Distinguishing mummified thyroid nodules from malignant thyroid nodules

Abstract

Aim: To study the ultrasonographic (US) differences between “mummified” thyroid nodules and malignant thyroid nodules in order to achieve a more accurate imaging-based diagnosis and to avoid unnecessary biopsy.Material and methods: We retrospectively reviewed the US features of mummified thyroid nodules, as confirmed by fine-needle aspiration cytology (FNAC), in 193 cases. The US features included content, echo, shape, margin, microcalcification, suspicious lymph nodes and some characteristic features, including the cystic wall shrinkage sign, the concentric configuration or finger sign, calcification and halo. All of these features were classified and compared with those of 109 malignant lesions. The changes of these mummified nodules during the follow-up period were also examined.Results: The cystic wall shrinkage sign and the concentric configuration or finger sign were highly specific indicators of mummified thyroid nodules and could be used to distinguish mummified nodules from thyroid cancer with a specificity of 91.7% and 99.9%, respectively. A continuous decrease in the cyst size was observed during follow-up.Conclusions: Mummified thyroid nodules are characterized by the cystic wall shrinkage sign and the concentric configuration or finger sign on US and a continuous decrease in size during follow-up. These features may be useful for the differential imaging-based diagnosis of mummified versus malignant thyroid nodules.

Contrast-Enhanced Ultrasound: An Effective Method for Noninvasive Diagnosis of Mummified Thyroid Nodules

“…At the same time, the decrease of tension in the nodule causes the capsule wall to collapse, which leads to the irregular margin between the nodule and the surrounding parenchyma. The typical manifestation is the existence of a “double ring sign” [ 11 ]. The inner hyperechoic ring may be the collapsed capsule wall, and the outer hypoechoic ring may be fibrous capsule or inflammatory reaction zone [ 2 ].…”

Mummified thyroid nodule: a diagnostic and management conundrum

“…1 Various sonographic features of mummified thyroid nodules have been reported, but typically include necrosis associated shrinkage and avascularity, posterior shadowing, as well as regular peripheral black and white halos corresponding to subcapsular granulation tissue and dystrophic eggshell calcifications, respectively. [1][2][3][4] As benign nodules mummify, some of their morphological changes can resemble or mimic malignancy. For example, mummified nodules may demonstrate irregular ill-defined nodule margins due to capsular collapse, taller-than-wide shape from asymmetric fibrous healing with transverse shrinking, replacement of cystic contents with isoto-hypoechoic 'solid' contents due to fibrosis and internal echogenic foci attributed to dystrophic calcifications or colloid material, usually seen in Figure 1 Baseline thyroid ultrasound in October 2017 (A) showed a solitary mixed solid-cystic nodule (denoted n1 on hand drawn diagram) with mild peripheral vascularity, mainly occupying the left lobe with extension into the isthmus.…”

Value of Contrast-Enhanced Ultrasound in Mummified Thyroid Nodules

“…According to the Thyroid Imaging Reporting and Data System (TI-RADS), five US suspicious features were applied to categorize the thyroid nodules, whereas the MTNs usually have more than two suspicious features and are classified as TIRADS scores 4b to 5 (9). Thus, some patients with MTNs undergo fineneedle aspiration (FNA) or even surgery, which results in the potential for over-management (10).…”