Risk for Malignancy of Thyroid Nodules as Assessed by Sonographic Criteria

Iannuccilli, Jason D.; Cronan, John J.; Monchik, Jack M.

doi:10.7863/jum.2004.23.11.1455

Cited by 314 publications

(280 citation statements)

References 9 publications

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“…Only a small percentage of thyroid nodules (5e6.5%) present features consistent with malignancy [9], but this possibility must always be considered, even when the nodule is small. In fact, malignancy shows no correlation with nodule size, and it is not uncommon to find lymph node metastases in patients with papillary carcinomas measuring no more than a few millimeters or even those that are occult [10].…”

Section: Clinical Applications Thyroidmentioning

confidence: 99%

“…The high-frequency ultrasound transducers currently being used display high sensitivity in detecting thyroid nodules, but they are less helpful in distinguishing malignant nodules from those that are benign [10]. Currently available techniques are thus highly accurate tools for discovering thyroid nodules, and ultrasonography can also be useful in the follow-up phase to detect changes in nodule size, but it does not make any significant contribution to the characterization of these nodules, which is based exclusively on ultrasound-guided fine-needle biopsy (FNAB).…”

Section: Clinical Applications Thyroidmentioning

confidence: 99%

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The role of sonoelastography in the differential diagnosis of neck nodules

Rubaltelli

Stramare

Tregnaghi

et al. 2009

Journal of Ultrasound

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KEYWORDSTechnology assessment; Thyroid; Tumor.Abstract Sonoelastography is an imaging technique that provides information on tissue elasticity. Its use as a diagnostic procedure is based on the premise that pathological processes like cancer alter the physical characteristics of the involved tissue. Ultrasonographic studies of the neck can reveal the nonpalpable thyroid nodules, but the nature of these lesions generally has to be established on the basis of FNAB findings. In our hands, sonoelastography displayed a diagnostic accuracy of 86.2% in identifying thyroid nodule malignancy, with positive and negative predictive values (PPV and NPV) of 64% and 94.5%, respectively. In the study of cervical lymph nodes, the results were less impressive (sensitivity 75%, specificity 80%, accuracy 77%, PPV 80%, NPV 70%), but the information obtained with this technique can in our opinion be a useful adjunct to sonographic findings. Indeed, in 5 lymph nodes with sonographic features consistent with malignancy, sonoelastography revealed diffuse elasticity that was indicative of benign disease, which was confirmed by pathological studies. Other nodular lesions of the neck can also be evaluated with sonoelastography, including enlarged parotid glands, but the data in the literature are too limited to allow hypotheses on the role of this imaging modality in this field. Sonoelastography is rapid and simple to perform, and it appears to be a potentially useful tool for the differential diagnosis of neck nodules. This is particularly true of thyroid nodules. Our experience with these lesions indicates that diffuse elasticity is strongly correlated with benign disease. If this finding is confirmed in larger studies, sonoelastography might be used to identify thyroid nodules that do not require immediate biopsy.Sommario L'elastosonografia è una tecnica di imaging che fornisce informazioni relative alla elasticità dei tessuti e che può essere utilizzata nella pratica clinica basandosi sul presupposto che i processi patologici, come il cancro, inducono modificazioni della caratteristiche fisiche dei tessuti ammalati. Lo studio ecografico della loggia cervicale permette di individuare formazioni nodulari non palpabili all'interno della tiroide, tuttavia l'accuratezza diagnostica di questa tecnica è scarsa e per tale motivo il ricorso alla FNAB è spesso necessario. Nella nostra esperienza l'elastosonografia ha dimostrato, nella diagnosi differenziale dei nodi tiroidei, un'accuratezza diagnostica del 86,2% con VPN 94,5% e VPP 64%. Nello studio dei linfonodi cervicali i risultati ottenuti sono meno brillanti (sensibilità, specificità e accuratezza rispettivamente del 75%, 80% e 77% con VPP e VPN di 80% e 70%), ma riteniamo che le informazioni ottenibili possono in molti casi essere utili per integrare i dati ecografici; in particolare in 5 casi di linfonodi con caratteristiche morfo-strutturali indicative di malignità, l'elastosonografia ha dimostrato un pattern di completa elasticità, riconoscendo la natura benigna confermata dalle succes...

