Ultrasonography and the Ultrasound-Based Management of Thyroid Nodules: Consensus Statement and Recommendations

Moon, Won-Jin; Baek, Jung Hwan; Jung, So Lyung; Kim, Dong Wook; Kim, Min Jung; Kim, Ji Young; Kwak, Jin Young; Lee, Jeong Hyun; Lee, Joon‐Hyung; Lee, Young Hen; Na, Dong Gyu; Park, Jeong Seon; Park, Sun Won

doi:10.3348/kjr.2011.12.1.1

Cited by 432 publications

(389 citation statements)

References 63 publications

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“…in benign and malignant nodules (7,18). Previously, peripheral calcification was thought to occur secondary to chronic degenerative changes and therefore indicate a benign status.…”

Section: Evaluation Of Macrocalcification In Thyroid Nodulesmentioning

confidence: 99%

Evaluation of cytopathological findings in thyroid nodules with macrocalcification: macrocalcification is not innocent as it seems

Arpacı

Özdemır

Çuhacı

et al. 2014

Arq Bras Endocrinol Metab

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Objective: Microcalcification is strongly correlated with papillary thyroid cancer. It is not clear whether macrocalcification is associated with malignancy. In this study, we aimed to assess the result of fine needle aspiration biopsies (FNAB) of thyroid nodules with macrocalcifications. Subjects and methods: We retrospectively evaluated 269 patients (907 nodules). Macrocalcifications were classified as eggshell and parenchymal macrocalcification. FNAB results were divided into four groups: benign, malignant, suspicious for malignancy, and non-diagnostic. Results: There were 79.9% female and 20.1% male and mean age was 56.9 years. Macrocalcification was detected in 46.3% nodules and 53.7% nodules had no macrocalcification. Parenchymal and eggshell macrocalcification were observed in 40.5% and 5.8% nodules, respectively. Cytologically, malignant and suspicious for malignancy rates were higher in nodules with macrocalcification compared to nodules without macrocalcification (p = 0.004 and p = 0.003, respectively). Benign and non-diagnostic cytology results were similar in two groups (p > 0.05). Nodules with eggshell calcification had higher rate of suspicious for malignancy and nodules with parenchymal macrocalcification had higher rates of malignant and suspicious for malignancy compared to those without macrocalcification (p = 0.01, p = 0.003 and p = 0.007, respectively). Conclusions: Our findings suggest that macrocalcifications are not always benign and are not associated with increased nondiagnostic FNAB results. Macrocalcification, particularly the parenchymal type should be taken into consideration. Arq Bras Endocrinol Metab. 2014;58(9):939-45 Keywords Thyroid nodule; macrocalcification; malignancy; suspicious of malignancy RESUMO Objetivo: A microcalcificação está fortemente correlacionada com o câncer papilar de tiroide. Não está claro se a macrocalcificação também está associada com malignidade. Neste estudo, nosso objetivo foi avaliar o resultado da biópsia de aspiração por agulha fina (FNAB) de nó-dulos tiroidianos com macrocalcificações. Sujeitos e métodos: Avaliamos retrospectivamente 269 pacientes (907 nódulos). As macrocalcificações foram classificadas como periféricas (casca de ovo) ou parenquimatosas (interna). Os resultados da FNAB foram divididos em quatro grupos citológicos: benignos, com malignidade, suspeita de malignidade e não diagnósticos. Resultados: Das amostras, 79,9% foram coletadas de mulheres e 20,1% de homens, e a idade média foi de 56,9 anos. A macrocalcificação foi detectada em 46,3% dos nódulos, e em 53,7% dos nódulos não havia macrocalcificação. A macrocalcificação parenquimatosa e periférica foi observada em 40,5% e 5,8% dos nódulos, respectivamente. Em termos citológicos, a malignidade e suspeita de malignidade foram mais comuns em nódulos com macrocalcificação em comparação com nódulos sem macrocalcificação (p = 0,004 e p = 0,003, respectivamente). Resultados benignos e não diagnósticos da citologia foram similares em ambos os grupos (p > 0,05). Os nódulos com calci...

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“…in benign and malignant nodules (7,18). Previously, peripheral calcification was thought to occur secondary to chronic degenerative changes and therefore indicate a benign status.…”

Section: Evaluation Of Macrocalcification In Thyroid Nodulesmentioning

confidence: 99%

Evaluation of cytopathological findings in thyroid nodules with macrocalcification: macrocalcification is not innocent as it seems

Arpacı

Özdemır

Çuhacı

et al. 2014

Arq Bras Endocrinol Metab

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“…Informed consent for US-FNA was obtained from before each procedure. US-FNA was performed according to recommendations for thyroid nodules (3,8,11,12,24,25). Factors related to US-FNA procedure, such as diameter of the needle, the pass number of the needle per one nodule, whether performing fluid aspiration just before US-FNA, application of the suction during US-FNA were assessed to reveal the relationship with hemorrhagic complication.…”

Section: Us-guided Fna Biopsymentioning

confidence: 99%

“…Indeterminate nodules included those with US findings with neither malignant nor benign features (3). The internal content of a nodule was categorized according to the ratio of the cystic portion to the solid portion, as reported previously (3). Heavy calcification was defined as calcification occupying more than 90% of the nodule.…”

