Advertisement

Annals of Surgical Oncology

, Volume 20, Issue 3, pp 906–913 | Cite as

Sonographic Characteristics Suggesting Papillary Thyroid Carcinoma According to Nodule Size

  • Ga Ram Kim
  • Myung Hyun Kim
  • Hee Jung Moon
  • Woong Youn Chung
  • Jin Young Kwak
  • Eun-Kyung Kim
Head and Neck Oncology

Abstract

Purpose

To determine differences in ultrasonography (US) features suggesting papillary thyroid carcinoma (PTC) between nodules larger than 10 mm (large lesions) and nodules ≤10 mm in diameter (small lesions).

Methods

We included 1,238 nodules in 1,173 patients that were confirmed through cytology or histopathology between February 2007 and June 2007 in the study. Nodules were divided into large lesions (571 lesions) and small lesions (667 lesions). Sonographic features were defined as composition, echogenicity, margin, calcifications, shape, and vascularity. Logistic regression analyses were performed to determine the odds ratios (OR) of each feature to predict PTC.

Results

On multivariate analysis, irregular margin (OR = 37.788, P < 0.001), microcalcifications (OR = 17.799, P < 0.001), microlobulated margin (OR = 10.385, P < 0.001), and no vascularity (OR = 5.975, P < 0.001) were independent factors for PTC in the large lesions and irregular margin (OR = 7.185, P < 0.001), microlobulated margin (OR = 5.952, P < 0.001), microcalcifications (OR = 3.722, P < 0.001), marked hypoechogenicity (OR = 2.873, P = 0.004), and taller than wide shape (OR = 2.698, P < 0.001) were independent factors for PTC in the small lesions.

Conclusions

The OR of each US finding for predicting PTC is different between large and small lesions. Therefore, it would be helpful to weight certain US features according to nodule size when reporting thyroid nodules with different risks of PTC.

Keywords

Papillary Thyroid Carcinoma Thyroid Nodule Small Lesion Large Lesion Nodule Size 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

None of the authors has any conflicts of interest to disclose.

