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Irish Journal of Medical Science (1971 -)

, Volume 183, Issue 4, pp 633–637 | Cite as

Ultrasound predictors of malignancy in indeterminate thyroid nodules

  • M.-L. Matthey-Gie
  • S. M. Walsh
  • A. C. O’Neill
  • A. Lowery
  • D. Evoy
  • D. Gibbons
  • R. S. Prichard
  • S. Skehan
  • E. W. McDermott
Original Article

Abstract

Background

Asymptomatic thyroid nodules are an increasingly common clinical problem. Lesions greater than a centimetre require cytological assessment. Indeterminate lesions often need surgical excision to establish a definitive diagnosis and plan further management. If a definitive diagnosis could be accurately predicted pre-operatively, the most appropriate surgical procedure could be performed at the initial operation.

Aim

The aim of this study was to identify whether specific thyroid ultrasound features could predict malignancy in indeterminate thyroid nodules.

Methods

A retrospective review of all patients undergoing surgery for an indeterminate thyroid lesion between 2006 and 2012 was performed. Demographic features, surgical intervention and final histological findings were determined. Pre-operative ultrasound findings and final histology were correlated and the ultrasonic markers predictive of malignancy were determined.

Results

A total of 40 patients were identified as having undergone surgical intervention for indeterminate thyroid nodules. The majority of patients were diagnosed with a follicular adenoma (n = 22; 55 %). Papillary thyroid carcinoma was identified in three patients (7.5 %) and follicular carcinoma in a further 3 (7.5 %). Ultrasound features associated with malignancy included poorly defined nodule borders and increased vascularity. The presence of malignancy was not related to nodule size, echogenicity or the presence of calcifications.

Conclusions

The majority of indeterminate thyroid lesions are benign on final histological assessment. High nodule vascularity associated with ill-defined borders is associated with malignancy. Further research is warranted to identify predictors of malignancy in indeterminate nodules in order to avoid unnecessary or repeated procedures.

Keywords

Thyroid nodule Thyroid carcinoma Thyroid ultrasound Indeterminate thyroid lesion 

Notes

Conflict of interest

None.

References

  1. 1.
    Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid Off J Am Thyroid Assoc 19:1167–1214CrossRefGoogle Scholar
  2. 2.
    McHenry CR (2012) Thyroid Incidentaloma. Best Pract Res Clin Endocrinol Metab 26:83–86PubMedCrossRefGoogle Scholar
  3. 3.
    Bomeli SR, LeBeau SO, Ferris RL (2010) Evaluation of a thyroid nodule. Otolaryngol Clin North Am 43:229–238PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Bastin S, Bolland MJ, Croxson MS (2009) Role of ultrasound in the assessment of nodular thyroid disease. Review article. J Med Imaging Radiat Oncol 53:177–187PubMedCrossRefGoogle Scholar
  5. 5.
    Texeira GV, Chikota H, Teixeira T et al (2012) Incidence in malignancy in thyroid nodules determined to be follicular lesions of undetermined significance on fine-needle aspiration. World J Surg 36:69–74CrossRefGoogle Scholar
  6. 6.
    Castro MR, Espiritu RP, Bahn RS et al (2011) Predictors of malignancy in patients with cytologically suspicious thyroid nodules. Thyroid 21:1191–1198PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Pacini F, Castagna MG (2012) Approach to and treatment of differentiated thyroid carcinoma. Med Clin North Am 96:369–383PubMedCrossRefGoogle Scholar
  8. 8.
    Kilfoy BA, Briseis A, Tongzhang Z et al (2009) International patterns and trends in thyroid cancer incidence, 1973–2002. Cancer Causes Control 20:525–531PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Rorive S, D’Haene N, Fossion C et al (2010) Ultrasound-guided fine-needle aspiration of thyroid nodules: stratification of malignancy risk using follicular proliferation grading, clinical and ultrasonographic features. Eur J Endocrinol 162:1107–1115PubMedCrossRefGoogle Scholar
  10. 10.
    Yunus M, Ahmed Z (2010) Significance of ultrasound features in predicting malignant solid thyroid nodules: need for fine-needle aspiration. J Pak Med Assoc 60:848–853PubMedGoogle Scholar
  11. 11.
    Bonavita JA, Mayo J, Babb J et al (2009) Pattern recognition of benign nodules at ultrasound of the thyroid: which nodules can be left alone? AJR Am J Roentgenol 193:207–213PubMedCrossRefGoogle Scholar
  12. 12.
    Dutta S, Thaha MA, Smith DM (2011) Do sonographic and cytological features predict malignancy in cytologically indeterminate thyroid nodules? Ann R Coll Surg Engl 93:361–364PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Nikiforov YE, Ohori NP, Hodak SP et al (2011) Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules: a prospective analysis of 1056 FNA samples. J Clin Endocrinol Metab 96(11):3390–3397PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Deandreis D, Al Ghuzlan A, Auperin A et al (2012) Is (18)F-fluorodeoxyglucose-PET/CT useful for the presurgical characterization of thyroid nodules with indeterminate fine needle aspiration cytology? Thyroid 22:165–172PubMedCrossRefGoogle Scholar
  15. 15.
    Nakahira M, Saito N, Murata S et al (2012) Quantitative diffusion-weighted magnetic resonance imaging as a powerful adjunct to fine needle aspiration cytology for assessment of thyroid nodules. Am J Otolaryngol 33:408–416PubMedCrossRefGoogle Scholar
  16. 16.
    Park KT, Ahn SH, Mo JH et al (2011) Role of core needle biopsy and ultrasonographic finding in management of indeterminate thyroid nodules. Head Neck 33:160–165PubMedCrossRefGoogle Scholar
  17. 17.
    Nasrollah N, Trimboli P, Guidobaldi L et al (2013) Thin core biopsy should help to discriminate thyroid nodules cytologically classified as indeterminate. A new sampling technique. Endocrine 43:659–665PubMedCrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2014

Authors and Affiliations

  • M.-L. Matthey-Gie
    • 1
  • S. M. Walsh
    • 1
  • A. C. O’Neill
    • 2
  • A. Lowery
    • 1
  • D. Evoy
    • 1
  • D. Gibbons
    • 3
  • R. S. Prichard
    • 1
  • S. Skehan
    • 2
  • E. W. McDermott
    • 1
  1. 1.Department of Breast and Endocrine SurgerySt. Vincent’s University HospitalDublin 4Ireland
  2. 2.Department of RadiologySt. Vincent’s University HospitalDublin 4Ireland
  3. 3.Department of PathologySt. Vincent’s University HospitalDublin 4Ireland

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