Ultrasound predictors of malignancy in indeterminate thyroid nodules

Matthey-Giè, Marie-Laure; Walsh, Siún; O’Neill, Ailbhe C.; Lowery, Aoife; Evoy, Denis; Gourichon, David; Prichard, Ruth; Skehan, Stephen J.; McDermott, Enda

doi:10.1007/s11845-013-1065-0

Cited by 4 publications

(1 citation statement)

References 17 publications

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“…Unfortunately, the predictive power of sonographic features for CIN is variable. While it has been observed retrospectively that CIN have increased vascularity, even the use of power Doppler ultrasound flow was unable to discriminate between benign and malignant nodules with sufficient accuracy as we observe in our study and as well in others 18–21 . Our study demonstrates that the presence of peripheral and/or internal vascularity was found in 76% (68/89) of CIN.…”

Section: Discussioncontrasting

confidence: 50%

Utility of mutational analysis for risk stratification of indeterminate thyroid nodules in a real‐world setting

Torrecillas

Sharma

Neuberger

et al. 2021

Clinical Endocrinology

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Objective American Thyroid Association (ATAn) 2015 guidelines recommend repeat fine‐needle aspiration with molecular marker profiling (MMP) or diagnostic lobectomy in thyroid nodules yielding atypia of unknown significance/follicular lesion of unknown significance (AUS/FLUS) or follicular neoplasm/suspicious for follicular neoplasm (FN/SFN) cytology. Our objective is to describe the molecular profiles and histological correlates of these cytologically indeterminate nodules (CIN) to aid risk stratification. Design Retrospective chart review. Patients Adults with CIN that underwent MMP from 2017 to 2020. Measurements Pearsons' χ2, Fisher's exact test, nonparametric testing and multiple regression analysis were performed. Results A total of 89 CIN underwent mutational analysis. Of 55% (n = 49) were Bethesda class III AUS/FLUS and 45% (n = 40) were Bethesda class IV FN/SFN. The US phenotype of a CIN was isoechoic (53%) or hypoechoic (32%) with well‐defined margins (98%), absence of calcifications (75%) and mildly increased internal vascularity (70%). A total of 84% and 87% of nodules were classified as mild/moderate or low/intermediate risk per the Thyroid Imaging Reporting and Data System and ATA classifications, respectively. Based on the Thyroseq patient management resource, 6.7% (n = 6) of nodules had a high predicted probability of cancer (≥95%), 41.6% (n = 37) were intermediate probability (40%–94%) and 51.7% (n = 46) were low probability (<40%). MMP revealed positive mutations in 45% (n = 40) of nodules, with 71% demonstrating RAS mutations. Of the nodules that underwent resection (n = 38), 39% (n = 15) had malignant pathology. Increasing the threshold to recommend surgical resection to a Thyroseq predicted probability of cancer to ≥50%, had a 100% sensitivity and 65% specificity for detecting malignant nodules (area under the ROC curve: 0.86). The positive predictive value was 37% and the negative predictive value was 100%. Conclusion US phenotypes of CIN nodules were variable and did not aid in differentiating malignant from benign nodules. Of the CIN nodules with a positive MMP, most were RAS and had a benign pathology. With the exception of high‐risk genetic markers for malignancy, the threshold to recommend surgical resection should be raised for CIN. Further studies to improve risk stratification in these nodules are required.

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Section: Discussioncontrasting

confidence: 50%

Utility of mutational analysis for risk stratification of indeterminate thyroid nodules in a real‐world setting

Torrecillas

Sharma

Neuberger

et al. 2021

Clinical Endocrinology

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Effects of fine-needle aspiration biopsy (FNAB) nodule depth on pain score

et al. 2015

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The use of semi-quantitative ultrasound elastosonography in combination with conventional ultrasonography and contrast-enhanced ultrasonography in the assessment of malignancy risk of thyroid nodules with indeterminate cytology

et al. 2014

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BackgroundThe pre-surgical selection of thyroid nodules with indeterminate cytology (Thy 3 according to British Thyroid Association) after fine-needle aspiration biopsy (FNAB) is currently required in order to reduce unnecessary total thyroidectomy. The objective of our study was to use a surgical series of Thy 3 nodules to evaluate the predictive role of ultrasound elastosonography (USE) and contrast-enhanced ultrasonography (CEUS) in pre-surgical diagnoses of malignancy.Subjects and methodsWe enrolled 63 patients with Thy 3 nodules in which cytological–histological correlation was available. The ELX 2/1 strain index was obtained by means of semi-quantitative USE, which was performed before surgery in addition to conventional ultrasonography (US) and contrast-enhanced US (CEUS) on the Thy 3 nodules. The ELX 2/1 strain index, a five-item US score and both peak (P) index and time to peak (TTP) index from CEUS were correlated with the histological results. After surgical diagnosis, the data were analysed by using a receiver-operating characteristic (ROC) curve.ResultsHistology was benign in 50 and malignant in 13 Thy 3 nodules. No difference in maximal diameter was noted between benign (22.8 ± 1.6 mm) and malignant (18.9 ± 2.9 mm) nodules. Significant correlations were found between histology and cumulative US findings (p=0.005), ELX 2/1 index (p=0.002), P index (p=0.01) and TTP index (p=0.02). On analysing data from US, USE and CEUS, significant ROC areas under the curve were observed (p<0.0001). A cut-off value was set for US (>2), ELX 2/1 (>0.95), P index (<0.99) and TTP index (>0.98) scores. The diagnostic power of the cumulative pre-surgical analysis of Thy 3 nodules with US, USE and CEUS, considering the experimental cut-off points obtained from the ROC curves was: sensitivity 64%, specificity 92%, PPV 75% and accuracy 84%.ConclusionThe ELX 2/1 index in conjunction with the US score can be useful in orienting surgical strategies in Thy 3 nodules. The information added by CEUS is less sensitive than that provided by US and USE. The use of a cut-off based on histology can reduce thyroidectomy. Observation should be the first choice when not all instrumental results are suspect.

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Ultrasound predictors of malignancy in indeterminate thyroid nodules

Cited by 4 publications

References 17 publications

Utility of mutational analysis for risk stratification of indeterminate thyroid nodules in a real‐world setting

Utility of mutational analysis for risk stratification of indeterminate thyroid nodules in a real‐world setting

Effects of fine-needle aspiration biopsy (FNAB) nodule depth on pain score

The use of semi-quantitative ultrasound elastosonography in combination with conventional ultrasonography and contrast-enhanced ultrasonography in the assessment of malignancy risk of thyroid nodules with indeterminate cytology

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