Pattern Recognition of Benign Nodules at Ultrasound of the Thyroid: Which Nodules Can Be Left Alone?

Bonavita, Jacopo; Mayo, J.; Babb, James S.; Bennett, Genevieve; Oweity, Thaira; Macari, Michael; Yee, Joseph

doi:10.2214/ajr.08.1820

Cited by 206 publications

(131 citation statements)

References 27 publications

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“…In light of these considerations and our results, spongiform nodules, in the absence of other suspicious features, should not require FNAB. These nodules are associated with a very low risk for malignancy, as previously demonstrated by other researchers (7,25,27,29).…”

Section: Discussionsupporting

confidence: 73%

“…All nodules were evaluated and classified according to the presence of 20 predefined ultrasound features, mostly retrieved from a literature review (4,5,(7)(8)(9)(10)(11)21,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) and detailed in Table 1. These features were included in a multiple logistic regression analysis to determine whether they were (or not) independently associated with the likelihood of malignancy (4,5,(8)(9)(10)(11)(24)(25)(26)(28)(29)(30)34).…”

Section: Thyroid Ultrasound and Fnab Evaluationsmentioning

confidence: 99%

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Likelihood of malignancy in thyroid nodules according to a proposed Thyroid Imaging Reporting and Data System (TI-RADS) classification merging suspicious and benign ultrasound features

Delfim

Veiga

Vidal

et al. 2017

Arch. Endocrinol. Metab.

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Objective: The aim of this study was to describe the ultrasound features of benign and malignant thyroid nodules and evaluate the likelihood of malignancy associated with each feature according to the Bethesda System for Reporting Thyroid Cytopathology and histopathology. With this analysis, we propose a new TI-RADS classification system. Materials and methods: The likelihood of malignancy from ultrasound features were assessed in 1413 thyroid nodules according to the Bethesda System for Reporting Thyroid Cytopathology and histopathological findings. A score was established by attributing different weights to each ultrasound feature evaluated. Results: Features positively associated with malignancy in bivariate analysis received a score weight of +1. We attributed a weight of +2 to features which were independently associated with malignancy in a multivariate analysis and +3 for those associated with the highest odds ratio for malignancy (> 10.0). Hence, hypoechogenicity (graded as mild, moderate or marked, according to a comparison with the overlying strap muscle), microcalcification and irregular/microlobulated margin received the highest weights in our scoring system. Features that were negatively associated with malignancy received weights of -2 or -1. In the proposed system a cutoff score of 2 (sensitivity 97.4% and specificity 51.6%) was adopted as a transition between probably benign (TI-RADS 3) and TI-RADS 4a nodules. Overall, the frequency of malignancy in thyroid nodules according to the categories was 1.0% for TI-RADS 3, 7.8% for TI-RADS 4a, 35.3% for TI-RADS 4b, and 84.7% for TI-RADS 5. Conclusion: A newly proposed TI-RADS classification adequately assessed the likelihood of malignancy in thyroid nodules. Arch Endocrinol Metab. 2017;61(3):211-21.

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Section: Discussionsupporting

confidence: 73%

Section: Thyroid Ultrasound and Fnab Evaluationsmentioning

confidence: 99%

Likelihood of malignancy in thyroid nodules according to a proposed Thyroid Imaging Reporting and Data System (TI-RADS) classification merging suspicious and benign ultrasound features

Delfim

Veiga

Vidal

et al. 2017

Arch. Endocrinol. Metab.

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“…Some investigators [37,38] have preferred to consider a more pattern-oriented US approach as an alternative to the analysis of individual features. More nodular patterns with or without indication for FNAB were depicted.…”

Section: Prace Oryginalnementioning

confidence: 99%

“…Four patterns invariably benign were identified (histological diagnosis). The patterns with no indication for FNAB are represented by the following: 1 -spongiform nodule ('puff pastry'); 2 -cyst with colloid clot; 3 -' giraffe', and 4 -hyperechoic nodule ('white knight') [37,38].…”

Section: Prace Oryginalnementioning

confidence: 99%

Clinical, ultrasonographical and histopathological aspects in Hashimoto’s thyroiditis associated with malignant and benign thyroid nodules