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Section: Clinical Applications Thyroidmentioning

confidence: 99%

Section: Clinical Applications Thyroidmentioning

confidence: 99%

The role of sonoelastography in the differential diagnosis of neck nodules

Rubaltelli

Stramare

Tregnaghi

et al. 2009

Journal of Ultrasound

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“…US examination is the preferred first line modality of imaging in evaluating thyroid nodules, providing detection of signs associated with malignant nature, such as microcalcifications, hypoechogenicity, irregular margins or absent halo, intranodular vascularization greater than perinodular, and deeper than wide shape [2]. Even though sensitivity and specificity can be improved by combining these parameters, no single suspicious US feature is sufficiently sensitive or specific for diagnosing malignancy and the overall performance of US is not satisfactory [3][4][5][6]. Currently, fine needle aspiration cytology (FNAC) is the standard procedure to determine malignancy and is the method with the highest specificity (60-98 %), but with a varying sensitivity of 54-90 % [7].…”

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of acoustic radiation force impulse technology in the differentiation of thyroid nodules: accuracy and interobserver variability assessment

et al. 2014

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Purpose The aim of this study is to assess the diagnostic efficacy and interobserver agreement of acoustic radiation force impulse (ARFI) elasticity imaging in differentiating thyroid nodules. Methods In our study, 74 consecutive patients (52 females, 22 males; age range 27-77 years, mean: 41 years) with 82 thyroid nodules (60 benign nodules, and 22 malignant) were examined by two radiologists with different experience. Patients underwent either cytology using fine needle aspiration cytology or thyroid surgery. The diagnostic performance of the two operators at ARFI with sensitivity, specificity, positive predictive and negative predictive value, and ROC curves was estimated. Interreader variability between the two operators was defined using Cohen's k.Results According to receiver operating characteristics ROC curves (AUROC = 0.86 for observer 1; 0.81 for observer 2) sensitivity, specificity, PPV and NPV of reader 1 and 2 were respectively: 90, 75, 90.91 and 96.55 %; (cutoff value of shear wave: 2.455 m/s); 90, 72, 90 and 96.90 % (cut-off value shear wave: 2.365 m/s). Concordance between the two operators was good (k = 0.755). Conclusions This work is a feasibility study evaluating ARFI imaging. Its results suggest that ARFI imaging is a reproducible method which can be utilized with good diagnostic performance in the thyroid for discriminating benign and malignant nodules using the cut-off value of 2.455 m/s. However, larger studies are needed to validate this method.Keywords Acoustic radiation force impulse (ARFI) Á Elastography Á Benign thyroid nodules Á Malignant thyroid nodules Á Ultrasound Riassunto Scopo Lo scopo di questo studio è la valutazione della efficacia diagnostica e della concordanza inter-osservatore dell'imaging elastografico ARFI, per la differenziazione di noduli tiroidei. Metodo Nel nostro studio, 74 pazienti consecutivi (52 femmine, 22 maschi; range di età 22-77 anni, età media 41 anni) con 82 noduli tiroidei (60 noduli benigni e 22 maligni), sono stati esaminati da due radiologi con diverso livello di esperienza. I pazienti sono stati sottoposti o a citologia aspirativa con ago sottile (FNAC), o a chirurgia tiroidea. La performance diagnostica dei due operatori all' ARFI è stata stimata con la sensibilità, la specificità, il valore predittivo positivo (VPP) e negativo (VPN), attraverso le curve ROC (receiver operating characteristics). La variabilità inter-osservatore tra i due operatori, è stata definita usando la kappa di Cohen. (2014( ) 17:13-20 DOI 10.1007 Risultati Secondo le curve ROC (AUROC = 0.86 per il primo osservatore; 0.81 per il secondo osservatore) la sensibilità, la specificità, il VPP e il VPN per gli osservatori 1 e 2, erano rispettivamente: 90, 75, 90,91, e 96.55 %; (valore medio di shear wave: 2.455 m/s); 90, 72, 90 e 96.90 % (valore medio di shear wave: 2.365 m/s). La concordanza tra I due operatori era buona (k = 0.755). Conclusioni Questo lavoro è uno studio preliminare che valuta l'imaging elastografico con Acustic Radiation Force Impulse. I risultati sug...

