Thyroid Nodule Location on Ultrasonography as a Predictor of Malignancy

Zhang, Fan; Oluwo, Oluwaseun; Castillo, Fiorella; Gangula, Priyadarshini; Castillo, Matthew; Farag, Fady; Sibai, Zakaria; Zahedi, Tooraj

doi:10.4158/ep-2018-0361

Cited by 31 publications

(29 citation statements)

References 36 publications

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“…No previous study in the literature has examined the risk of thyroid malignancy according to the anatomical site of thyroid nodules, except for a preliminary report [7]. In our study, an analysis of the distribution of thyroid nodules showed a higher prevalence of lesions in the inferior pole, with no differences between the two lobes.…”

Section: Discussionsupporting

confidence: 40%

“…Various US characteristics of nodules, such as microcalcifications; hypoechogenicity; irregular, microlobulated, or infiltrative margins; and taller-than-wide shape, are all associated with greater malignancy risk, but no prior study has examined the risk of malignancy in relation to location in the upper versus lower pole of the thyroid, except for a poster presented at the American Association of Clinical Endocrinologists (AACE) 2018 Annual Scientific and Clinical Congress showing that nodules located in the upper pole of the thyroid gland may carry a greater risk for malignancy than those in the lower pole [7]. The aim of this study was to evaluate the frequency of thyroid nodules in various parts of the gland and to correlate the anatomical location with the risk of malignancy.…”

Section: Introductionmentioning

confidence: 99%

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Is thyroid nodule location associated with malignancy risk?

Ramundo¹,

Lamartina²,

Falcone³

et al. 2019

Ultrasonography

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Purpose: Nodules located in the upper pole of the thyroid may carry a greater risk for malignancy than those in the lower pole. We conducted a study to analyze the risk of malignancy of nodules depending on location. Methods: The records of patients undergoing thyroid-nodule fine-needle aspiration cytology (FNAC) at an academic thyroid cancer unit were prospectively collected. The nodules were considered benign in cases of a benign histology or cytology report, and malignant in cases of malignant histology. Pathological findings were analyzed based on the anatomical location of the nodules, which were also scored according to five ultrasonographic classification systems. Results: Between November 1, 2015 and May 30, 2018, 832 nodules underwent FNAC, of which 557 had a definitive diagnosis. The prevalence of malignancy was not significantly different in the isthmus, right, or left lobe. Among the 227 nodules that had a precise longitudinal location noted (from 219 patients [155 females], aged 56.2±14.0 years), malignancy was more frequent in the middle lobe (13.2%; odds ratio [OR], 9.74; 95% confidence interval [CI], 1.95 to 48.59). This figure was confirmed in multivariate analyses that took into account nodule composition and the Thyroid Imaging, Reporting, and Data System (TIRADS) classification. Using the American College of Radiologists TIRADS, the upper pole location also demonstrated a slightly significant association with malignancy (OR, 6.92; 95% CI, 1.02 to 46.90; P=0.047). Conclusion: The risk of thyroid malignancy was found to be significantly higher for mid-lobar nodules. This observation was confirmed when suspicious ultrasonographic features were included in a multivariate model, suggesting that the longitudinal location in the lobe may be a risk factor independently of ultrasonographic appearance.

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Section: Discussionsupporting

confidence: 40%

Section: Introductionmentioning

confidence: 99%

Is thyroid nodule location associated with malignancy risk?