Section: Ultrasonographymentioning

confidence: 99%

“…Recently, thyroid nodules have been detected with increasing frequency as the use of ultrasound (US) has increased for evaluating the thyroid gland (1)(2)(3). US-guided fine needle aspiration (US-FNA) biopsy is a safe, accurate, and cost-effective method for the preoperative evaluation of thyroid nodules (2,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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Contributory Factors to Hemorrhage After Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules with an Emphasis on Patients Taking Antithrombotic or Anticoagulant Medications

et al. 2018

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Background: Thyroid nodules are a common clinical problem and ultrasound-guided fine needle aspiration (US-FNA) biopsy is widely used for evaluation of thyroid nodules. However, few studies have addressed the contributing factors to hemorrhage after US-FNA of thyroid nodules. Objectives: To assess the contributory factors related to patient characteristics, ultrasound (US) features of the thyroid nodules, and the US-FNA procedures to affect hemorrhage complications after US-FNA of thyroid nodules. Methods: Between March 2014 and April 2015, 366 consecutive patients who underwent US-FNA of thyroid nodules were enrolled in this retrospective study. The characteristics of hematomas, including the location, maximum size, and clinical course, were assessed. The relationships between hematomas and factors related to the medical characteristics of patients, US characteristics of the nodules, and FNA procedural factors were analyzed. Results: Data on 365 nodules in 321 patients who underwent US-FNA of thyroid nodules were analyzed. Minor hemorrhagic complications developed in 14 (3.8%) of the 365 nodules. There were no statistically significant differences between patients taking or not taking an anticoagulant or antithrombotic (P = 0.270). Factors related to increased risk of hematoma were male sex (P = 0.031), larger maximum size (P = 0.002), a cystic or predominantly cystic nodule (P < 0.0001), a probable benign nodule (P < 0.0001), thicker needle size (P < 0.0001), and a greater number of the needle passes (P = 0.005). Conclusions: US-FNA can be performed safely even in patients taking anticoagulant or antithrombotic agents. Factors related to hemorrhagic complications are male sex, larger nodules, cystic or predominantly cystic nodules, probably benign nodules, thicker needles and a greater number of needle passes.

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“…Nodules were examined by means of conventional high-resolution US with a color-Doppler module (MyLab Five, Esaote Biomedica, Genoa, Italy) equipped with a 7.5 MHz linear probe. In accordance with US guidelines (Moon et al, 2011), the following parameters were investigated: echogenicity vs. non-nodular tissue, presence or absence of a halo sign, presence or absence of microcalcifications, and presence or absence of an inner nodular flow pattern. All USE examinations were performed by the same radiologist (GT) with more than five years of experience by means of a MyLab 70 XvG US scanner (Esaote Biomedica) equipped with an LA-522 linear probe working in the range of 7-12 MHz and software for the quantification of the USE features of the tissue.…”

Section: Thyroid Us Use and Ceusmentioning

confidence: 99%

Retrospective cytological evaluation of indeterminate thyroid nodules according to the British Thyroid Association 2014 classification and comparison of clinical evaluation and outcomes

Giusti¹,

Massa²,

Balestra³

et al. 2017

J. Zhejiang Univ. Sci. B

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Abstract:The cytology of 130 indeterminate nodules (Thy 3) was retrospectively reviewed according to the British Thyroid Association 2014 classification. Nodules were divided into Thy 3a (atypical features) and Thy 3f (follicular lesion) categories. Histology was available as a reference for 97 nodules. Pre-surgical evaluations comprised biochemical tests, color-Doppler ultrasonography (US), semi-quantitative elastography-US (USE), contrast-enhanced US (CEUS), and mutation analysis from cytological slides. Thyroid malignancy was the final diagnosis for 19% of surgicallytreated nodules. No statistically significant difference in the risk of malignancy was found between Thy 3a (26%) and Thy 3f (14%) nodules. Histology of the Thy 3a and Thy 3f nodules showed a higher incidence of Hurtle cell adenomas in Thy 3f (29%) than in Thy 3a (3%) nodules (P=0.01). The only pre-surgical difference concerned the BRAF V600E mutation, which was positive in some Thy 3a but not in any Thy 3f nodules (P=0.04). Receiver-operating characteristic (ROC) analysis was used to obtain cut-off values from US (score), USE (ELX 2/1 strain index), and CEUS (time-topeak index and peak index) data. The cut-off values were similar for Thy 3a and Thy 3f nodules. Data showed that malignancy can be suspected if the US score is >2, ELX 1/2 strain index >1, time-to-peak index >1, and peak index <1. In a sub-group of 24 revised nodules (12 Thy 3a and 12 Thy 3f) with histology as a reference, the diagnostic power of cumulative pre-surgical analysis by means of US, USE, and CEUS showed high positive and negative predictive values (83% and 100%, respectively) for the presence of malignancy in Thy 3a and Thy 3f nodules. In conclusion, in our series of revised Thy 3 nodules, malignancy was low and displayed no significant differences between Thy 3a and Thy 3f categories. The use of cut-offs based on histology as a reference could reduce surgery. Our data support the conviction that, in mutation-negative Thy 3a and Thy 3f nodules, observation should be the first choice when not all instrumental results are suspect.

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Ultrasonography and the Ultrasound-Based Management of Thyroid Nodules: Consensus Statement and Recommendations

Cited by 432 publications

References 63 publications

Evaluation of cytopathological findings in thyroid nodules with macrocalcification: macrocalcification is not innocent as it seems

Evaluation of cytopathological findings in thyroid nodules with macrocalcification: macrocalcification is not innocent as it seems

Contributory Factors to Hemorrhage After Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules with an Emphasis on Patients Taking Antithrombotic or Anticoagulant Medications

Retrospective cytological evaluation of indeterminate thyroid nodules according to the British Thyroid Association 2014 classification and comparison of clinical evaluation and outcomes

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