Jill Eve Langer MD, Presenter: Consultant, BioClinica, Inc

1) Discuss the sonographic characteristics that are associated with a high probability that a thyroid nodule is likely malignant or likely benign. 3) Gain an understanding of the rationale of the current guidelines for recommending thyroid fine needle aspiration.

As an overview, this presentation will review the epidemiology of thyroid nodules and correlate the sonographic findings with the risk of malignancy or the likelihood that the appearance represents a benign hyperplastic thyroid nodule rather than a true neoplasm. Additionally, the rationale for current guidelines for recommending thyroid fine needle aspiration will be discussed. The prevalence of palpable thyroid nodules is estimated to be 6.4% in women and 1.5% in men between 30 to 60 years of age, living in iodine-sufficient regions. However, high resolution sonography of the neck has been shown to be a much more sensitive technique than palpation, detecting nodules in 19 to 67% of randomly selected adults, with detection rates greater in women and increasing with age for both genders. Fortunately the vast majority of sonographically detected thyroid nodules are benign, hyperplasic regions of the thyroid. Fine-needle aspiration biopsy (FNA) is still considered the most reliable diagnostic test to determine if a thyroid nodule is malignant. Malignant nodules account for approximately 5% of all nodules that undergo palpation-guided FNA and approximately 10 to 15% of nodules that undergo sonography-guided FNA procedures. Analysis of the sonographic features of thyroid nodules has become the preeminent non-invasive tool for analyzing the risk of malignancy of thyroid nodules and aids in selecting which nodules should undergo fine needle aspiration (FNA). A number of recently published guidelines and consensus statements emphasize that the sonographic appearance of a nodule is a superior predictor of malignancy compared with nodule size or palpability and that when sonographic features of malignancy are noted, the nodule should undergo FNA. A number of sonographic features have shown a high specificity for the diagnosis of thyroid cancer and include marked hypoechogenicity, the presence of microcalcifications, infiltrating or micro-lobulated borders, and a taller-

Langer, J, Thyroid Nodules: When and What to Biopsy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14000584.html