Advertisement

Ultrasound of the Thyroid and Soft Tissues of the Neck

  • Jennifer A SiposEmail author
Chapter

Abstract

Ultrasonography (US) is a critical imaging modality for visualizing structures in the neck. A safe and inexpensive test, US can be easily performed in the outpatient setting by clinicians with specialty training and experience. This chapter will outline the initial approach to a patient suspected of having a thyroid nodule including laboratory testing and indications for ultrasonography and thyroid scintigraphy. The advantages of an office-based US exam over that performed by radiology will be outlined. Finally, the sonographic features of nodules and lymph nodes and their attendant malignancy risk will be outlined.

Keywords

Ultrasonography Thyroid nodule Thyroid cancer Lymph nodes Risk stratification Calcifications Echogenicity Scintigraphy Thyroid-stimulating hormone Cold nodule Hot nodule Toxic adenoma 

References

  1. 1.
    Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med. 1993;328(8):553–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Yang J, et al. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer. 2007;111(5):306–15.CrossRefPubMedGoogle Scholar
  3. 3.
    Yassa L, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111(6):508–16.CrossRefPubMedGoogle Scholar
  4. 4.
    Kwong N, et al. The Influence of patient age on thyroid nodule formation, multinodularity, and thyroid cancer risk. J Clin Endocrinol Metab. 2015;100(12):4434–40.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Brander A, et al. Clinical versus ultrasound examination of the thyroid gland in common clinical practice. J Clin Ultrasound. 1992;20(1):37–42.CrossRefPubMedGoogle Scholar
  6. 6.
    Marqusee E, et al. Usefulness of ultrasonography in the management of nodular thyroid disease. Ann Intern Med. 2000;133(9):696–700.CrossRefPubMedGoogle Scholar
  7. 7.
    Haugen BR, et al. 2015 American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Van Nostrand D, et al. (124)I positron emission tomography versus (131)I planar imaging in the identification of residual thyroid tissue and/or metastasis in patients who have well-differentiated thyroid cancer. Thyroid. 2010;20(8):879–83.CrossRefPubMedGoogle Scholar
  9. 9.
    Wong KT, et al. Current role of radionuclide imaging in differentiated thyroid cancer. Cancer Imaging. 2008;8:159–62.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bahn RS, Castro MR. Approach to the patient with nontoxic multinodular goiter. J Clin Endocrinol Metab. 2011;96(5):1202–12.CrossRefPubMedGoogle Scholar
  11. 11.
    Cooper DS, American Thyroid Association Guidelines Taskforce on Thyroid, N, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167–214.CrossRefPubMedGoogle Scholar
  12. 12.
    Alexander EK, et al. Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. N Engl J Med. 2012;367(8):705–15.CrossRefPubMedGoogle Scholar
  13. 13.
    Reschini E, et al. The trapping-only nodules of the thyroid gland: prevalence study. Thyroid. 2006;16(8):757–62.CrossRefPubMedGoogle Scholar
  14. 14.
    Arnold JE, Pinsky S. Comparison of 99mTc and 123I for thyroid imaging. J Nucl Med. 1976;17(4):261–7.PubMedGoogle Scholar
  15. 15.
    Shambaugh 3rd GE, et al. Disparate thyroid imaging. Combined studies with sodium pertechnetate Tc 99m and radioactive iodine. JAMA. 1974;228(7):866–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Hamer PW, Aspinall SR, Malycha PL. Clinician-performed ultrasound in assessing potentially malignant thyroid nodules. ANZ J Surg. 2014;84(5):376–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97(5):418–28.CrossRefPubMedGoogle Scholar
  18. 18.
    Grant CS, et al. Risks and adequacy of an optimized surgical approach to the primary surgical management of papillary thyroid carcinoma treated during 1999–2006. World J Surg. 2010;34(6):1239–46.CrossRefPubMedGoogle Scholar
  19. 19.
    Bardet S, et al. Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma. Eur J Endocrinol. 2008;158(4):551–60.CrossRefPubMedGoogle Scholar
  20. 20.
    Urken ML, et al. Management of recurrent and persistent metastatic lymph nodes in well-differentiated thyroid cancer: a multifactorial decision-making guide for the thyroid cancer care collaborative. Head Neck. 2015;37(4):605–14.CrossRefPubMedGoogle Scholar
  21. 21.
    Carneiro-Pla D, Amin S. Comparison between preconsultation ultrasonography and office surgeon-performed ultrasound in patients with thyroid cancer. World J Surg. 2014;38(3):622–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Sharen G, et al. Retrospective epidemiological study of thyroid nodules by ultrasound in asymptomatic subjects. Chin Med J (Engl). 2014;127(9):1661–5.Google Scholar
  23. 23.
    Sipos JA. Advances in ultrasound for the diagnosis and management of thyroid cancer. Thyroid. 2009;19(12):1363–72.CrossRefPubMedGoogle Scholar
  24. 24.
    Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295(18):2164–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Frates MC, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab. 2006;91(9):3411–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Moon WJ, et al. Benign and malignant thyroid nodules: US differentiation–multicenter retrospective study. Radiology. 2008;247(3):762–70.CrossRefPubMedGoogle Scholar
  27. 27.
    Moon HJ, et al. Diagnostic performance of gray-scale US and elastography in solid thyroid nodules. Radiology. 2012;262(3):1002–13.CrossRefPubMedGoogle Scholar
  28. 28.
    Kwak JY, 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(3):892–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Papini E, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab. 2002;87(5):1941–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Kim DS, et al. Sonographic features of follicular variant papillary thyroid carcinomas in comparison with conventional papillary thyroid carcinomas. J Ultrasound Med. 2009;28(12):1685–92.CrossRefPubMedGoogle Scholar
  31. 31.
    Park YJ, et al. Thyroid nodules with macrocalcification: sonographic findings predictive of malignancy. Yonsei Med J. 2014;55(2):339–44.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Cappelli C, et al. The predictive value of ultrasound findings in the management of thyroid nodules. QJM. 2007;100(1):29–35.CrossRefPubMedGoogle Scholar
  33. 33.
    Cerbone G, et al. Power Doppler improves the diagnostic accuracy of color Doppler ultrasonography in cold thyroid nodules: follow-up results. Horm Res. 1999;52(1):19–24.PubMedGoogle Scholar
  34. 34.
    Moon HJ, et al. Can vascularity at power Doppler US help predict thyroid malignancy? Radiology. 2010;255(1):260–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Malhi H, et al. Echogenic foci in thyroid nodules: significance of posterior acoustic artifacts. AJR Am J Roentgenol. 2014;203(6):1310–6.CrossRefPubMedGoogle Scholar
  36. 36.
    Russ G, et al. Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. Eur J Endocrinol. 2013;168(5):649–55.CrossRefPubMedGoogle Scholar
  37. 37.
    Cheng SP, et al. Characterization of thyroid nodules using the proposed thyroid imaging reporting and data system (TI-RADS). Head Neck. 2013;35(4):541–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Park JY, et al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Thyroid. 2009;19(11):1257–64.CrossRefPubMedGoogle Scholar
  39. 39.
    Hamming JF, et al. The value of fine-needle aspiration biopsy in patients with nodular thyroid disease divided into groups of suspicion of malignant neoplasms on clinical grounds. Arch Intern Med. 1990;150(1):113–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Park JS, et al. Performance of preoperative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC/UICC TNM classification system. AJR Am J Roentgenol. 2009;192(1):66–72.CrossRefPubMedGoogle Scholar
  41. 41.
    Ahn JE, et al. Diagnostic accuracy of CT and ultrasonography for evaluating metastatic cervical lymph nodes in patients with thyroid cancer. World J Surg. 2008;32(7):1552–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Kuna SK, et al. Ultrasonographic differentiation of benign from malignant neck lymphadenopathy in thyroid cancer. J Ultrasound Med. 2006;25(12):1531–7; quiz 1538–40.CrossRefPubMedGoogle Scholar
  43. 43.
    Solbiati L, et al. Ultrasound of thyroid, parathyroid glands and neck lymph nodes. Eur Radiol. 2001;11(12):2411–24.CrossRefPubMedGoogle Scholar
  44. 44.
    Ahuja AT, et al. Power Doppler sonography of metastatic nodes from papillary carcinoma of the thyroid. Clin Radiol. 2001;56(4):284–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Leboulleux S, et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab. 2007;92(9):3590–4.CrossRefPubMedGoogle Scholar
  46. 46.
    Ying M, Ahuja A. Sonography of neck lymph nodes. Part I: normal lymph nodes. Clin Radiol. 2003;58(5):351–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Ahuja A, Ying M. Sonography of neck lymph nodes. Part II: abnormal lymph nodes. Clin Radiol. 2003;58(5):359–66.CrossRefPubMedGoogle Scholar
  48. 48.
    Wunderbaldinger P, et al. Cystic lymph node metastases in papillary thyroid carcinoma. AJR Am J Roentgenol. 2002;178(3):693–7.CrossRefPubMedGoogle Scholar
  49. 49.
    Gorman B, et al. Medullary thyroid carcinoma: role of high-resolution US. Radiology. 1987;162(1 Pt 1):147–50.CrossRefPubMedGoogle Scholar
  50. 50.
    Hong HS, et al. Ultrasonography of various thyroid diseases in children and adolescents: a pictorial essay. Korean J Radiol. 2015;16(2):419–29.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Sakai F, et al. Ultrasonography of thymoma with pathologic correlation. Acta Radiol. 1994;35(1):25–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Kwak JY, Kim EK. Sonographic findings of Zenker diverticula. J Ultrasound Med. 2006;25(5):639–42.CrossRefPubMedGoogle Scholar
  53. 53.
    Kobaly K, Mandel SJ, Langer JE. Clinical review: Thyroid cancer mimics on surveillance neck sonography. J Clin Endocrinol Metab. 2015;100(2):371–5.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Endocrinology and MetabolismThe Ohio State UniversityColumbusUSA

Personalised recommendations