Skip to main content
Top
Published in: BMC Medical Imaging 1/2019

Open Access 01-12-2019 | Ultrasound | Research article

Echogenic foci in thyroid nodules: diagnostic performance with combination of TIRADS and echogenic foci

Authors: Su Min Ha, Yun Jae Chung, Hye Shin Ahn, Jung Hwan Baek, Sung Bin Park

Published in: BMC Medical Imaging | Issue 1/2019

Login to get access

Abstract

Background

The malignancy risks of various echogenic foci in thyroid nodules are not consistent. The association between malignancy and echogenic foci and various Thyroid Imaging Reporting and Data System (TIRADS) in thyroid nodules has not been evaluated. We evaluated the malignancy probability and diagnostic performance of thyroid nodules with various echogenic foci and in combination with TIRADS.

Methods

This retrospective study was approved by Institutional Review Board. The data were retrospectively collected from January 2013 to December 2014. In total, 954 patients (mean age, 50.8 years; range, 13–86 years) with 1112 nodules were included. Using χ2 test, we determined the prevalence of benign and malignant nodules among those with and without echogenic foci; we associated each of 6 echogenic foci types with benign and malignant nodules. Diagnostic performance was compared between the 6 types alone and in combination with various TIRADS.

Results

Among 1112 nodules, 390 nodules (35.1%) were found to have echogenic foci, and 722 nodules (64.9%) were not. Among nodules with echogenic foci, 254 nodules (65.1%) were malignant. The punctate echogenic foci with comet-tail artifact showed malignancy rate of 77.8% in solid and predominantly solid nodules. Our study demonstrated relatively low PPV (33.3–56.4%) in nodules with large echogenic foci without shadowing, macrocalcification, and peripheral curvilinear or eggshell echogenic foci with or without shadowing. However, when combined with high suspicion category of TIRADS, PPV increased to 50.0–90.9%.

Conclusion

Combination with TIRADS with different types of echogenic foci offer better stratification of the malignancy risk.

