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Ultrasound malignancy risk stratification of thyroid nodules based on the degree of hypoechogenicity and echotexture

  • Ji Ye Lee
  • Dong Gyu NaEmail author
  • So Jin Yoon
  • Hye Yun Gwon
  • Wooyul Paik
  • Taeeun Kim
  • Jin Yub Kim
Ultrasound
  • 37 Downloads

Abstract

Objectives

The ultrasound (US) lexicon of nodule echogenicity and echotexture is one of the major differences among various risk stratification systems of thyroid nodules. This study aimed to stratify the US malignancy risk of thyroid nodules based on their degree of hypoechogenicity and echotexture.

Material and methods

This retrospective study included a total of 2255 consecutive thyroid nodules (≥ 1 cm) with final diagnoses (malignancy rate, 13%) from 2011 to 2016. Thyroid nodules were stratified according to the US degree of hypoechogenicity (mild, moderate, or marked hypoechogenicity) and echotexture (homogeneous vs. heterogeneous). The calculated malignancy risk was compared between each category.

Results

There was no significant difference of malignancy risk between the homogeneous markedly hypoechoic and moderately hypoechoic nodules (p ≥ .18). However, the malignancy risks of markedly and moderately hypoechoic nodules were significantly higher than those of mildly hypoechoic nodules (p < .001). Heterogeneous predominantly hypoechoic thyroid nodules showed a significantly higher malignancy risk than predominantly iso- or hyperechoic thyroid nodules (p < .001). There were no significant differences of malignancy risk between heterogeneous predominantly hypoechoic and homogeneous hypoechoic nodules according to the degree of hypoechogenicity (p ≥ .12) and between heterogeneous predominantly iso- or hyperechoic nodules and homogeneous iso- or hyperechoic thyroid nodules (p = .36).

Conclusions

The malignancy risk of nodule hypoechogenicity is stratified as mild vs. moderate to marked hypoechogenicity, and the malignancy risk of nodules with heterogeneous echotexture is stratified by the predominant echogenicity of the nodules.

Key Points

• Thyroid nodule echogenicity is categorized as marked, moderate, or mild hypoechogenicity and iso- or hyperechogenicity with the reference standard of adjacent thyroid tissue and anterior neck muscles.

• The malignancy risk of thyroid nodule echogenicity is stratified as iso- or hyperechoic vs. mild vs. moderate or marked hypoechogenicity.

• The malignancy risk of nodules with heterogeneous echotexture is stratified by the predominant echogenicity.

Keywords

Thyroid gland Thyroid nodule Ultrasonography Cytology Biopsy 

Abbreviations

ACR

American College of Radiology

ETA

European Thyroid Association

FNA

Fine needle aspiration

KSThR

Korean Society of Thyroid Radiology

PTC

Papillary thyroid carcinoma

SCM

Sternocleidomastoid muscles

US

Ultrasonography

Notes

Funding information

This research was supported by the Medical Research Promotion Program through the Gangneung Asan Hospital funded by the Asan Foundation (2018-C03).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Dong Gyu Na.

Conflict of interest

The authors declare that they have no competing interests.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.

Methodology

• Retrospective

• Cross-sectional study

• Performed at one institution

Supplementary material

330_2019_6527_MOESM1_ESM.docx (27 kb)
ESM 1 Supplementary Table 1. Malignancy risk stratified by degree of hypoechogenicity and echotexture, after excluding nodules with single benign FNA result and high suspicion US feature (n = 2176). Supplementary Table 2. Malignancy risk stratified by degree of hypoechogenicity and echotexture (Reader 2). (DOCX 27 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology, Eulji Medical CenterSeoulRepublic of Korea
  2. 2.Department of Radiology, Gangneung Asan Hospital, College of MedicineUniversity of UlsanGangneungRepublic of Korea
  3. 3.Department of Pathology, Gangneung Asan Hospital, College of MedicineUniversity of UlsanGangneungRepublic of Korea
  4. 4.Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangneung Asan Hospital, College of MedicineUniversity of UlsanGangneungRepublic of Korea

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