Management of Thyroid Nodules Detected at US: Society of Radiologists in Ultrasound Consensus Conference Statement

Abstract

The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to come to a consensus on the management of thyroid nodules identified with thyroid ultrasonography (US), with particular focus on which nodules should be subjected to US-guided fine needle aspiration and which thyroid nodules need not be subjected to fine-needle aspiration. The panel met in Washington, DC, October 26-27, 2004, and created this consensus statement. The recommendations in this consensus statement, which are based on analysis of the current literature and common practice strategies, are thought to represent a reasonable approach to thyroid nodular disease.

Thyroid nodules and evaluation of thyroid cancer risk

“…The predictive value of these ultrasound characteristics is highly variable across the literature 13 . Microcalcifications and abnormal cervical lymph nodes probably have the highest predictive values for thyroid cancer (up to 94% and 100% respectively), although their sensitivity is generally low (26% and 5% respectively) 2 , 12 – 15 .…”

“…Microcalcifications seen as punctate echogenicities are due to calcified psammoma bodies typical of papillary thyroid cancer 12 . They can be difficult to distinguish from colloid but the presence of comet‐tail artifacts associated with colloid crystals may be helpful 2 , 13 . The association of macrocalcifications with thyroid cancer is less consistent 8 , 11 , 12 , 15 .…”

“…Nodule size is not predictive of malignancy either in a solitary nodule or multinodular thyroid 8 , 9 , 13 . One study showed that in patients with multiple nodules and thyroid cancer, if only the largest nodule was selected for biopsy, nearly 50% of cancer would be missed 8 .…”

“…A number of guidelines are available to assist the clinician in selecting thyroid nodules for FNAB 1 , 2 , 13 . A decision analysis study suggests that criteria for FNAB based on nodule size and high‐risk ultrasound findings such as microcalcifications result in better outcomes than selection based on nodule size alone in weighing the risk of missing cancer diagnosis against having surgery for benign nodules 20 .…”

“…However some small nodules, especially those > 0.5 cm, may be considered for FNAB if they are associated with abnormal lymph nodes on palpation or imaging at presentation, ‘high risk’ history, focal avidity on PET scanning or suspicious ultrasound features 2 , 18 . Guidelines from the American Association of Clinical Endocrinologists and Society of Radiologists in Ultrasound similarly use suspicious ultrasound findings to recommend FNAB although their size criteria differ from the ATA Guidelines 1 , 2 , 13 .…”