Diagnostic accuracy of ultrasound characteristics in the identification of malignant thyroid nodules

Abstract

Objective This study was aimed at determining the diagnostic accuracy of the ultrasound characteristics in the identification of malignant thyroid nodules in patients attending the surgical clinic at a tertiary care hospital in Sri Lanka. Results This prospective validation study was conducted among 263 patients attending the surgical clinic at a tertiary care hospital, Sri Lanka. The ultrasound characteristics having statistically significant associations with thyroid malignancies were identified by employing a multivariable analysis. These ultrasound characteristics were compared with Fine Needle Aspiration Cytology results and indicators of diagnostic accuracy were computed. The study sample consisted of 33 malignant and 230 benign nodules. Internal vascularity, hypoechogenicity and microcalcification showed statistically significant positive associations with thyroid malignancy (p < 0.05). The highest positive likelihood ratio was observed for the presence of microcalcifications (10.4, 95% CI 4.6–23.7) with a specificity of 96.5% (95% CI 93.3–98.5%). Hypoechogenicity had a sensitivity of 66.7% (95% CI 48.2–82.0%) and a specificity of 74.8% (95% CI 68.6–80.3%). The presence of at least one positive ultrasound characteristic yielded the highest sensitivity (87.9%, 95% CI 71.8–96.6%), whereas, the presence of all three characteristics yielded a near perfect specificity (99.6%, 95% CI 97.6–99.9%). Hence, the presence of microcalcifications was found to be the single most useful criterion in predicting thyroid malignancy.

Modified Models for Predicting Malignancy Using Ultrasound Characters Have High Accuracy in Thyroid Nodules With Small Size

“…In this study, five typical ultrasound characteristics were analyzed as predictor of thyroid malignancy. It was congruent with the findings of most previous studies (Moon et al, 2008;Wettasinghe et al, 2019;Alam et al, 2014). ECHO nodules showed a sensitivity of 87.1% in another study conducted on 500 patients (Papini et al, 2002).…”

“…It suggested that the nodule size has a limit effect on OR values of TTW. Previous studies suggested that EF and ITC are reliable indicators of diagnostic accuracy(Wettasinghe et al, 2019) (Nachiappan et al, 2014). Our results showed that both EF and ITC have biggest OR values in nodules with size >1 cm.…”

Thyroid hemiagenesis with a TI-RADS 2 nodule in the contralateral lobe

“…Therefore, scintigraphy findings should be confirmed by ultrasound to avoid false positive results [18]. Ultrasonography is a better diagnostic tool as it is widely available and costeffective with no radiation exposure to the patient [19]. However, in case of ectopic thyroid gland in the retrosternal or mediastinal location, scintigraphy with I-123 is the investigation of choice as it has high specificity [20].…”

Diagnostic Accuracy of a New Sonographic Classification System in Diagnosing Malignant Thyroid Nodules

“…This tool will help the radiologist to further guide for the need of FNAC on selected patients as it is not possible to target all the nodules to aspiration which can be both a financial and physical burden. 9 So, nodules classified into U2 were always benign so they just needed to be reported as such, no intervention was needed. But categories U4 and U5 had features which either in solitude or multitude were associated with malignancy, so had to be aspirated.…”