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“…These include nodule hypoechogenicity, microcalcifications, irregular margins, an anteroposterior diameter that exceeds the longitudinal diameter, and chaotic intranodular vascularization. The strongest predictor of malignancydaside from hypoechogenicitydis the absence of the halo, according to some authors [13], or the presence of microcalcifications, according to others [14]. Our experience indicates that, despite its fundamental role in the study of thyroid nodules, sonography is not capable of clearly and definitively distinguishing between benign and malignant nodules.…”

Section: Discussionmentioning

confidence: 65%

Ultrasoundelastography: Can it provide valid information for differentiation of benign and malignant thyroid nodules?

Raggiunti

Capone²,

Franchi

et al. 2011

Journal of Ultrasound

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KEYWORDSThyroid; Thyroid sonography; Thyroid nodules; Sonoelastography; FNAC.Abstract Ultrasoundelastography (USE) is a new imaging technique that is performed with a normal ultrasound transducer. It provides improved characterization of a tissue or nodule based on the latter's elasticity and stiffness. The aim of the present, prospective study was to assess the validity of USE in characterizing thyroid nodules. USE patterns were analyzed in light of nodule cytology (British Thyroid Association classification) to determine whether these patterns can be used to decide whether or not fine-needle aspiration cytology (FNAC) is indicated. We examined a consecutive series of 617 thyroid nodules in patients referred for the first time to the Endocrinology Unit of Atri Hospital (Atri, [TE]). Patients underwent ultrasonographic and USE examinations of their thyroid nodules, which were then subjected to FNAC. All nodules with Thy 1 cytology were excluded, leaving 567 nodules for analysis. USE findings were classified on the basis of the degree and distribution of elasticity within the lesion: four patterns were identified (1, 2, 3a, 3b, or 4).None of the nodules with Thy 4 cytology (malignant) had USE pattern 1 or 2; patterns 3 and 4 were associated with higher cytologic grades. In conclusion, USE provides additional information on thyroid nodules, which can be used with ultrasound features of the nodules, to decide whether FNAC is indicated. In fact, patterns 1 and 2 do not seem to be associated with Thy 4 cytology.Sommario L'Elastosonografia (ESG) è una nuova tecnica d'immagine che, utilizzando una normale sonda ecografica, consente una migliore caratterizzazione tissutale, fornendo informazioni su elasticità e durezza di un tessuto o di un nodulo.L'obiettivo di questo studio prospettico è quello di valutare l'effettiva validità della ESG nel caratterizzare i noduli tiroidei, associando il pattern elastosonografico al grading citologico e, * Corresponding author.E-mail address: raggibruno@virgilio.it (B. Raggiunti). quindi, valutare se eseguire o meno l'agoaspirazione del nodulo tiroideo, in base al pattern ESG. Sono stati studiati, in serie successiva, 617 noduli tiroidei di pazienti afferiti per la prima volta presso la nostra UO di Endocrinologia del P.O. di Atri (TE), sottoposti ad esame ecografico, elastosonografico e ad agoaspirato con ago sottile (FNAC), per lo studio citologico. Tutti i noduli che al referto citologico presentavano un grado Thy 1 sono stati esclusi dallo studio, pertanto sono stati esaminati 567 noduli. Lo score elastosonografico utilizzato prevede 5 patterns cromatografici (1; 2; 3a; 3b e 4) a seconda della distribuzione di tessuto più o meno elastico all'interno del nodulo. I risultati dell'ESG hanno evidenziato che nessun nodulo con citologico Thy 4 presenta un grado elastosonografico 1 o 2; passando ai patterns elastosonografici 3 e 4 si assiste ad una crescita concomitante del grading citologico. In conclusione l'ESG può essere considerata un ulteriore parametro, in associazione alle caratt...

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Risk for Malignancy of Thyroid Nodules as Assessed by Sonographic Criteria

Cited by 314 publications

References 9 publications

The role of sonoelastography in the differential diagnosis of neck nodules

The role of sonoelastography in the differential diagnosis of neck nodules

Prospective evaluation of acoustic radiation force impulse technology in the differentiation of thyroid nodules: accuracy and interobserver variability assessment

Ultrasoundelastography: Can it provide valid information for differentiation of benign and malignant thyroid nodules?

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