Sonographic Criteria Predictive of Malignant Thyroid Nodules

Rationale and Objectives

The objective of this study was to evaluate the ultrasound features of thyroid nodules and their association with malignancy, focusing on establishing feature-oriented ultrasound criteria to determine proper management of a thyroid nodule.

Materials and Methods

A sample of 379 thyroid nodules were biopsied (from a total of 357 patients aged 59.8 ± 14.8 years) and 300 were included in the final study (271 benign nodules and 29 malignant ones). Ultrasound features were recorded for each nodule: size, echogenicity, homogeneity, contours, shape, texture, peripheral halo, calcifications, and the presence of adenopathy. Statistical analysis of the data was performed using the Mann-Whitney U test and chi-square test. The sensitivity and the specificity of variables seen to have a statistically significant association with the malignancy of nodules were assessed and a logistic regression was performed.

Results

A taller-than-wide shape, an ill-defined contour, the presence of a halo, microcalcifications, and adenopathy were found to have a statistically significant relationship ( P < 0.05) with malignancy, although with a low sensitivity and a high specificity. The presence of at least one suspicious feature yields great sensitivity (89.7%) in detecting malignant disease.

Conclusions

The ultrasound features of thyroid nodules alone do not allow the radiologist to make a confident diagnosis regarding the malignancy of a nodule without performing a biopsy. However, a nodule showing a taller-than-wide shape, microcalcifications, a peripheral halo, an ill-defined contour, or associated adenopathy should be considered for cytology.

Introduction

There is an increasing rate of diagnosis of thyroid nodules in the general population, much due to the widespread availability of ultrasound equipment and better health care worldwide . Up to two-thirds of the general population has thyroid nodules at an ultrasound examination. Although only a small percentage of nodules are malignant, prognosis for patients with thyroid cancer is good, attaining a 5-year survival rate of 98.1% in the United States, mainly related to the early diagnosis of small lesions .

Ultrasound examination, although very sensitive in identifying thyroid nodules, lacks the accuracy to differentiate between benign and malignant nodules . Fine-needle aspiration cytology (FNAC) technique under ultrasound guidance is the most used method to obtain biologic material from a thyroid nodule, leading to a definite benign or malignant result in about 90% of cases .

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Materials and Methods

Patients

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Ultrasound Technique

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Ultrasound Interpretation

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Histologic Analysis

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Statistical Analysis

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Results

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TABLE 1

Demographic Features of the Sample \*

Demographic Features Malignant Nodules ( n = 29) Benign Nodules ( n = 271)P Value Gender 0.339 Male 6 (15.4) 33 (84.6) Female 23 (8.8) 238 (91.2) Age 54.1 y (37.8–66.1) 60.44 y (50.2–72.1) 0.034

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TABLE 2

Frequency and Statistical Analysis of the Ultrasound Features \*

Ultrasound Features Malignant Nodules ( n = 29) Benign Nodules ( n = 271)P Value Diameter 22 mm (14–26) 24 mm (16–31) 0.387 Echogenicity 0.361 Hypoechoic 21 (72.4) 160 (59.0) Isoechoic 6 (20.7) 77 (28.4) Hyperechoic 2 (6.9) 34 (12.5) Homogeneity 0.282 Homogeneous 7 (24.1) 44 (16.2) Heterogeneous 22 (75.9) 227 (83.8) Texture 0.071 Solid 25 (79.3) 169 (62.4) Cystic or mixed type 6 (20.7) 102 (37.6) Contours 0.041 Well defined 13 (44.8) 174 (64.2) Ill defined 16 (55.2) 97 (35.8) Shape 0.007 Parallel to gland plane or spherical 26 (89.7) 266 (98.2) Taller-than-wide shape 3 (10.3) 5 (1.8) Peripheral halo 0.044 Absence 17 (58.6) 204 (75.8) Presence 12 (42.4) 65 (24.2) Calcifications 0.010 Absence or gross calcifications 22 (75.9) 247 (91.1) Microcalcifications 7 (24.1) 24 (8.9) Adenopathy 0.001 Absence 27 (93.1) 270 (99.6) Presence 2 (6.9) 1 (0.4) At least one of the ultrasound features associated with malignancy 0.017 None 3 (10.3) 86 (31.7) At least one 26 (89.7) 185 (68.3)

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TABLE 3

Sensitivity, Specificity, and Accuracy of Each of the Statistical Significant Ultrasound Features

Ultrasound Features Sensitivity ( n = 29) Specificity ( n = 271) Accuracy ( n = 300) Ill-defined contour 16 (55.2) 174 (64.2) 190 (63.3) Taller-than-wide shape 3 (10.3) 266 (98.2) 269 (89.7) Peripheral halo 12 (41.4) 204 (75.8) 216 (72.0) Microcalcifications 7 (24.1) 247 (91.1) 254 (84.7) Adenopathy 2 (6.9) 270 (99.6) 272 (90.7) At least one of the ultrasound features associated with malignancy 26 (89.7) 86 (31.7) 112 (37.3)

Data presented as number (percentage).

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TABLE 4

Results of Multiple Regression Analysis for Detection of Malignant Nodules

Ultrasound Features β ± Standard Error_Z_ Value Odds Ratios 95% Confidence Interval_P_ Value Ill-defined contour 1.887 ± 0.51 3.701 6.598 2.538–19.054 <0.01 Taller-than-wide shape 2.271 ± 0.854 2.659 9.692 1.634–51.904 0.008 Peripheral halo 1.649 ± 0.509 3.238 5.201 1.961–14.727 0.001 Microcalcifications 1.222 ± 0.553 2.21 3.393 1.081–9.765 0.027 Adenopathies 2.811 ± 1.495 1.88 16.63 0.97–513.899 0.06 Age −0.035 ± 0.011 −3.077 0.966 0.944–0.987 0.002 Female gender −0.56 ± 0.56 −1 0.571 0.2–1.863 0.317

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Discussion

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Conclusions

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References

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Sonographic Criteria Predictive of Malignant Thyroid Nodules

Rationale and Objectives

Materials and Methods

Results

Conclusions

Introduction

Materials and Methods

Patients

Ultrasound Technique

Ultrasound Interpretation

Histologic Analysis

Statistical Analysis

Results

Discussion

Conclusions

References

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