Francisco Campoy-Balbontin, Presenter: Nothing to Disclose

Carmen Jurado-Gómez MD, Abstract Co-Author: Nothing to Disclose

Alberto Amador-Gil MD, Abstract Co-Author: Nothing to Disclose

 To prospectively evaluate the diagnostic accuracy of ultrasonography (US) criteria for the depiction of benign and malignant thyroid nodules by using cytology and tissue diagnosis as the reference Standard.

 From January 2009 through December 2010, 344 consecutive patients undergo thyroid US and fine needle biopsy (FNB). A total of 344 patients (301 women, 43 men, aged from 9 to 86 years, mean age 53.9) with 390 nodules (245 solid and 145 mixed) were ultrasonographically evaluated by a senior radiologist. Nodule size (three diameters), echotexture, echogenicity, cyst component (25–50 %, 50–75 % y >75%) , calcifications (microcalcifications and macrocalcifications), presence of halo (thin or large, well or bad defined) and Doppler color vascularization (peripheral, central and, peripheral and central) were evaluated. The cytolocical results classify the nodules as T1 (insufficient for diagnosis, 27 %), T2 (benign, 57 %), T3 (Follicular lesion of uncertain significance, 1 %), T4 (follicular proliferation, 9 %), T5 (suspicious for malignancy, 4 %) and T6 (malignant, 2 %). As a consequence there are a surgical (T4, T5, T6) and non surgical (T1, T2, T3) groups. A Statistical analysis are performed using X2, Fisher and t-Student tests. Sensitivity, specificity, positive and negative predictive values and positive likelihood ratio are obtained.  

Statistically significant results findings of surgical nodules, are marked hypoechogenicity (sensitivity, 9%; specificity, 95 %; positive likelihood ratio, 1.8), microcalcification (sensitivity, 35%; specificity, 85%; positive likelihood ratio, 2.3) and central vascularization (sensitivity, 2 %; specificity, 98%; positive likelihood ratio 1). The US findings for non surgical nodules  were isoechogenicity (sensitivity, 31 %; specificity, 78%; positive likelihood ratio, 1.4) and spongiform appearance (sensitivity, 21%, specificity, 96 %; positive likelihood ratio, 5.25).

US criteria for the discrimination of malignant from benign nodules are marked hypoechogenicity, hyperechogenicity, central vascularization  and the presence of microcalcifications. Isoechogenicity and spongiform pattern are useful US criteria for benign nodules.

Spongiform pattern can determine a follow up procedure instead of biopsy, probably even when the nodule is more than two cm. "Very hypoechoic and microcalcification" sugest malignant nodule.

Campoy-Balbontin, F, Jurado-Gómez, C, Amador-Gil, A, Benign and Malignant Thyroid Nodules: US Differentiation-Prospective Study.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034326.html