Evidence-Based Assessment of the Role of Ultrasonography in the Management of Benign Thyroid Nodules
- 419 Downloads
Although ultrasonographic (US) evaluation is currently recommended for the workup of all palpable thyroid nodules, little guidance exists regarding the manner in which US data are to be used. Herein, we examine the available evidence and recommend how US can be used most effectively to predict malignancy. We discuss the role of US-guided fine needle aspiration (FNA) and other special topics regarding US evaluation and management of benign nodules.
We also present a systematic review of the literature using evidence-based criteria.
US features alone cannot predict malignancy or benignity, but techniques that combine US features and FNA cytology are most effective and most accurate for predicting malignancy (Level III and IV evidence). US features suggesting malignancy include a blurred or ill-defined margin, irregular shape, solid echo structure, hypoechogenicity, absent halo, fine calcifications, and intranodular vascular pattern. Most patients with malignancies have more than two US features characteristic of malignancy. US-guided FNA has nonsignificantly higher sensitivity, specificity, and accuracy than the palpation-guided technique (Level III and IV evidence). US guidance is particularly beneficial in patients with nonpalpable, multiple, or heterogeneous nodules for preferentially aspirating a specific segment of the nodule (large or partially cystic nodule) or when nodule palpation is difficult (patients with diffuse glandular disease or obesity).
US is an essential component of thyroid nodule evaluation and management. Techniques that combine US features and FNA cytology for thyroid nodule workup are more accurate than either technique alone. US-guided FNA can decrease the rate of nondiagnostic aspirates.
KeywordsThyroid Cancer Fine Needle Aspiration Thyroid Nodule Fine Needle Aspiration Cytology American Thyroid Association
- 2.Thijs L (1970) Diagnostic US in clinical thyroid investigation. J Clin Endocrinol Metab 32:709–716Google Scholar
- 7.Anonymous (2006) AACE/AME Task Force on Thyroid Nodules, American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 12:63–102Google Scholar
- 11.American Institute of US in Medicine (2003) AIUM practice guideline for the performance of thyroid and parathyroid US examination. J US Med 22:1126–1130Google Scholar
- 15.Wiest P, Hartshorne MF, Inskip PD et al (1998) Thyroid palpation versus high-resolution thyroid ultrasonography in the detection of nodules. J US Med 17:487–496Google Scholar
- 16.Gogel B, Ferry KM, Livingston SA et al (2000) The effect of surgical office-based thyroid US on clinical decision making. Proc Baylor Univ Med Center 13:207–209Google Scholar
- 20.Iannuccilli J, Cronan JJ, Monchick JM (2004) Risk of malignancy of thyroid nodules as assessed by sonographic criteria: the need for biopsy. J US Med 23:1455–1464Google Scholar
- 21.Cappelli C, Castellano M, Pirola I et al (2006) The predictive value of US findings in the management of thyroid nodules. Q J Med 100:29–35Google Scholar
- 23.Wienke J, Chong WK, Fielding JR et al (2003) Sonographic features of benign thyroid nodules: interobserver reliability and overlap with malignancy. J US Med 22:1027–1031Google Scholar
- 28.Frates M, Benson CB, Doubilet PM et al (2003) Can color Doppler sonography aid in the prediction of malignancy of thyroid nodules? J US Med 22:127–131Google Scholar
- 30.Rosario P, de Faria S, Bicalho L et al (2005) Ultrasonographic differentiation between metastatic and benign lymph nodes in patients with papillary thyroid carcinoma. J US Med 24:1385–1389Google Scholar