Abstract
Aim
The purpose of this study was to assess the positive predictive value of the suspicious
sonographic features of solid nodules of the thyroid.
Materials and methods
After approval by our institutional review board, we evaluated 594 sonographically
detected nodules on which fine needle aspiration biopsy had been performed from January
to December 2005. Among these, pure cystic lesions and inadequate pathologic results
were excluded. The remaining 530 solid thyroid nodules were analyzed by two radiologists.
Each lesion was classified based on four sonographic features that suggested malignancy:
microcalcifications; an irregular or microlobulated margin; marked hypoechogenicity;
and a shape that was taller than wide. The sensitivity, specificity, positive predictive
value, and negative predictive value of the each sonographic feature were calculated.
Results
Final pathologic results showed that 97 (18.3%) of 530 nodules were malignant. The
positive predictive values for malignancy in each sonographic feature were microcalcifications,
38.6% (39/101); an irregular or microlobulated margin, 28.2% (70/248); marked hypoechogenecity,
49.4% (38/77); taller than wide shape, 59.8% (49/82). In terms of relative risk, microcalcification
[P<.01, relative risk (RR)=3.115, 95% CI: 1.724–5.628], hypoechogenecity (P<.01, RR=2.510, 95% CI: 1.290–4.881). The shape of nodule which was taller than wide
(P<.01, RR=7.624, 95% CI: 4.156–13.986) revealed the highest predictive sonographic
finding suggesting malignancy. However, margin is the least significant feature of
detection of thyroid malignancy (P=.27, RR=1.395, 95% CI: 0.777–2.505).
Conclusion
The three sonographic features of solid thyroid nodule, that is, microcalcifications,
marked hypoechogenecity, and a taller than wide shape are meaningful findings in the
diagnosis of thyroid malignancy. The shape that was taller than wide was the most
reliable sonographic feature for predicting malignancy.
Keywords
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References
- Sonography of thyroid nodules: a “classic pattern” diagnostic approach.Ultrasound Q. 2005; 21: 157-165
- Value of sonography in determining the nature of thyroid nodules.J Diagn Med Sonography. 2005; 21: 38-44
- Usefulness of ultrasonography in the management of nodular thyroid disease.Ann Intern Med. 2000; 133: 696-700
- New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid.AJR Am J Roentgenol. 2002; 178: 687-691
- Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement.Radiology. 2005; 237: 794-800
- Is the anteroposterior and transverse diameter ratio of nonpalpable thyroid nodules a sonographic criteria for recommending fine-needle aspiration cytology?.Clin Endocrinol (Oxf). 2005; 63: 689-693
- Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features.J Clin Endocrinol Metab. 2002; 87: 1941-1946
- Small carcinomas of the thyroid. A long-term follow-up of 867 patients.Arch Surg. 1996; 131: 187-191
- An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid.Thyroid. 2003; 13: 381-387
- The endocrinologists' view of ultrasound guidelines for fine needle aspiration.Thyroid. 2006; 16: 207-208
- Papillary microcarcinoma of the thyroid—prognostic significance of lymph node metastasis and multifocality.Cancer. 2003; 98: 31-40
- Thyroid nodule: a potentially malignant lesion; optimal management from a surgical perspective.Cancer Treat Rev. 2006; 32: 191-202
- Ultrasonography: is it useful in the diagnosis of cancer in thyroid nodules?.J Endocrinol Invest. 2002; 25: 39-43
- Ultrasonographic characteristics of thyroid nodules: prediction of malignancy.Arch Surg. 2001; 136: 334-337
- Common and uncommon sonographic features of papillary thyroid carcinoma.J Ultrasound Med. 2003; 22: 1083-1090
- Thyroid calcification and its association with thyroid carcinoma.Head Neck. 2002; 24: 651-655
- Can color Doppler sonography aid in the prediction of malignancy of thyroid nodules?.J Ultrasound Med. 2003; 22 ([quiz 132-124]): 127-131
- Role of conventional ultrasonography and color flow-Doppler sonography in predicting malignancy in ‘cold’ thyroid nodules.Eur J Endocrinol/Eur Fed Endocr Soc. 1998; 138: 41-46
- Microcalcifications: a clue in the diagnosis of thyroid malignancies.Radiology. 1990; (abst): 140
- Thyroid nodules: re-evaluation with ultrasound.J Clin Ultrasound. 1995; 23: 179-184
- Relative risk of cancer in sonographically detected thyroid nodules with calcifications.J Clin Ultrasound. 2000; 28: 347-352
- Papillary carcinoma of the thyroid; a study of the pathology of two hundred twenty-six cases.AMA Arch Pathol. 1958; 66: 518-525
- Psammoma bodies and thyroid cancer.Cancer. 1959; 12: 656-662
- BI-RADS for sonography: positive and negative predictive values of sonographic features.Am J Roentgenol. 2005; 184: 1260-1265
Article info
Publication history
Published online: September 14, 2009
Accepted:
October 10,
2008
Received:
August 1,
2008
Footnotes
☆Presented in part as scientific paper SSE12-03 at the 2006 Radiological Society of North America meeting, Chicago, IL, November 2006.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