Zosin¹,

Balaş²

2013

Endokrynologia Polska

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Intriduction: The reported prevalence of chronic autoimmune thyroiditis associated with differentiated thyroid cancer (DTC) is heterogeneous. The aim of this study was to evaluate some epidemiological, clinical, sonographical and histological features of operated thyroid nodules with background diffuse autoimmune thyroiditis. Material and methods:The study included 411 cases with Hashimoto's thyroiditis (HT), of which 118 presented thyroid nodular disease (TND). Thyroidectomy was performed in 76 cases. Of these patients, 24 presented histologically confirmed DTC and 52 benign lesions. DTC types were as follows: papillary thyroid cancer (PTC) (n = 6), follicular variant of PTC (FVPTC) (n = 6), papillary microcarcinomas (n = 8), follicular thyroid carcinoma (n = 1) and the mixed form (classic PTC and FVPTC) (n = 3). The benign nodules were dominated by: follicular adenoma (48%), and colloid goitre (40.3%). Results:The sonographic features with predictive risk for malignancy in cases with HT associated with TND were represented by: solid composition, hypoechogenicity and microcalcifications. The characters of margins, the nodular shape and the type of vascularity do not seem to be as useful for identification of malignant nodules in HT. Fine needle-aspiration biopsy (FNAB) showed in DTC cases different cytological smears: malignant (ten), indeterminate (eight), benign (two), and non-diagnostic (four). In the group of benign nodules, the indeterminate smears represented also a significant percentage (n = 12). Conclusions: The incidence of TND associated with HT was 28.7%. Among 76 operated cases, 31.5% presented DTC. The accuracy of FNAB in the preoperative diagnosis showed higher sensitivity (90.0%) and specificity (61.5%) compared to sonographic criteria. StreszczenieWstęp: Podawane w literaturze dane na temat rozpowszechnienia przewlekłego autoimmunologicznego zapalenia tarczycy związanego ze zróżnicowanym rakiem tarczycy (DTC, differentiated thyroid cancer) cechuje duża rozpiętość. Celem badania była ocena wybranych cech epidemiologicznych, klinicznych, ultrasonograficznych i histopatologicznych operowanych guzków tarczycy u pacjentów z rozlanym autoimmunologicznym zapaleniem tarczycy. Materiał i metody: Do badania włączono 411 przypadków choroby Hashimoto (HT, Hashimoto thyroiditis), z czego 118 pacjentów zgłosiło się do lekarza z powodu choroby guzkowej tarczycy (TND, thyroid nodular disease). Tyroidektomię wykonano u 76 pacjentów, przy czym u 24 pacjentów badanie histopatologiczne wykazało DTC, a u pozostałych 52 -zmiany łagodne. Postacie DTC były następujące: rak brodawkowaty tarczycy (PTC, papillary thyroid cancer) (n = 6), wariant pęcherzykowy PTC (FVPTC, follicular variant of papillary thyroid cancer) (n = 6), mikroraki brodawkowate (n = 8), rak pęcherzykowy tarczycy (n = 1) i postać mieszana (klasyczny PTC i FVPTC) (n = 3). Większość guzków łagodnych stanowiły gruczolaki pęcherzykowe (48%) i wole koloidalne (40,3%). Wyniki: Cechy ultrasonograficzne związane z ryzykiem rozpoznania nowotworu złośl...

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“…Cysts with colloid clot were identified during the TUE on the basis of the comet tail sign (Fig. 1b) [8]; fine needle aspiration cytology (FNAC) was not required. All category A subjects were recommended to undergo the next round of TUE two years later.…”

Section: Categories Of Tue Findingsmentioning

confidence: 99%

The protocol and preliminary baseline survey results of the thyroid ultrasound examination in Fukushima [Rapid Communication]

et al. 2016

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Abstract. After the Fukushima nuclear power plant accident on March 11, 2011, the public of Japan became particularly concerned about the possibility of an increased risk of childhood thyroid cancer, similar to what was observed after the Chernobyl's accident. Due to serious public health perception, there was an urgency to evaluate the baseline levels of childhood thyroid status in Fukushima prefecture. Therefore we have commenced a thyroid ultrasound examination (TUE) survey of the approximately 360,000 pediatric inhabitants (0 to 18 years of age) who lived in Fukushima at the time of the accident in October 2011. The subjects were divided into three categories according to the standardized diagnostic criteria of ultrasound findings. Category A contained the subjects whose TUE findings were intact or benign. Category B were recommended a confirmatory TUE. Category C was recommended an immediate confirmatory TUE. Results: The survey of 40,302 subjects in the first year was completed in March, 2013. There were 40,097 (99.5%), 205 (0.50%) and 0 subjects in categories A, B and C, respectively. Of the 82 category B subjects who underwent fine needle aspiration cytology (FNAC), 12 were diagnosed with a malignant tumor or were suspected to have malignancy. The 12 subjects received thyroid surgery and 11 thyroid cancers and one benign nodule were confirmed histologically after surgery. This is the first largescaled TUE survey to employ sophisticated ultrasound screening and aim to evaluate the baseline frequency of childhood thyroid nodules and cysts. The results will become the golden standard of future comparative TUE in Fukushima, Japan.Key words: Fukushima, Chernobyl, Ultrasound examination, Nodules, Thyroid cancer first few months after the Fukushima disaster.Due to the issue of concern and a strong request from the central and local governments, the Fukushima Health Management survey (FHM) body initiated several health protection surveys [5], including one that involved thyroid ultrasound examinations (TUE) of all pediatric inhabitants who lived or were staying in Fukushima at the time of the accident. The first objective of this survey was to evaluate the baseline rates of childhood thyroid nodules and cancer in Fukushima as this information was not yet available. The baseline survey commenced on October 9, 2011 [6,7] and was conducted by Fukushima Medical University (FMU). Since it is essentially important to follow the standardized ultrasound diagnostic criteria as a part of quality control when any large-scaled screening, the protocol and the initial data of the baseline TUE survey in Fukushima are reported concretely here for the first time.

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Pattern Recognition of Benign Nodules at Ultrasound of the Thyroid: Which Nodules Can Be Left Alone?

Abstract: Recognition of specific morphologic patterns is an accurate method of identifying benign thyroid nodules that do not require cytologic evaluation. Use of this approach may substantially decrease the number of unnecessary biopsy procedures.

Cited by 206 publications

References 27 publications

Likelihood of malignancy in thyroid nodules according to a proposed Thyroid Imaging Reporting and Data System (TI-RADS) classification merging suspicious and benign ultrasound features

Likelihood of malignancy in thyroid nodules according to a proposed Thyroid Imaging Reporting and Data System (TI-RADS) classification merging suspicious and benign ultrasound features

Clinical, ultrasonographical and histopathological aspects in Hashimoto’s thyroiditis associated with malignant and benign thyroid nodules

The protocol and preliminary baseline survey results of the thyroid ultrasound examination in Fukushima [Rapid Communication]

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