Journal List > J Korean Thyroid Assoc > v.6(2) > 1056530

Seung, Young, Yong, Myung, and Young: Otolaryngologist-Performed Ultrasound and Ultrasound-Guided Fine Needle Aspiration for Thyroid Nodule and Meaningful Ultrasound Finding


Background and Objectives

Ultrasonography is a safe and noninvasive imaging modality with high sensitivity that can be used to identify the presence, location, and size of thyroid nodules. Fine-needle aspiration (FNA) biopsy of thyroid nodules is a minimally invasive and safe procedure that is usually performed on an outpatient basis. The purpose of this study was to investigate the diagnostic efficacy of ultrasonography performed by an otolaryngologist (OUS) and OUS-guided FNA for the thyroid and determine the clinical value of OUS in predicting the presence of malignancy in thyroid nodules.

Materials and Methods

A single otolaryngologist examined 151 consecutive patients referred to our institution and performed OUS or OUS-guided FNA biopsies on all of them in an office setting. Final diagnosis was based on the FNA biopsy or pathological result of operation. We used the following parameters to assess the relevance of the sonographic findings in the prediction of thyroid malignancy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and relative risk (RR).


In total, 12.9% of all the patients showed malignancy. The PPVs for the sonographic features were as follows: a taller-than-wide shape, 63.6%; marked hypoechogenicity, 61.5%; microcalcification, 46.7%; microcalcification or macrocalcification, 44.0%; and spiculated margin, 38.2%. The RR values showed that microcalcification or macrocalcification (p<0.05, RR=7.2) and marked hypoechogenicity (p<0.05, RR=6.7) are significant findings that indicate thyroid malignancy.


Microcalcification or macrocalcification and marked hypoechogenicity observed on OUS are significant finding that indicate thyroid malignancy, and the most reliable finding are microcalcification or macrocalcification.


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Table 1.
Cytologic results of OUS-guided FNA
Cytologic results Number of patients (%)
Unsatisfactory 13 (12.9)
Benign 67 (66.3)
Atypia 5 (5)
Follicular neoplasm 0
Suspicious for malignancy 3 (3)
Malignancy 13 (12.9)
Table 2.
Diagnostic index for individual sonographic criteria of malignant thyroid nodule
US characteristics Sensitivity (%) Specificity (%) PPV (%) NPV (%)
Taller than wide 43.8 94.0 63.6 87.5
Spiculated margin 81.3 68.7 38.2 93.9
Microcalcification 43.8 88.1 46.7 86.8
Microcalcification or macrocalcification 68.8 79.1 44.0 91.4
Marked hypoechogenicity 50.0 92.5 61.5 88.6

PPV: positive predictive value, NPV: negative predictive value

Table 3.
Results of univariate analysis for individual sonographic criteria of malignant thyroid nodules
US characteristics Relative risk p value
Taller than wide 9.б 0.00б
Spiculated 12.1 0.001
Microcalcification б.б 0.00б
Microcalcification or macrocalcification 8.2 0.001
Marked hypoechogenicity 12.2 < 0.01
Table 4.
Risk for individual sonographic criteria of malignant thyroid nodules (multivariate logistic regression analysis)
US characteristics Relative risk 9б% CI p value
Taller than wide б.б 1.0-42.1 0.0б0
Spiculated б.3 0.8-3б.2 0.087
Microcalcification 0.8 0.1-б.8 0.830
Microcalcification or macrocalcification 7.2 1.б-33.1 0.011
Marked hypoechogenicity б.7 1.2-38.3 0.034

CI: confidence interval

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