Thyroid Nodule Size at Ultrasound as a Predictor of Malignancy and Final Pathologic Size

Cavallo, Allison; Johnson, Daniel N.; White, Michael G.; Siddiqui, Saaduddin; Antic, Tatjana; Mathew, Melvy Sarah; Grogan, Raymon H.; Angelos, Peter; Kaplan, Edwin L.; Cipriani, Nicole A.

doi:10.1089/thy.2016.0336

Cited by 93 publications

(111 citation statements)

References 37 publications

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“…We learned from the results that with the increase in the thyroid nodular size from 0.3 to 2 cm, the sensitivity of the UGSR to diagnose PTCs decreased while the specificity increased. The results of subgroup analysis may be because smaller nodules had higher malignancy rates than larger nodules in the PTC group . Therefore, the predictive value of the hypoechogenicity for malignancy decreased with increasing size.…”

Section: Discussionmentioning

confidence: 98%

The diagnostic value of the ultrasound gray scale ratio for different sizes of thyroid nodules

Chen

Gao

et al. 2019

Cancer Medicine

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At present, hypoechogenicity, as one of the clinically relevant features associated with suspicion of malignant thyroid disease, is affected by the variability of modules and the experience of sonographers, thus leading to unsatisfying results. We propose the ultrasound gray scale ratio (UGSR) to obtain an objective, numerical estimate of the echogenicity degree in different‐sized thyroid nodules, and we then evaluate its diagnostic efficacy in differentiating benign and malignant thyroid lesions. In total, 553 ultrasound images of thyroid nodules from one kind of ultrasonographic scanner were analyzed, among which 281 were papillary thyroid carcinomas (PTCs) and 272 were nodular goiters (NGs). The UGSR of the PTCs, NGs, and surrounding normal thyroid tissue was measured by image analysis software. The best cut‐off value for distinguishing various sizes of PTCs and NGs was determined by receiver operating characteristic (ROC) curve analysis. As the UGSR increased, the sensitivity of the diagnosing PTCs decreased, and the specificity increased. When the maximum Jordan index was 0.611, the best cut‐off value was 0.692, and the corresponding sensitivity and specificity of diagnosing PTCs were 87.9% and 73.2%, respectively. For the analysis of subgroups of different tumor sizes, as the size of thyroid nodules increased from 0.3 to 2 cm, the sensitivity of the diagnosis of PTCs decreased from 97.5% to 58.8%, and the specificity increased from 72.4% to 90.9%. These results strongly suggest that the UGSR is an appropriate objective, numerical method for estimating the echogenicity degree and has various diagnostic efficacies in different‐sized thyroid nodules. Thus, the UGSR can be used as an additional ultrasound parameter in the diagnosis of different‐sized PTCs and NGs.

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Section: Discussionmentioning

confidence: 98%

The diagnostic value of the ultrasound gray scale ratio for different sizes of thyroid nodules

Chen

Gao

et al. 2019

Cancer Medicine

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“…The accumulated data presented in Table shows that the majority of malignant tumors with false negative FNA results in large thyroid nodules were FTC (32.3%) and follicular variant PTC (53.8%). The prevalence of FTC was higher among large nodules and the proportion of FTC was higher among large malignant thyroid tumors . A recent study has reported that follicular variant PTC with false negative FNA results was exclusively found in encapsulated follicular variant PTC, and the size of follicular variant PTC with false negative FNA results was larger than that of follicular variant PTC without false negative FNA results .…”

Section: Discussionmentioning

confidence: 91%

“…There have been many conflicting reports in terms of false negative rate and nodule size in overall thyroid nodules . Although the reason for the conflicting results among the studies is not clear, it may be related to the proportion of FTC among malignant tumors and the size distribution of PTC in the study population.…”

