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Ultrasonographic risk factors of malignancy in thyroid nodules

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Abstract

Introduction

Between 40 and 50 % of the population will have at least one thyroid nodule, although only 5–8 % will have a malignant one.

Objective

The objective of this study was to establish the ultrasonographic characteristics which allow us to distinguish benignity from malignancy in thyroid nodules.

Methods

In the study population, inclusion criteria are (1) a single thyroid nodule and (2) multinodular goiter and exclusion criteria are (1) previous thyroid surgery and (2) fine needle aspiration (FNA) in the past month. This study is a double-blind prospective study. The study protocol is as follows: (1) clinical study; (2) ultrasound examination; (3) FNA; and (4) surgery—follow-up. The variables analysed are as follows: a multinodular nodule or goitre; colloid degeneration; morphology; margins; hyperechoic rim; rim thickness; rim morphology; size; angle between the major axis and the skin; echostructure; posterior acoustic findings; calcifications; thick colloid; localization of the intrathyroid nodular tissue; and characteristics in the Doppler scan.

Results

A total of 221 thyroid nodules were analysed. The following ultrasound findings were associated with malignancy (p < 0.05): a nodule with posterior acoustic shadowing; the echotexture of the nodule; intranodular colloid degeneration; nodule margins; nodular morphology; the presence of thick colloid; the angle between the major axis and the skin; characteristics of the intranodular vessels using color Doppler and Doppler energy; and calcifications. In the multivariate analysis, the following factors persisted as predictors of malignancy: the echotexture of the nodule (odds ratio 12.81), microcalcifications (OR 9.05), and chaotic vascularisation in the Doppler energy (OR 43.47).

Conclusions

The high-resolution ultrasound allowed for a more reliable diagnosis of malignancy. The main findings of malignancy were the hypoechogenicity echotexture, microcalcifications, and chaotic intranodular vessels using Doppler energy.

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    Authors and Affiliations

    1. Department of Surgery, Pediatrics and Obstetricians, and Gynecology, University of Murcia, Murcia, Spain

      A Rios, J. M. Rodríguez & P. Parrilla

    2. Service of General Surgery and of the Digestive System, Virgen de la Arrixaca University Hospital, El Palmar, Murcia Health Service, Murcia, Spain

      A Rios, J. M. Rodríguez & P. Parrilla

    3. Murcia Institute of Bio-Health Research at the Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain

      A Rios, J. M. Rodríguez & P. Parrilla

    4. Avenida de la Libertad n° 208, Casillas, 30007, Murcia, Spain

      A Rios

    5. Radiology Service, Virgen de la Arrixaca University Hospital, El Palmar, Murcia Health Service, Murcia, Spain

      B. Torregrosa, D. Rodríguez, A. Cepero & M. D. Abellán

    6. Service of General Surgery and of the Digestive System, Santa Lucia University Hospital, Cartagena, Murcia Health Service, Murcia, Spain

      N. M. Torregrosa

    7. Service of Endocrinology and Nutrition, Teaching and Continuous Education Unit, Virgen de la Arrixaca University Hospital, El Palmar, Murcia Health Service, Murcia, Spain

      A. M. Hernández

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    1. A Rios
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    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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    This study was not funded by any company.

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    Informed consent was obtained from all individual participants included in the study.

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    The authors have nothing to disclose.

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    The authors declare that they have no conflict of interest.

    Additional information

    Antonio Ríos Zambudio and B. Torregrosa contributed equally to this work.

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    Rios, A., Torregrosa, B., Rodríguez, J.M. et al. Ultrasonographic risk factors of malignancy in thyroid nodules. Langenbecks Arch Surg 401, 839–849 (2016). https://doi.org/10.1007/s00423-016-1451-y

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