Echogenic foci in thyroid nodules: diagnostic performance with combination of TIRADS and echogenic foci

Ha, Su Min; Chung, Yun Jae; Ahn, Hye Shin; Baek, Jung Hwan; Park, Sung Bin

doi:10.1186/s12880-019-0328-2

Cited by 21 publications

(25 citation statements)

References 36 publications

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“…However, our study showed that nodules with rim calcification showed a lower malignancy risk than that in nodules with macrocalcification in the analysis of all nodules. Previous studies reported conflicting findings and variable results regarding the malignancy risk of nodules with rim calcification, including a higher malignancy risk [ 23 24 ], similar malignancy risk [ 7 10 ], and lower malignancy risk [ 8 25 ] than those of nodules with macrocalcifications. A recent study [ 23 ] reported that peripheral calcifications were highly associated with malignancy; however, the association with malignancy was not statistically proven.…”

Section: Discussionmentioning

confidence: 99%

Malignancy Risk Stratification of Thyroid Nodules with Macrocalcification and Rim Calcification Based on Ultrasound Patterns

Shin

Paik

et al. 2021

Korean J Radiol

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Objective To determine the association of macrocalcification and rim calcification with malignancy and to stratify the malignancy risk of thyroid nodules with macrocalcification and rim calcification based on ultrasound (US) patterns. Materials and Methods The study included a total of 3603 consecutive nodules (≥ 1 cm) with final diagnoses. The associations of macrocalcification and rim calcification with malignancy and malignancy risk of the nodules were assessed overall and in subgroups based on the US patterns of the nodules. The malignancy risk of the thyroid nodules was categorized as high (> 50%), intermediate (upper-intermediate: > 30%, ≤ 50%; lower-intermediate: > 10%, ≤ 30%), and low (≤ 10%). Results Macrocalcification was independently associated with malignancy in all nodules and solid hypoechoic (SH) nodules ( p < 0.001). Rim calcification was not associated with malignancy in all nodules ( p = 0.802); however, it was independently associated with malignancy in partially cystic or isoechoic and hyperechoic (PCIH) nodules ( p = 0.010). The malignancy risks of nodules with macrocalcification were classified as upper-intermediate and high in SH nodules, and as low and lower-intermediate in PCIH nodules based on suspicious US features. The malignancy risks of nodules with rim calcification were stratified as low and lower-intermediate based on suspicious US features. Conclusion Macrocalcification increased the malignancy risk in all and SH nodules with or without suspicious US features, with low to high malignancy risks depending on the US patterns. Rim calcification increased the malignancy risk in PCIH nodules, with low and lower-intermediate malignancy risks based on suspicious US features. However, the role of rim calcification in risk stratification of thyroid nodules remains uncertain.

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Section: Discussionmentioning

confidence: 99%

Malignancy Risk Stratification of Thyroid Nodules with Macrocalcification and Rim Calcification Based on Ultrasound Patterns

Shin

Paik

et al. 2021

Korean J Radiol

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“…NEF with CTA has been considered as a US feature of colloid material that is mostly found in benign cystic thyroid nodules [ 16 ]. Although several studies [ 15 , 18 , 21 , 22 ] have proposed an association between NEF with CTA with malignancy, the malignancy risk and diagnostic value of various types of NEF with CTA have not previously been investigated. Our study showed that the malignancy risk of NEF with CTA varied according to the location of NEF and US patterns of composition and echogenicity of nodules.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies [12,15] have suggested that some types of NEF with a comet tail artifact (CTA) may be associated with malignancy, but this possibility remains controversial. Although several studies [12,[15][16][17][18] have investigated the clinical significance of NEF with or without CTA, the malignancy risk and diagnostic value of various types of NEF have not been established. Therefore, this study aimed to determine the malignancy risk and diagnostic value of various types of NEF for the risk stratification of thyroid nodules.…”

