Differentiation between Benign and Malignant Solid Thyroid Nodules Using an US Classification System

Abstract

ObjectiveTo evaluate the diagnostic accuracy of a new ultrasound (US) classification system for differentiating between benign and malignant solid thyroid nodules.Materials and MethodsIn this study, we enrolled 191 consecutive patients who received real-time US and subsequent US diagnoses for solid thyroid nodules, and underwent US-guided fine-needle aspiration. Each thyroid nodule was prospectively classified into 1 of 5 diagnostic categories by real-time US: "malignant," "suspicious for malignancy," "borderline," "probably benign," and "benign". We evaluated the diagnostic accuracy of thyroid US and the cut-off US criteria by comparing the US diagnoses of thyroid nodules with cytopathologic results.ResultsOf the 191 solid nodules, 103 were subjected to thyroid surgery. US categories for these 191 nodules were malignant (n = 52), suspicious for malignancy (n = 16), borderline (n = 23), probably benign (n = 18), and benign (n = 82). A receiver-operating characteristic curve analysis revealed that the US diagnosis for solid thyroid nodules using the 5-category US classification system was very good. The sensitivity, specificity, positive and negative predictive values, and accuracy of US diagnosis were 86%, 95%, 91%, 92%, and 92%, respectively, when benign, probably benign, and borderline categories were collectively classified as benign (negative).ConclusionThe diagnostic accuracy of thyroid US for solid thyroid nodules is high when the above-mentioned US classification system is applied.

Ultrasound-Based Diagnostic Classification for Solid and Partially Cystic Thyroid Nodules

“…17,23 However, this study showed the diagnostic accuracy of US for thyroid nodules on a larger scale, correlated these with histopathologic results, and attempted to use a different US classification system for solid nodules versus PCTNs. The diagnostic accuracies for nodules in SN-US class I, SN-US class II, SN-US class III, SN-US class V, PCTN-US class I, and PCTN-US class IV are considerably higher than those for SN-US class IV, PCTN-US class II, and PCTN-US class III.…”

WOMEN IN CANCER THEMATIC REVIEW: Thyroid-stimulating hormone in thyroid cancer: does it matter?

“…Moreover, this imaging modality aids the decision-making processes of which nodules to target for fine needle aspiration biopsy (FNAB) and increases the diagnostic yield of thyroid cell sampling (Perros et al 2014, American Cancer Society 2015, Pitoia & Miyauchi 2015. Multiple studies have confirmed typical sonographic features associated with increased risks of (Table 2) (Frates et al 2005, Hambly et al 2011, Lee et al 2011, and current guidelines now recommend the use of a combination of these features in algorithms predicting the likelihood of thyroid malignancy as well as the selection of nodules requiring FNAB (Perros et al 2014, Haugen et al 2015, Pitoia & Miyauchi 2015. Highresolution ultrasonography by an experienced operator is highly recommended in the initial evaluation of patients with thyroid nodules.…”

DIAGNOSIS OF ENDOCRINE DISEASE: Thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications

“…However, as evidenced by several large-scale studies (24,25,26,27,28,29,30,31,32,33), certain US features appear reliably associated with a higher risk for malignancy in thyroid nodules (2). A taller-than-wide shape and centrifugal growth across the tissue planes are indicators of malignancy.…”