Effect of Thyroid Gland Volume in Preoperative Detection of Suspected Malignant Thyroid Nodules in a Multinodular Goiter

Abstract

The detection of suspected malignant thyroid nodules by ultrasonography is associated with thyroid gland volume and tumor size. Design: Prospective clinical trial. Setting: A tertiary referral center. Patients: Three hundred sixty-five patients with a multinodular goiter with coexistent dominant nodules. Main Outcome Measures: The correlation between thyroid gland volume and tumor size and the detection of suspected malignant thyroid nodules by ultrasonography. The incidence of thyroid carcinoma inside and outside the dominant nodules and thyroid gland volume and tumor size in suspected or unsuspected malignant thyroid nodules by ultrasonography were determined. Receiver operating characteristic analysis was used to identify the cutoffs of the tumor size and thyroid gland volume. Results: One hundred thyroid carcinomas were found in 69 (18.9%) patients. Forty-one of these carcinomas were inside the dominant nodule, whereas 59 were outside the dominant nodule. Only 9 of the 59 thyroid carcinomas outside the dominant nodules were suspected of being malignant by ultrasonography. Thyroid gland volume less than 38 mL and tumor size larger than 7 mm had 48-fold (odds ratio, 48; PϽ.001) and 21.5-fold (odds ratio, 21.5; PϽ.001) increased rates, respectively, of detecting suspected malignant thyroid nodules by ultrasonography. Conclusions: Thyroid gland volume and tumor size were significantly associated with detection of suspected malignant thyroid nodules by ultrasonography. Small thyroid gland volume was associated with detection of suspected malignant thyroid nodules in multinodular goiters.

Are There Predictors of Malignancy in Patients with Multinodular Goiter?1

“…Our results are confirmed by work performed by Erbil et al 2 who showed a positive correlation between a smaller thyroid volume and a higher detection rate of suspected malignant thyroid nodules in patients with MNG. They found that thyroid gland volumes less than 38 ml had a 48-fold increase in the rate of detecting suspected thyroid cancer.…”

Does ultrasonographic volume of the thyroid gland correlate with difficult intubation? An observational study

“…7 Also Erbil et al reported in a population of 402 patients, that the thyroid volume in patients with thyroid carcinoma was 38 ± 18 mL and in patients with benign diseases it was 73.3 ± 48 mL. 8 The mean thyroid volume of our study group was 26.38 ± 14 mL, which is higher than the healthy population but still lower than Erbil's results. These findings may explain the fact that in our study this volume did not have any effect on intubation condition.…”

Developments in the use of ultrasound for thyroid cancer

“…More recently, ultrasound compressibility or elastography has been shown to distinguish between benign and malignant nodules in which significantly higher stiffness or less compressibility of thyroid lesions correlates highly with malignancy [14 ]. Additionally, smaller thyroid gland volume less than 38 ml and malignant thyroid nodule size of greater than 0.7 cm measured by ultrasound are associated with a 48-fold increased rate of malignancy [15].…”