Section: Introductionmentioning

confidence: 99%

Malignancy risk of thyroid nodules with nonshadowing echogenic foci

Sohn

Paik

et al. 2021

Ultrasonography

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This study was conducted to determine the malignancy risk and diagnostic value of various types of nonshadowing echogenic foci (NEF) in the risk stratification of thyroid nodules. Methods: A total of 1,018 consecutive thyroid nodules (≥1 cm) with final diagnoses were included. The presence of NEF was determined and types of NEF were classified according to the presence of a comet tail artifact (CTA), location, and size through a prospective evaluation. The associations with malignancy, malignancy risk, and diagnostic value of various types of NEF were assessed. Results: Intrasolid punctate NEF without CTA was the only type of NEF that was an independent predictor of malignancy (P<0.001). The malignancy risk of intrasolid punctate NEF without CTA was substantially higher in solid hypoechoic nodules than in isoechoic or nonsolid nodules (71.3% vs. 9.2%, P<0.001). In solid hypoechoic nodules, slightly increased sensitivity (70.8% vs. 67.9%) for malignancy and a similar malignancy risk (71.4% vs. 71.3%) were observed for intrasolid punctate NEF (with or without CTA) and intrasolid punctate NEF without CTA, respectively. NEF with CTA at the margin of the cystic component was not associated with malignancy or benignity in nonsolid nodules (P≥0.236). Conclusion: Intrasolid punctate NEF without CTA was the only independent predictor of malignancy. However, solid hypoechoic nodules with intrasolid punctate NEF should be classified as high-suspicion nodules regardless of coexisting CTA. Other types of NEF had no added value for detecting malignancy compared to intrasolid punctate NEF without CTA.

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“…For these reasons, the European Thyroid Association ( 14 ), the Korean Society of Thyroid Radiology ( 15 ), and the ACR ( 32 ) have developed specific lexicons to be used with their risk-assessment systems. The definitions of certain critical nodule descriptors, such as echogenicity ( 33 ), shape ( 34 ), hyperechoic foci ( 35 ), and extrathyroidal extension ( 36 ), can significantly impact the diagnostic performance of thyroid US. As a result, interobserver agreement for US-based risk-stratification systems remains only fair to moderate (kappa, 0.34-0.44) ( 10 ).…”

Section: Thyroid Ultrasound and Sonographic Risk-stratification Systementioning

confidence: 99%

Contemporary Thyroid Nodule Evaluation and Management

Grani

Sponziello

Pecce

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

192

140

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Context Approximately 60% of adults harbor 1 or more thyroid nodules. The possibility of cancer is the overriding concern, but only about 5% prove to be malignant. The widespread use of diagnostic imaging and improved access to health care favor the discovery of small, subclinical nodules and small papillary cancers. Overdiagnosis and overtreatment is associated with potentially excessive costs and nonnegligible morbidity for patients. Evidence Acquisition We conducted a PubMed search for the recent English-language articles dealing with thyroid nodule management. Evidence Synthesis The initial assessment includes an evaluation of clinical risk factors and sonographic examination of the neck. Sonographic risk-stratification systems (e.g., Thyroid Imaging Reporting and Data Systems) can be used to estimate the risk of malignancy and the need for biopsy based on nodule features and size. When cytology findings are indeterminate, molecular analysis of the aspirate may obviate the need for diagnostic surgery. Many nodules will not require biopsy. These nodules and those that are cytologically benign can be managed with long-term follow-up alone. If malignancy is suspected, options include surgery (increasingly less extensive), active surveillance or, in selected cases, minimally invasive techniques. Conclusion Thyroid nodule evaluation is no longer a 1-size-fits-all proposition. For most nodules, the likelihood of malignancy can be confidently estimated without resorting to cytology or molecular testing, and low-frequency surveillance is sufficient for most patients. When there are multiple options for diagnosis and/or treatment, they should be discussed with patients as frankly as possible to identify an approach that best meets their needs.

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Echogenic foci in thyroid nodules: diagnostic performance with combination of TIRADS and echogenic foci

Cited by 21 publications

References 36 publications

Malignancy Risk Stratification of Thyroid Nodules with Macrocalcification and Rim Calcification Based on Ultrasound Patterns

Malignancy Risk Stratification of Thyroid Nodules with Macrocalcification and Rim Calcification Based on Ultrasound Patterns

Malignancy risk of thyroid nodules with nonshadowing echogenic foci

Contemporary Thyroid Nodule Evaluation and Management

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