinoma (FVPC) share cytological features. In the present study, we investigate whether review of sonographic findings in patients with thyroid nodules suspicious of FN spares diagnostic thyroidectomies (DTs) by excluding benign diseases such as NH or not.
Methods
From June 1999 to May 2007, DTs were performed on 98 patients who had nodules suspicious of FN. High resolution sonographic findings are available for 53 patients. According to the final histologic diagnosis: Group I (23 patients) consisted of 20 FNs (11 FTCs), 1 Hürthle cell adenoma, 2 FVPC; Group II (30 patients) consisted of all others (23 NHs, 4 Hashimoto's thyroiditis, 3 papillary carcinomas (PTCs). Sonographic features were compared between the two groups.
Results
Three differential sonographic findings (DSF) i.e. irregular margin, absence of peripheral halo or marked inhomogeniety were identified more often in Group II than Group I (P<0.05). If we spared DTs for patients who have at least one DSF, 18 patients (34.0%) would have been selected for clinical follow-up whose final diagnoses were 14 NHs and 4 PTCs (including 1 FVPC). Sparing DTs by DSFs shows sensitivity, 56.7%; specificity, 95.7%; positive predictive value, 94.4%; negative predictive value, 62.9%; and accuracy, 73.6%, respectively.
Figures and Tables
Fig. 1
Ultrasonographic feature and characteristics of thyroid nodules. Demarcation, smooth (A) versus irregular (B); peripheral low echogenic rim (halo), present (C) versus absent (D); degree of inhomogeneity, mild to moderate (E) versus marked (F).
Table 2
Selection of Group 2 patients by differential sonographic findings
*DSF = differential sonographic findings (an irregular margin, absence of peripheral halo, and marked inhomogeneity); †A case of papillary thyroid carcinoma of a follicular variant; ‡Three cases of papillary thyroid carcinoma, 2 of them are suspected malignancy by sonographic findings. Sensitivity = 56.7%, specificity = 95.7%, positive predictive value = 94.4%, negative predictive value = 62.9%, accuracy = 73.6%, odd ratio = 28.8, relative risk = 2.5.
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