Literature
  1. Brander A, Viikinkoski P, Nickels J, Kivisaari L. Thyroid gland: US screening in a random adult population. Radiology. 1991;181:683–7.View Article
  2. Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. Management of thyroid nodules detected at US: Society of Radiologists in ultrasound consensus conference statement. Radiology. 2005;237:794–800.View Article
  3. Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 1997;126:226–31.View Article
  4. Cheng SP, Lee JJ, Lin JL, Chuang SM, Chien MN, Liu CL. Characterization of thyroid nodules using the proposed thyroid imaging reporting and data system (TI-RADS). Head Neck. 2013;35:541–7.View Article
  5. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, 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;26:1–133.View Article
  6. Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009;94:1748–51.View Article
  7. Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, et al. Ultrasonography diagnosis and imaging-based Management of Thyroid Nodules: revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol. 2016;17:370–95.View Article
  8. Ha EJ, Moon WJ, Na DG, Lee YH, Choi N, Kim SJ, et al. A multicenter prospective validation study for the Korean thyroid imaging reporting and data system in patients with thyroid nodules. Korean J Radiol. 2016;17:811–21.View Article
  9. Choi YJ, Baek JH, Baek SH, Shim WH, Lee KD, Lee HS, et al. Web-based malignancy risk estimation for thyroid nodules using ultrasonography characteristics: development and validation of a predictive model. Thyroid. 2015;25:1306–12.View Article
  10. Russ G, Royer B, Bigorgne C, Rouxel A, Bienvenu-Perrard M, Leenhardt L. Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. Eur J Endocrinol. 2013;168:649–55.View Article
  11. Seiberling KA, Dutra JC, Grant T, Bajramovic S. Role of intrathyroidal calcifications detected on ultrasound as a marker of malignancy. Laryngoscope. 2004;114:1753–7.View Article
  12. Takashima S, Fukuda H, Nomura N, Kishimoto H, Kim T, Kobayashi T. Thyroid nodules: re-evaluation with ultrasound. J Clin Ultrasound. 1995;23:179–84.View Article
  13. Taki S, Terahata S, Yamashita R, Kinuya K, Nobata K, Kakuda K, et al. Thyroid calcifications. sonographic patterns and incidence of cancer Clin Imaging. 2004;28:368–71.PubMed
  14. Wang N, Xu Y, Ge C, Guo R, Guo K. Association of sonographically detected calcification with thyroid carcinoma. Head Neck. 2006;28:1077–83.View Article
  15. Kakkos SK, Scopa CD, Chalmoukis AK, Karachalios DA, Spiliotis JD, Harkoftakis JG, et al. Relative risk of cancer in sonographically detected thyroid nodules with calcifications. J Clin Ultrasound. 2000;28:347–52.View Article
  16. Khoo ML, Asa SL, Witterick IJ, Freeman JL. Thyroid calcification and its association with thyroid carcinoma. Head Neck. 2002;24:651–5.View Article
  17. Fukatsu H, Makino N, Kodama Y, Ikeda M, Ishigaki T, Sakuma S. Evaluation of thyroid calcification using computed radiography with image plate. Eur J Radiol. 1989;9:22–8.PubMed
  18. Bruneton JN, Balu-Maestro C, Marcy PY, Melia P, Mourou MY. Very high frequency (13 MHz) ultrasonographic examination of the normal neck: detection of normal lymph nodes and thyroid nodules. J Ultrasound Med. 1994;13:87–90.View Article
  19. Peccin S, de Castsro JA, Furlanetto TW, Furtado AP, Brasil BA, Czepielewski MA. Ultrasonography: is it useful in the diagnosis of cancer in thyroid nodules? J Endocrinol Investig. 2002;25:39–43.View Article
  20. Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, et al. ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017;14:587–95.View Article
  21. Watters DA, Ahuja AT, Evans RM, Chick W, King WW, Metreweli C, et al. Role of ultrasound in the management of thyroid nodules. Am J Surg. 1992;164:654–7.View Article
  22. Malhi H, Beland MD, Cen SY, Allgood E, Daley K, Martin SE, et al. Echogenic foci in thyroid nodules: significance of posterior acoustic artifacts. AJR Am J Roentgenol. 2014;203:1310–6.View Article
  23. Na DG, Kim DS, Kim SJ, Ryoo JW, Jung SL. Thyroid nodules with isolated macrocalcification: malignancy risk and diagnostic efficacy of fine-needle aspiration and core needle biopsy. Ultrasonography. 2016;35:212–9.View Article
  24. Cibas ES, Ali SZ, NCITFSotS C. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132:658–65.View Article
  25. Jung CK, Min HS, Park HJ, Song DE, Kim JH, Park SY, et al. Pathology reporting of thyroid Core needle biopsy: a proposal of the Korean endocrine pathology thyroid Core needle biopsy study group. J Pathol Transl Med. 2015;49:288–99.View Article
  26. Russ G. Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS: description and reflections. Ultrasonography. 2016;35:25–38.View Article
  27. Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, 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.View Article
  28. Ulisse S, Bosco D, Nardi F, Nesca A, D'Armiento E, Guglielmino V, et al. Thyroid imaging reporting and data system score combined with the new Italian classification for thyroid cytology improves the clinical Management of Indeterminate Nodules. Int J Endocrinol. 2017;2017:9692304.View Article
  29. He YP, Xu HX, Zhao CK, Sun LP, Li XL, Yue WW, et al. Cytologically indeterminate thyroid nodules: increased diagnostic performance with combination of US TI-RADS and a new scoring system. Sci Rep. 2017;7:6906.View Article
  30. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab. 2006;91:3411–7.View Article
  31. Kim MJ, Kim EK, Kwak JY, Park CS, Chung WY, Nam KH, et al. Differentiation of thyroid nodules with macrocalcifications: role of suspicious sonographic findings. J Ultrasound Med. 2008;27:1179–84.View Article
  32. Koike E, Noguchi S, Yamashita H, Murakami T, Ohshima A, Kawamoto H, et al. Ultrasonographic characteristics of thyroid nodules: prediction of malignancy. Arch Surg. 2001;136:334–7.View Article
  33. Beland MD, Kwon L, Delellis RA, Cronan JJ, Grant EG. Nonshadowing echogenic foci in thyroid nodules: are certain appearances enough to avoid thyroid biopsy? J Ultrasound Med. 2011;30:753–60.View Article
  34. Ahuja A, Chick W, King W, Metreweli C. Clinical significance of the comet-tail artifact in thyroid ultrasound. J Clin Ultrasound. 1996;24:129–33.View Article
  35. Bonavita JA, Mayo J, Babb J, Bennett G, Oweity T, Macari M, et al. Pattern recognition of benign nodules at ultrasound of the thyroid: which nodules can be left alone? AJR Am J Roentgenol. 2009;193:207–13.View Article
  36. Amrikachi M, Ramzy I, Rubenfeld S, Wheeler TM. Accuracy of fine-needle aspiration of thyroid. Arch Pathol Lab Med. 2001;125:484–8.PubMed
  37. Park M, Shin JH, Han BK, Ko EY, Hwang HS, Kang SS, et al. Sonography of thyroid nodules with peripheral calcifications. J Clin Ultrasound. 2009;37:324–8.View Article
  38. Consorti F, Anello A, Benvenuti C, Boncompagni A, Giovannone G, Moles N, et al. Clinical value of calcifications in thyroid carcinoma and multinodular goiter. Anticancer Res. 2003;23:3089–92.PubMed
Metadata
Title
Echogenic foci in thyroid nodules: diagnostic performance with combination of TIRADS and echogenic foci
Authors
Su Min Ha
Yun Jae Chung
Hye Shin Ahn
Jung Hwan Baek
Sung Bin Park
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Medical Imaging / Issue 1/2019
Electronic ISSN: 1471-2342
DOI
https://doi.org/10.1186/s12880-019-0328-2

Other articles of this Issue 1/2019

BMC Medical Imaging 1/2019 Go to the issue