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Ultrasound malignancy risk stratification of thyroid nodules based on the degree of hypoechogenicity and echotexture

  • Ultrasound
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Abstract

Objectives

The ultrasound (US) lexicon of nodule echogenicity and echotexture is one of the major differences among various risk stratification systems of thyroid nodules. This study aimed to stratify the US malignancy risk of thyroid nodules based on their degree of hypoechogenicity and echotexture.

Material and methods

This retrospective study included a total of 2255 consecutive thyroid nodules (≥ 1 cm) with final diagnoses (malignancy rate, 13%) from 2011 to 2016. Thyroid nodules were stratified according to the US degree of hypoechogenicity (mild, moderate, or marked hypoechogenicity) and echotexture (homogeneous vs. heterogeneous). The calculated malignancy risk was compared between each category.

Results

There was no significant difference of malignancy risk between the homogeneous markedly hypoechoic and moderately hypoechoic nodules (p ≥ .18). However, the malignancy risks of markedly and moderately hypoechoic nodules were significantly higher than those of mildly hypoechoic nodules (p < .001). Heterogeneous predominantly hypoechoic thyroid nodules showed a significantly higher malignancy risk than predominantly iso- or hyperechoic thyroid nodules (p < .001). There were no significant differences of malignancy risk between heterogeneous predominantly hypoechoic and homogeneous hypoechoic nodules according to the degree of hypoechogenicity (p ≥ .12) and between heterogeneous predominantly iso- or hyperechoic nodules and homogeneous iso- or hyperechoic thyroid nodules (p = .36).

Conclusions

The malignancy risk of nodule hypoechogenicity is stratified as mild vs. moderate to marked hypoechogenicity, and the malignancy risk of nodules with heterogeneous echotexture is stratified by the predominant echogenicity of the nodules.

Key Points

• Thyroid nodule echogenicity is categorized as marked, moderate, or mild hypoechogenicity and iso- or hyperechogenicity with the reference standard of adjacent thyroid tissue and anterior neck muscles.

• The malignancy risk of thyroid nodule echogenicity is stratified as iso- or hyperechoic vs. mild vs. moderate or marked hypoechogenicity.

• The malignancy risk of nodules with heterogeneous echotexture is stratified by the predominant echogenicity.

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Abbreviations

ACR:

American College of Radiology

ETA:

European Thyroid Association

FNA:

Fine needle aspiration

KSThR:

Korean Society of Thyroid Radiology

PTC:

Papillary thyroid carcinoma

SCM:

Sternocleidomastoid muscles

US:

Ultrasonography

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Funding

This research was supported by the Medical Research Promotion Program through the Gangneung Asan Hospital funded by the Asan Foundation (2018-C03).

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Authors and Affiliations

  1. Department of Radiology, Eulji Medical Center, Seoul, 01830, Republic of Korea

    Ji Ye Lee

  2. Department of Radiology, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung, 25440, Republic of Korea

    Dong Gyu Na, So Jin Yoon, Hye Yun Gwon & Wooyul Paik

  3. Department of Pathology, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung, 25440, Republic of Korea

    Taeeun Kim

  4. Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung, 25440, Republic of Korea

    Jin Yub Kim

Authors
  1. Ji Ye Lee
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Corresponding author

Correspondence to Dong Gyu Na.

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Guarantor

The scientific guarantor of this publication is Dong Gyu Na.

Conflict of interest

The authors declare that they have no competing interests.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the institutional review board.

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Institutional review board approval was obtained.

Methodology

• Retrospective

• Cross-sectional study

• Performed at one institution

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ESM 1

Supplementary Table 1. Malignancy risk stratified by degree of hypoechogenicity and echotexture, after excluding nodules with single benign FNA result and high suspicion US feature (n = 2176). Supplementary Table 2. Malignancy risk stratified by degree of hypoechogenicity and echotexture (Reader 2). (DOCX 27 kb)

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Lee, J.Y., Na, D.G., Yoon, S.J. et al. Ultrasound malignancy risk stratification of thyroid nodules based on the degree of hypoechogenicity and echotexture. Eur Radiol 30, 1653–1663 (2020). https://doi.org/10.1007/s00330-019-06527-8

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  • DOI: https://doi.org/10.1007/s00330-019-06527-8

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