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.
3.Tan GH., Gharib H. Thyroid incidentalomas: Management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 1997. 126:226–31.
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.
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.
12.Solbiati L., Arsizio B., Ballarati E. Microcalcification: a clue in the diagnosis of thyroid malignancies. (abstr) Radiology. 1990. 117(suppl):40.
Table 1.
Table 2.
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 |