The predictive value of ultrasound findings in the management of thyroid nodules

Cappelli, Carlo; Castellano, Maurizio; Pirola, Ilenia; Cumetti, Davide; Agosti, Barbara; Gandossi, Elena; Rosei, Enrico Agabiti

doi:10.1093/qjmed/hcl121

Cited by 247 publications

(199 citation statements)

References 25 publications

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“…Similar data on the high rate of extrathyroidal extension of thyroid small carcinomas have been reported from other regions suffering from iodine deficiency, as well as from iodine-rich areas (13,14,(25)(26)(27). In our material, preoperative diagnoses failed to discover two cases of small invasive cancers.…”

Section: Second Version (%)supporting

confidence: 89%

The fine-needle aspiration biopsy efficacy of small thyroid nodules in the area of recently normalized iodine supply

Słowińska-Klencka

Popowicz²,

Lewiński³

et al. 2008

European Journal of Endocrinology

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Objective: To evaluate the incidence of focal lesions in the thyroid in the area of recently normalized iodine supply as well as to compare the efficacy of fine-needle aspiration biopsy (FNAB) of small (infracentimetric) and large thyroid lesions in this area. Methods: The outcomes of 13 646 ultrasound (US) examinations, 13 437 US-guided FNABs of the thyroid and 1694 results of post-operative histopathological examinations were analysed. Results: Infracentimetric nodules (INs %10 mm) were revealed by US examinations in 43.5% of patients; in the majority of the cases (82.2%) INs were multiple. The percentage of revealed carcinomas by aspiration of INs is similar to that observed when large nodules (LNs O10 mm) are examined cytologically. However, the efficiency of preoperative diagnosis of INs is lower than LNs with respect to both US selection of lesions for FNAB and the percentage of false negative results of FNAB (29.8 vs 5.4%, P!0.001). In post-operative histopathological examination, extrathyroidal extension of thyroid cancers was observed in nearly 30% of microcarcinomas. Conclusions: In endemic or post-endemic areas, the efficiency of FNAB is lower in the case of small lesions than larger ones. In spite of this, the percentage of cytologically revealed carcinomas among small lesions is not lower than larger ones. Thus, it is particularly indicated to follow up small thyroid lesions with repeated US examinations in such areas.European Journal of Endocrinology 159 747-754

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Section: Second Version (%)supporting

confidence: 89%

The fine-needle aspiration biopsy efficacy of small thyroid nodules in the area of recently normalized iodine supply

Słowińska-Klencka

Popowicz²,

Lewiński³

et al. 2008

European Journal of Endocrinology

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“…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.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

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

Campanella

Ianni

Rota

et al. 2014

European Journal of Endocrinology

107

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Objective: In order to quantify the risk of malignancy of clinical and ultrasonographic features of thyroid nodules (TNs), we did a systematic review and meta-analysis of published studies. Methods: We did a literature search in MEDLINE for studies published from 1st January 1989 until 31st December 2012. Studies were considered eligible if they investigated the association between at least one clinical/ultrasonographic feature and the risk of malignancy, did not have exclusion criteria for the detected nodules, had histologically confirmed the diagnoses of malignancy, and had a univariable analysis available. Two reviewers independently extracted data on study characteristics and outcomes. Results: The meta-analysis included 41 studies, for a total of 29 678 TN. A higher risk of malignancy expressed in odds ratio (OR) was found for the following: nodule height greater than width (OR: 10.15), absent halo sign (OR: 7.14), microcalcifications (OR: 6.76), irregular margins (OR: 6.12), hypoechogenicity (OR: 5.07), solid nodule structure (OR: 4.69), intranodular vascularization (OR: 3.76), family history of thyroid carcinoma (OR: 2.29), nodule size R4 cm (OR: 1.63), single nodule (OR: 1.43), history of head/neck irradiation (OR: 1.29), and male gender (OR: 1.22). Interestingly, meta-regression analysis showed a higher risk of malignancy for hypoechoic nodules in iodine-sufficient than in iodine-deficient geographical areas. Conclusions: The current meta-analysis verified and weighed out each suspicious clinical and ultrasonographic TN feature. The highest risk was found for nodule height greater than width, absent halo sign, and microcalcifications for ultrasonographic features and family history of thyroid carcinoma for clinical features. A meta-analysis-derived grading system of TN malignancy risk, validated on a large prospective cohort, could be a useful tool in TN diagnostic work-up.

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“…The best compromise between the risk of missing carcinomas of potential clinical aggressiveness and the need to avoid unnecessary procedures is probably to use FNAB on nodules with at least one of the following components: microcalcifications, blurred margins, or hypoechoic pattern (19,20). Color and power Doppler sonography have been widely evaluated as diagnostic tools for detecting thyroid cancer.…”

Section: Thyroid Ultrasonographymentioning

confidence: 99%

Latin American Thyroid Society recommendations for the management of thyroid nodules

Camargo

Corigliano

Friguglietti

et al. 2009

Arq Bras Endocrinol Metab

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Several guidelines on diagnosis and treatment of thyroid nodules and cancer have recently been published. However, recommended practices are not always appropriate to different settings or countries. The aim of this consensus was to develop Clinical Guidelines for evaluation and management of patients with thyroid nodules applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society involved with research and management of thyroid nodules and cancer from different medical centers in Latin America. The consensus was produced based on the expert opinion of the panel with use of principles of evidence-based medicine. Following a group meeting, a first draft based on the expert opinion of the panel was elaborated and later circulated among panel members for further revision. After revision, this document was submitted to all LATS members for commentaries and considerations and finally revised and refined by the authors. The final recommendations represent state of the art on management of thyroid nodules applied to all Latin American countries. Arq Bras Endocrinol Metab. 2009;53(9):1167-75 Keywords Thyroid nodule; thyroid ultrasonography; thyroid aspiration biopsy; radioactive iodine therapy resumo Vários consensos têm sido publicados acerca do diagnóstico e do tratamento de nódulos e cân-cer da tireoide. Entretanto, as recentes recomendações nem sempre são apropriadas para diferentes regiões ou países. O objetivo deste trabalho foi oferecer uma série de recomendações para a avaliação e conduta de pacientes portadores de nódulos tireoideos aplicáveis a todos os países da América Latina. O trabalho foi realizado por um comitê composto por 13 membros da Sociedade Latino-Americana de Tireoide envolvidos com pesquisa e manejo de pacientes portadores de nódulos e carcinoma diferenciado da tireoide, de diferentes centros médicos da América Latina. As recomendações foram estabelecidas, após consenso, utilizando as opiniões especializadas de cada membro e os princípios da medicina baseada em evidência. Após a primeira reunião do grupo, um primeiro documento foi elaborado e encaminhado a todos os membros para revisão. Posteriormente, o documento foi enviado aos membros da Sociedade Latino-Americana de Tireoide para avaliação, sugestões e comentários. A versão final, elaborada após refinada revisão de todos os autores, representa o estado da arte no diagnóstico e na conduta de nódulos tireoideos, aplicáveis a todos os países da América Latina.

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The predictive value of ultrasound findings in the management of thyroid nodules

Abstract: No single parameter, including nodule size, satisfactorily identifies a subset of patients to be electively investigated by FNAC, although several may be useful in this regard.

Cited by 247 publications

References 25 publications

The fine-needle aspiration biopsy efficacy of small thyroid nodules in the area of recently normalized iodine supply

The fine-needle aspiration biopsy efficacy of small thyroid nodules in the area of recently normalized iodine supply

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

Latin American Thyroid Society recommendations for the management of thyroid nodules

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