Thyroid palpation versus high-resolution thyroid ultrasonography in the detection of nodules.

Abstract

Detection of thyroid nodules by physical examination and high-resolution ultrasonography was compared using small groups of blinded, experienced physician examiners working with a sample of 2441 persons from Estonia, most of whom were Chernobyl nuclear reactor clean-up workers. A random subsample of 113 (5%) persons was subjected to triple control examinations with both physical examination and high-resolution ultrasonography. Positive high-resolution ultrasonographic findings were considerably more reproducible among different observers than were positive physical examination findings. Agreement between methods was poor. Nodules were found in 169 (6.9%) subjects by physical examination and in 249 (10.2%) subjects by high-resolution ultrasonography. Physical examination found only 53 (21%) of the 249 nodules found by high-resolution ultrasonography. High-resolution ultrasonography did not confirm the existence of 115 (68%) of the 169 nodules found by physical examination. Only 6.4% of nodules less than 0.5 cm in diameter, as based on high-resolution ultrasonographic results, were detected by physical examination. Physical examination detection improved with increasing nodule size but was still only 48.2% for nodules larger than 2 cm. Physical examination was relatively effective in detecting nodules in the isthmus of the thyroid gland but much less so for nodules in the upper pole of the gland. Clinical evaluation and epidemiologic studies of nodular thyroid disease stand to benefit from the greater sensitivity and specificity of ultrasonographic examinations.

Importance of image guided fine needle aspiration in diagnosis of benign and malignant lesions

“…Real-time US permits visualization of the needle within the lesion, thereby facilitating accurate biopsy of small nonpalpable nodules. 23,24 Limitations of study As this study has been conducted in a hospital which is in a remote area of India. It is often difficult to provide ancillary techniques.…”

Sonographically guided fine needle aspiration of thyroid nodule: Discrepancies between cytologic and histopathologic findings

“…T he prevalence of thyroid nodules in the general population has been reported to be 4-7% on palpation alone 1 and 10-41% on sonography (US), [2][3][4] with approximately 9.2-12.0% of the latter being malignant. 5,6 To avoid inadequate sampling during fine needle aspiration (FNA), US guidance has been used increasingly to direct the fine needle into minute nonpalpable thyroid nodules or into the solid or peripheral areas of complex nodules to avoid cystic or necrotic areas, which might lead to inadequate samples.…”

High Prevalence of Carcinoma in Ultrasonography-guided Fine Needle Aspiration Cytology of Thyroid Nodules

“…THYROID nodules are present in 4-7% of the general population by palpation [1][2][3]. The number of thyroid incidentalomas is increasing due to widely use of highly sensitive ultrasonography for routine health examinations [4].…”