Ramundo¹,

Lamartina²,

Falcone³

et al. 2019

Ultrasonography

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“…Recently, the intraglandular location of the nodule has also been confirmed to be an independent risk factor for malignancy. Nodules arising in the isthmus are the most likely to be diagnosed as cancer, whereas those found in the lower third of a lobe carry the lowest risk ( 48 ), as compared with those in the middle ( 49 ) or upper pole of the lobe ( 50 ).…”

Section: Clinical Risk Factorsmentioning

confidence: 99%

Contemporary Thyroid Nodule Evaluation and Management

Grani

Sponziello

Pecce

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

192

140

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Context Approximately 60% of adults harbor 1 or more thyroid nodules. The possibility of cancer is the overriding concern, but only about 5% prove to be malignant. The widespread use of diagnostic imaging and improved access to health care favor the discovery of small, subclinical nodules and small papillary cancers. Overdiagnosis and overtreatment is associated with potentially excessive costs and nonnegligible morbidity for patients. Evidence Acquisition We conducted a PubMed search for the recent English-language articles dealing with thyroid nodule management. Evidence Synthesis The initial assessment includes an evaluation of clinical risk factors and sonographic examination of the neck. Sonographic risk-stratification systems (e.g., Thyroid Imaging Reporting and Data Systems) can be used to estimate the risk of malignancy and the need for biopsy based on nodule features and size. When cytology findings are indeterminate, molecular analysis of the aspirate may obviate the need for diagnostic surgery. Many nodules will not require biopsy. These nodules and those that are cytologically benign can be managed with long-term follow-up alone. If malignancy is suspected, options include surgery (increasingly less extensive), active surveillance or, in selected cases, minimally invasive techniques. Conclusion Thyroid nodule evaluation is no longer a 1-size-fits-all proposition. For most nodules, the likelihood of malignancy can be confidently estimated without resorting to cytology or molecular testing, and low-frequency surveillance is sufficient for most patients. When there are multiple options for diagnosis and/or treatment, they should be discussed with patients as frankly as possible to identify an approach that best meets their needs.

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“…This finding indicates that upper pole tumours more likely involve the lateral compartment than tumours located at other positions, which has also been reported in several studies [ 18 , 19 ]. Another study [ 20 ] has shown that upper pole tumours seem to be at a high risk for malignancy. Jasim et al [ 21 ] argued that upper thyroid nodules had a higher risk for malignancy, with an OR of 1.8 (1.2–2.7), followed by middle and lower thyroid nodules in a review of 3313 adult patients.…”

Section: Discussionmentioning

confidence: 99%

PTC located in the upper pole is more prone to lateral lymph node metastasis and skip metastasis

Dou

Chen

et al. 2020

World J Surg Onc

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Background Lateral lymph node metastasis (LLNM) is very common in papillary thyroid carcinoma (PTC). The influence of tumour location on LLNM remains controversial. The purpose of this study was to reveal the association between PTC tumours located in the upper pole and LLNM. Methods We reviewed a total of 1773 PTC patients who underwent total thyroidectomy with central and lateral lymph node dissection between 2013 and 2018. Patients were divided into two groups according to tumour location. Univariate and multivariate analyses were performed to identify risk factors associated with LLNM and “skip metastasis”. Results In the upper pole group, LLNM and skip metastasis were significantly likely to occur. Multivariate analysis showed that tumours located in the upper pole, male sex, extrathyroidal extension (ETE), central lymph node metastasis (CLNM) and tumour size were independent risk factors for LLNM, with odds ratios ([ORs], 95% confidence intervals [CIs]) of 2.136 (1.707–2.672), 1.486 (1.184–1.867), 1.332 (1.031–1.72), 4.172 (3.279–5.308) and 2.496 (1.844–3.380), respectively. Skip metastasis was significantly associated with the primary tumour location in the upper pole and age > 55 years, with ORs of 4.295 (2.885–6.395) and 2.354 (1.522–3.640), respectively. Conclusions In our opinion, papillary thyroid tumours located in the upper pole may have an exclusive drainage pathway to the lateral lymph nodes. When the tumour is located in the upper pole, lateral neck dissection should be evaluated meticulously.

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Thyroid Nodule Location on Ultrasonography as a Predictor of Malignancy

Cited by 31 publications

References 36 publications

Is thyroid nodule location associated with malignancy risk?

Is thyroid nodule location associated with malignancy risk?

Contemporary Thyroid Nodule Evaluation and Management

PTC located in the upper pole is more prone to lateral lymph node metastasis and skip metastasis

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