Journal List > Korean J Endocr Surg > v.10(4) > 1060008

M.D., M.D., M.D., M.D., M.D., and M.D.: Sonographic Analysis of Malignant Thyroid Nodules by Surgeon

Abstract

Purpose:

Ultrasound is most effective study for evaluating thyroid nodules. In this review, we discuss that sonographic findings to differentiate benign from malignant nodules and suggest recommendations for indications of fine needle aspiration biopsy and thyroid nodule management.

Methods:

Sonographic scans of 206 thyroid nodules in 164 patients were candidated for this study. We evaluated sonographic findings by shape, calcification, margin, and echogenicity, retrospectively. Sonographic findings that suggested malignancy included microcalcifications, a speculated margin, marked hypoechogenicity and a shape that was taller than wide. The final diagnosis of lesion as benign (n=180) or malignant (n=26) was confirmed by fine needle aspiration biopsy and follow-up (>6 months). We demonstrated the difference of the sensitivity, specificity, positive predictive value, negative predictive value and accuracy.

Results:

Of 206 thyroid nodules, 26 were malignant. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy based on our sonographic classification method were 84.6%, 73.9%, 31.9%, 97.0% and 75.2%. Conclusion: Sonography can be helpful for making the differentiation between and malignant nodules. So, when well trained surgeon find thyroid nodules on sonography, we can make correct diagnosis of malignant nodules. (Korean J Endocrine Surg 2010;10:224-228)

REFERENCES

1.Harach HR., Franssila KO., Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systemic autopsy study. Cancer. 1985. 56:531–8.
2.Brander A., Viikinkoski P., Nickels J., Kivisaari L. Thyroid gland: US screening in a random adult population. Radiology. 1991. 181:683–7.
crossref
3.Tan GH., Gharib H. Thyroid incidentalomas: Management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 1997. 126:226–31.
crossref
4.Frates MC., Benson CB., Charboneau JW., Cibas ES., Clark OH., Coleman BG, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2005. 237:794–800.
crossref
5.Nam-Goong IS., Kim HY., Gong G., Lee HK., Hong SJ., Kim WB, et al. Ultrasonography-guided fine needle aspiration of thyroid incidentaloma: Correlation with pathological findings. Clin Endocrinol (Oxf). 2004. 60:21–8.
6.American Association of Clinical Endocrinologists and Associzione Midici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2006. 12:63–102.
7.Moon WJ., Jung SL., Lee JH., Na DG., Baek JH., Lee YH, et al. Benign and malignant thyroid nodule: US differentiation - ulticenter retrospective study. Radiology. 2008. 247:762–70.
8.Koike E., Noguchi S., Yamashita H., Murakami T., Ohshima A., Kawamoto H, et al. Ultrasonographic characteristics of thyroid nodules: prediction of malignancy. Arch Surg. 2001. 136:334–7.
9.Cochand-Priollet B., Guillausseau PJ., Chanon S., Hoand C., Guillausseau-Scholer C., Chanson P. The diagnostic value of fine-needle aspiration biopsy under ultrasonography in nonfunctional thyroid nodules: a prospective study comparing cytology and histologic findings. Am J Med. 1994. 97:152–7.
10.Rosen IB., Azadian A., Walfish PG., Salem S., Lansdown E., Bedard YC. Ultrasound - guided fine needle aspiration biopsy in the management of thyroid disease. Am J Surg. 1993. 166:346–9.
11.Kim EK., Park CS., Chung WY., Oh KK., Kim DI., Lee JT, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol. 2002. 178:687–91.
crossref
12.Solbiati L., Arsizio B., Ballarati E. Microcalcification: a clue in the diagnosis of thyroid malignancies. (abstr) Radiology. 1990. 117(suppl):40.
13.Jeh SK., Jung SL., Kim BS., Lee YS. Evaluating the degree of conformity of papillary carcinoma and follicular carcinoma to the reported ultrasonographic findings of malignant thyroid tumor. Korean J Radiol. 2007. 8:192–7.
crossref

Table 1.
Ultrasonographic criteria for thyroid nodules
Category Ultrasonographic findings
Suspicious malignant nodule Taller than wide Spiculated margin Marked hypoechogenicity Micro- or macrocalicification
Probably benign nodule Simple cyst Predominantly cystic or Cystic nodule with comet-tail artifacts Spongiform nodule
Indeterminate nodule Isoechoic, hypoechoic or hyperechoic nodule Ovoid to round, or irregular shape Well-defined smooth or ill-defined Rim calcification
Table 2.
Comparison of sonographic and histologic findings
Sonographic classification Histologic finding
Malignant nodules (No) Benign nodules (No) Total (No)
Malignant (No) 22 47 69
Benign (No) 4 133 137
Total (No) 26 180 206
Table 3.
Sonographic findings in 206 malignant or benign nodules
Sonographic findings Malignant nodules (%) (n=26) Benign nodules (%) (n=180)
Micro- or Macrocalcification 12 (46.2) 16 (8.9)
Spiculated margin 12 (46.2) 13 (7.2)
Marked hypoechogenicity 7 (26.9) 13 (7.2)
Taller than wide 7 (26.9) 6 (3.3)
Table 4.
Diagnostic index for individual sonographic criteria of malignant thyroid nodules
Sonographic findings Sensitivity (%) Specificity (%) Positive predictive value (%) Negative predictive value (%) Accuracy (%)
Micro- or macrocalcification 12/26 (46.2) 164/180 (91.1) 12/28 (42.9) 164/178 (92.1) 176/206 (85.4)
Spiculated margin 12/26 (46.2) 167/180 (92.8) 12/25 (48.0) 167/181 (92.3) 179/206 (86.9)
Marked hypoechogenicity 7/26 (26.9) 167/180 (92.8) 7/20 (35.0) 167/186 (89.8) 174/206 (84.5)
Taller than wide 7/26 (26.9) 174/180 (96.7) 7/13 (53.8) 174/193 (90.2) 181/206 (87.9)
Table 5.
The number of nodules that have malignant ultrasonographic findings
Number of sonographic finding Malignancy Benign Total
0 4 133 137
1 9 42 51
More than 2 13 5 18
Total 26 180 206
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