William D. Middleton MD, Abstract Co-Author: Nothing to Disclose

Lauren Anderson BS, Presenter: Nothing to Disclose

Sharlene Ann Teefey MD, Abstract Co-Author: Siemens, Research grant

Carl C. Reading MD, Abstract Co-Author: Nothing to Disclose

Jill Eve Langer MD, Abstract Co-Author: Consultant, Bio-Imaging Technologies, Inc

Terry S. Desser MD, Abstract Co-Author: Nothing to Disclose

Margaret M. Szabunio MD, Abstract Co-Author: Nothing to Disclose

John Joseph Cronan MD, Abstract Co-Author: Nothing to Disclose

Susan Elizabeth Mandel MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Several professional societies recommend FNA be considered for thyroid nodules regardless of size and without consideration of ultrasound (US) appearance in patients with clinical risk factors for thyroid cancer. One of these risk factors is a family history of thyroid cancer. The purpose of this study is to determine if this approach is necessary.

As part of an ongoing, prospective, multi-institutional study, patients with thyroid nodules who underwent US and FNA of one or more thyroid nodules were analyzed for a variety of predetermined US features. Patients also completed a questionnaire including information about family history. Those that had a history of thyroid cancer in a first degree relative form the study population. The US appearance of cancer was compared to benign lesions in this group of patients and these results were compared to known historical trends in the appearance of these lesions in the general population.

19% (23/122) of the patients with a family history of thyroid cancer had FNAs positive for cancer. As expected, this was greater than the patients without a positive family history (10%). The cancers had an average mean size of 12 mm. The large majority of cancers were solid (95%) and hypoechoic (90%). 52% contained microcalcifications. 3 cancers had a halo (2 thin, 1 thick). Only 1 cancer contained cystic elements. None of the cancers were hyperechoic, more than 50% cystic, or appeared sponge-like. On the other hand, 55% of benign lesions contained cystic elements, 46% were hyper or isoechoic, and only 4% contained microcalcifications. The mean size of benign lesions was significantly larger (17.5 mm).

Patients with a family history of thyroid cancer are at increased risk of developing thyroid cancer themselves. However, cancers and benign lesions in these patients have an US appearance similar to what has been previously documented in low risk populations. Therefore, the decision to perform FNA can be based on the US appearance and size in a manner similar to what has been applied to the general population.

Recommendations for FNA in patients with thyroid nodules and a family history of thyroid cancer can be similar to those already established in the general population.

Middleton, W, Anderson, L, Teefey, S, Reading, C, Langer, J, Desser, T, Szabunio, M, Cronan, J, Mandel, S, et al, , Analysis of Sonographic Features and Recommendations for Management of Thyroid Nodules in Patients with a Family History of Thyroid Cancer.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6021871.html