Differential Profile of Ultrasound Findings Associated with Malignancy in Mixed and Solid Thyroid Nodules in an Elderly Female Population

Abstract

Objective. Ultrasonographic characteristics are associated with thyroid malignancy. Our aim was to compare the diagnostic value of ultrasound features in the detection of thyroid malignancy in both solid and mixed nodules. Methods. We prospectively studied female patients (≥50 years) referred to ultrasound-guided fine needle aspiration biopsy. Ultrasound features considered suspicious were hypoechogenicity, microcalcifications, irregular margins, high anteroposterior (AP)/axial-ratio, and absent halo. Associations were separately assessed in mixed and solid nodules. Results. In a group of 504 elderly female patients (age = 69 ± 8 years), the frequency of malignant cytology was 6%. Thirty-one percent of nodules were mixed and 60% were solid. The rate of malignant cytology was similar for mixed and solid nodules (7.4 versus 5.8%, P: 0.56). While in mixed nodules none of the ultrasound characteristics were associated with malignant cytology, in solid nodules irregular margins and microcalcifications were significant (all P < 0.05). The combination of irregular margins and/or microcalcifications significantly increased the association with malignant cytology only in solid nodules (OR: 2.76 (95% CI: 1.25–6.10), P: 0.012). Conclusions. Ultrasound features were of poor diagnostic value in mixed nodules, which harbored malignant lesions as often as solid nodules. Our findings challenge the recommended minimal size for ultrasound-guided fine needle aspiration biopsy in mixed nodules.

The utility of thyroid ultrasonography in the management of thyroid nodules

“…14,17,25,27,28 The proper application of this system would benefit most from the use of standardized synoptic reporting tools that have been embraced by the surgical community as well as pathologists. In varied settings, including thyroid cancer and pancreatic cancer, synoptic reporting has been examined by international studies and validated as a method for capturing clinical data and improving patient outcomes.…”

“…However, using varied prevalence rates accepted in the literature for thyroid malignancy in the general population (5%-12%), our likelihood ratios did not change significantly. 3,4,27 One strength of our study is the inclusion of final pathology, which ultimately has the biggest impact on patient management and outcomes. While individual assessments of sensitivity and specificity could vary, our results are qualitatively similar to those documented in studies that examined individual ultrasound features and the likelihood of malignancy in both urban and rural settings.…”

“…While individual assessments of sensitivity and specificity could vary, our results are qualitatively similar to those documented in studies that examined individual ultrasound features and the likelihood of malignancy in both urban and rural settings. 14,17,25,27,28 We acknowledge that there may be differences in the capabilities of individual ultrasonography machines that may limit in some form the reports provided. Finally, this was a retrospective assessment, and over the timeframe of the study there have been upgrades in technology and changes in ultrasonography protocol in different institutions.…”

Ultrasonography Diagnosis and Imaging-Based Management of Thyroid Nodules: Revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations

“…It has been investigated for its ability for the quantitative estimation of the malignancy risk using scoring systems based on the categorization of the US patterns ( 25 86 87 ) or based on the calculation of the number of suspicious US features and US risk scores ( 24 39 88 ). Previous reports suggest that the malignancy risk or the US features predicting the malignancy might differ according to the solidity ( 26 89 90 91 ) and echogenicity ( 40 ) of the thyroid nodules. Most thyroid society guidelines ( 20 92 93 94 95 ) suggest risk stratification systems based on the categorization of the US patterns for thyroid nodules.…”

Association of Ultrasonographic Findings and Thyroid Malignancy: A Cross-Sectional Study

“…3 A number of studies have been published associating specific sonographic findings with thyroid malignancy. 1,2,[4][5][6][7][8][9] Many elucidate the role of nodule size and presence of microcalcifications. 2,[4][5][6][7][8][9] The ATA listed presence of disrupted rim calcifications with small extrusive hypoechoic soft tissue component, evidence of extrathyroidal extension, nodule shape and features as determinants of malignancy.…”