Section: Discussionmentioning

confidence: 95%

“…Whether the high false negative rate in large thyroid nodules is real is still a matter of controversy; several studies have reported that large nodules were not associated with an increased risk of false negative FNA results . However, other studies have demonstrated that large thyroid nodules showed higher false negative rate than small nodules and that large nodules with benign cytology carry a higher risk of malignancy …”

Section: Introductionmentioning

confidence: 99%

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False negative rate of fine‐needle aspiration in thyroid nodules: impact of nodule size and ultrasound pattern

Ahn

Baek

et al. 2019

Head & Neck

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Background To retrospectively evaluate the false negative rate of ultrasound‐guided fine needle aspiration (FNA) according to the nodule size and ultrasound pattern. Methods We included 432 consecutive thyroid nodules from 384 patients who underwent ultrasound‐guided FNA with benign results (≥1 cm). The false negative rate in the nodules was assessed according to the nodule size and ultrasound pattern based on the Korean‐Thyroid Imaging Reporting and Data System (K‐TIRADS). Results The overall false negative rate was 3.2%. There was a trend toward an increasing false negative rate as the K‐TIRADS score increased (P < .001). In low or high suspicion nodules (K‐TIRADS 3 and 5), there was no significant difference in false negative rate according to the nodule size; however, among the intermediate suspicion nodules (K‐TIRADS 4), the false negative rate was higher in large nodules (≥3 cm, P = .039). Conclusion The impact of nodule size on the false negative rate differed according to the ultrasound pattern.

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“…Cavallo et al also investigated the association between nodule size and malignancy; they reported that malignancy risk was inversely correlated with nodule size, with smaller nodules having higher malignancy rates. Ultrasound and elastography both showed higher sensitivity for nodules larger than 10 mm and higher specificity for nodules smaller than 10 mm .…”

Section: Discussionmentioning

confidence: 99%

Which Is the Best Reference Tissue for Strain Elastography in Predicting Malignancy in Thyroid Nodules, the Sternocleidomastoid Muscle or the Thyroid Parenchyma?

Görgülü

2019

J of Ultrasound Medicine

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Objectives This study aimed to compare 2 types of strain ratios (SRs) in thyroid nodules. Two reference points were used: the sternocleidomastoid (SCM) muscle and the thyroid parenchyma. Methods A total of 101 nodules in 83 patients were prospectively enrolled in the study. For the semiquantitative analysis, 2 types of SRs were used: SR1, the ratio of the SCM muscle strain to the thyroid nodule strain; and SR2, the ratio of the surrounding normal thyroid tissue strain to the thyroid nodule strain. For each nodule, the SR1 and SR2 elastographic values were calculated, and their averages were compared. Results Eighty‐one (80.2%) of 101 thyroid nodules were benign, and 20 (19.8%) were malignant. In both benign and malignant histopathologic types, the SR1 averages were significantly higher than the SR2 averages (P = .001; P < .001, respectively). Both the SR1 and SR2 values were found to be significantly successful in differentiating benign from malignant histopathologic types (P < .001 for both). The areas under the curve were then compared for the methods, and the difference was found to be statistically significant (P = .046). The diagnostic accuracy of the SR1 was superior to that of the SR2. Conclusions The SR1 and SR2 are effective adjunctive diagnostic tools for identifying malignant thyroid nodules. Using the SCM muscle as a reference point instead of thyroid tissue may be a more valuable way to measure SRs.

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Thyroid Nodule Size at Ultrasound as a Predictor of Malignancy and Final Pathologic Size

Cited by 93 publications

References 37 publications

The diagnostic value of the ultrasound gray scale ratio for different sizes of thyroid nodules

The diagnostic value of the ultrasound gray scale ratio for different sizes of thyroid nodules

False negative rate of fine‐needle aspiration in thyroid nodules: impact of nodule size and ultrasound pattern

Which Is the Best Reference Tissue for Strain Elastography in Predicting Malignancy in Thyroid Nodules, the Sternocleidomastoid Muscle or the Thyroid Parenchyma?

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