Role of conventional ultrasonography and color flow-doppler sonography in predicting malignancy in 'cold' thyroid nodules

Abstract

The aim of the present study was to establish the usefulness of conventional thyroid ultrasonography (US) and color flow-doppler (CFD) sonography in the assessment of 'cold' thyroid nodules. One hundred and four consecutive patients with thyroid nodules who were to undergo surgery were examined by US and CFD before thyroidectomy. Conventional US evaluated the presence of a halo sign, hypoechogenicity and microcalcifications. The vascular pattern on CFD was classified as follows: Type I, absence of blood flow; Type II, perinodular blood flow; Type III, marked intranodular blood flow. On histology, 30 nodules were diagnosed as malignant (carcinoma, CA) and 74 as benign nodules (BN). On US, the echographic pattern most predictive for malignancy was absent halo sign, which was found in 20/30 CA and in 17/72 BN (P ¼ 0.0001; specificity 77.0%; sensitivity 66.6%). The most specific combination on US, absent halo sign/microcalcifications, was found in 8/30 CA and in 5/74 BN (P < 0.005; specificity 93.2%, sensitivity 26.6%). The Type III pattern on CFD was found in 20/30 CA and 38/74 BN (not statistically significant). The combination of absent halo sign on US with Type III pattern on CFD was found in 15/30 CA and in 8/74 BN (P < 0.0001; specificity 89.0%, sensitivity 50.0%). The combination of absent halo sign/microcalcifications on US with Type III pattern on CFD was the most specific combination of the two techniques, being found in 5/30 CA and in only 2/74 BN (P < 0.01; specificity 97.2%, sensitivity 16.6%).In conclusion, findings on US and CFD become highly predictive for malignancy only when multiple signs are simultaneously present in a thyroid nodule. Thus the predictive value of these techniques increases at the expense of their sensitivity. Only in a small proportion of patients with thyroid carcinoma is US and CFD information highly predictive of malignancy.

DIAGNOSIS IN ENDOCRINOLOGY: Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: a systematic review and meta-analysis

“…Of these, 235 studies were retrieved for further investigation, and 41 studies (14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54) met the final selection criteria and were included in the analysis. All 41 studies were observational studies published in peer-reviewed journals between 1989 and 2012.…”

Latin American Thyroid Society recommendations for the management of thyroid nodules

“…In contrast, other studies have reported that certain characteristics on Doppler US including vascular pattern, resistive index (RI) and maximal systolic velocity (MSV) are not useful parameters for distinguishing malignant from benign solid nodules (24)(25)(26). These characteristics, therefore, should not be used as diagnostic tools to determine which nodules should undergo FNAB (27).…”

Diagnosis of Malignancy for Thyroid Nodule by Ultrasound Findings: A Cross Sectional Study

“…[23,29,30] An innumerable studies suggested that unnecessary invasive procedures can be avoided by using ultrasonography for the diagnosis of nodes of thyroids. [31][32][33][34] Findings of the present study showed that the positive predictive value was 50% while the negative predictive value was 47%. These findings are very similar to the previous study of Leenhardt L et al as they observed that a nodule with hypoechogenicity has a moderate positive predictive value (up to 63%) for malignancy with 75% sensitivity and 83% specificity.…”