References

  1. 1.
    Sakorafas GH, Mastoraki A, Lappas C, Safioleas M. Small (<10 mm) thyroid nodules; how aggressively should they be managed? Onkologie. 2010;33:61–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Hegedus L. Clinical practice. The thyroid nodule. N Engl J Med. 2004;351:1764–71.PubMedCrossRefGoogle Scholar
  3. 3.
    Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedus L, Vitti P. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract. 2010;16(Suppl 1):1–43.PubMedCrossRefGoogle Scholar
  4. 4.
    Moon WJ, Jung SL, Lee JH, et al. Benign and malignant thyroid nodules: US differentiation–multicenter retrospective study. Radiology. 2008;247:762–70.PubMedCrossRefGoogle Scholar
  5. 5.
    Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.PubMedCrossRefGoogle Scholar
  6. 6.
    Frates MC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2005;237:794–800.PubMedCrossRefGoogle Scholar
  7. 7.
    Ahn SS, Kim EK, Kang DR, Lim SK, Kwak JY, Kim MJ. Biopsy of thyroid nodules: comparison of three sets of guidelines. AJR Am J Roentgenol. 2010;194:31–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Sipos JA. Advances in ultrasound for the diagnosis and management of thyroid cancer. Thyroid. 2009;19:1363–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Hoang JK, Lee WK, Lee M, Johnson D, Farrell S. US Features of thyroid malignancy: pearls and pitfalls. Radiographics. 2007;27:847–60; discussion 61–5.Google Scholar
  10. 10.
    Popowicz B, Klencki M, Lewinski A, Slowinska-Klencka D. The usefulness of sonographic features in selection of thyroid nodules for biopsy in relation to the nodule’s size. Eur J Endocrinol. 2009;161:103–11.PubMedCrossRefGoogle Scholar
  11. 11.
    Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, Dominguez M. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009;94:1748–51.PubMedCrossRefGoogle Scholar
  12. 12.
    Park JY, Lee HJ, Jang HW, Kim HK, Yi JH, Lee W, Kim SH. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Thyroid. 2009;19:1257–64.PubMedCrossRefGoogle Scholar
  13. 13.
    Cappelli C, Castellano M, Pirola I, et al. Thyroid nodule shape suggests malignancy. Eur J Endocrinol. 2006;155:27–31.PubMedCrossRefGoogle Scholar
  14. 14.
    Moon HJ, Kwak JY, Kim MJ, Son EJ, Kim EK. Can vascularity at power Doppler US help predict thyroid malignancy? Radiology. 2010;255:260–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Castro MR, Gharib H. Continuing controversies in the management of thyroid nodules. Ann Intern Med. 2005;142:926–31.PubMedGoogle Scholar
  16. 16.
    Cappelli C, Castellano M, Pirola I, Cumetti D, Agosti B, Gandossi E, Agabiti Rosei E. The predictive value of ultrasound findings in the management of thyroid nodules. QJM. 2007;100:29–35.PubMedCrossRefGoogle Scholar
  17. 17.
    Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16:109–42.PubMedCrossRefGoogle Scholar
  18. 18.
    Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, Yoo HS. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol. 2002;178:687–91.PubMedGoogle Scholar
  19. 19.
    Papini E, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab. 2002;87:1941–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011;260:892–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Berker D, Aydin Y, Ustun I, et al. The value of fine-needle aspiration biopsy in subcentimeter thyroid nodules. Thyroid. 2008;18:603–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Kim DW, Lee EJ, Kim SH, Kim TH, Lee SH, Rho MH. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules: comparison in efficacy according to nodule size. Thyroid. 2009;19:27–31.PubMedCrossRefGoogle Scholar
  23. 23.
    Moon HJ, Son E, Kim E, Yoon JH, Kwak JY. The diagnostic values of ultrasound and ultrasound-guided fine needle aspiration in subcentimeter-sized thyroid nodules. Annals of Surgical Oncology. 2012;19:52–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Lyshchik A, Drozd V, Demidchik Y, Reiners C. Diagnosis of thyroid cancer in children: value of gray-scale and power doppler US. Radiology. 2005;235:604–13.PubMedCrossRefGoogle Scholar
  25. 25.
    Appetecchia M, Solivetti FM. The association of colour flow Doppler sonography and conventional ultrasonography improves the diagnosis of thyroid carcinoma. Horm Res. 2006;66:249–56.PubMedCrossRefGoogle Scholar
  26. 26.
    Brunese L, Romeo A, Iorio S, et al. A new marker for diagnosis of thyroid papillary cancer: B-flow twinkling sign. J Ultrasound Med. 2008;27:1187–94.PubMedGoogle Scholar
  27. 27.
    Frates MC, Benson CB, Doubilet PM, Cibas ES, Marqusee E. Can color Doppler sonography aid in the prediction of malignancy of thyroid nodules? J Ultrasound Med. 2003;22:127–31; quiz 32–4.Google Scholar
  28. 28.
    Iannuccilli JD, Cronan JJ, Monchik JM. Risk for malignancy of thyroid nodules as assessed by sonographic criteria: the need for biopsy. J Ultrasound Med. 2004;23:1455–64.PubMedGoogle Scholar
  29. 29.
    Stacul F, Bertolotto M, De Gobbis F, et al. US, colour-Doppler US and fine-needle aspiration biopsy in the diagnosis of thyroid nodules. Radiol Med. 2007;112:751–62.PubMedCrossRefGoogle Scholar
  30. 30.
    Yuan WH, Chiou HJ, Chou YH, Hsu HC, Tiu CM, Cheng CY, Lee CH. Gray-scale and color Doppler ultrasonographic manifestations of papillary thyroid carcinoma: analysis of 51 cases. Clin Imaging. 2006;30:394–401.PubMedCrossRefGoogle Scholar
  31. 31.
    Wienke JR, Chong WK, Fielding JR, Zou KH, Mittelstaedt CA. Sonographic features of benign thyroid nodules: interobserver reliability and overlap with malignancy. J Ultrasound Med. 2003;22:1027–31.PubMedGoogle Scholar
  32. 32.
    Carcangiu ML, Zampi G, Rosai J. Papillary thyroid carcinoma: a study of its many morphologic expressions and clinical correlates. Pathol Annu. 1985;20 Pt 1:1–44.PubMedGoogle Scholar
  33. 33.
    Isarangkul W. Dense fibrosis. Another diagnostic criterion for papillary thyroid carcinoma. Arch Pathol Lab Med. 1993;117:645–6.PubMedGoogle Scholar
  34. 34.
    Vickery AL, Jr. Thyroid papillary carcinoma. Pathological and philosophical controversies. Am J Surg Pathol. 1983;7:797–807.PubMedGoogle Scholar
  35. 35.
    Choi SH, Kim EK, Kwak JY, Kim MJ, Son EJ. Interobserver and intraobserver variations in ultrasound assessment of thyroid nodules. Thyroid. 2010;20:167–72.PubMedCrossRefGoogle Scholar
  36. 36.
    Rosario PW, Mineiro Filho AF, Prates BS, Silva LC, Lacerda RX, Calsolari MR. Ultrasonographic screening for thyroid cancer in siblings of patients with apparently sporadic papillary carcinoma. Thyroid. 2012;22:805–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Moon HJ, Sung JM, Kim EK, Yoon JH, Youk JH, Kwak JY. Diagnostic performance of gray-scale US and elastography in solid thyroid nodules. Radiology. 2012;262:1002–13.PubMedCrossRefGoogle Scholar
  38. 38.
    Lee MJ, Hong SW, Chung WY, Kwak JY, Kim MJ, Kim EK. Cytological results of ultrasound-guided fine-needle aspiration cytology for thyroid nodules: emphasis on correlation with sonographic findings. Yonsei Med J. 2011;52:838–44.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Ga Ram Kim
    • 1
  • Myung Hyun Kim
    • 1
  • Hee Jung Moon
    • 1
  • Woong Youn Chung
    • 2
  • Jin Young Kwak
    • 1
  • Eun-Kyung Kim
    • 1
  1. 1.Department of RadiologyResearch Institute of Radiological Science, Severance Hospital, Yonsei University College of MedicineSeoulKorea
  2. 2.Department of SurgerySeverance Hospital, Yonsei University College of MedicineSeoulKorea

Personalised recommendations