Top

Published in:

01-11-2009 | Endocrine Tumors

Surgeon-Performed Ultrasound can Predict Differentiated Thyroid Cancer in Patients with Solitary Thyroid Nodules

Authors: Azad A. Jabiev, MD, Marcos H. Ikeda, MD, Isildinha M. Reis, DrPH, Carmen C. Solorzano, MD, John I. Lew, MD, FACS

Published in: Annals of Surgical Oncology | Issue 11/2009

Abstract

Introduction

Certain surgeon-performed ultrasound (SUS) features may predict differentiated thyroid cancer (DTC). The purpose of this study was to determine the SUS characteristics that are strongly associated with DTC in patients with solitary thyroid nodules.

Methods

A retrospective review of 115 patients with solitary thyroid nodules who had SUS before thyroid surgery was performed. Patients were subdivided into two groups based on final pathology results: patients with DTC(n = 61) and those with benign disease (BD) (n = 54). SUS characteristics of thyroid nodules were studied, including size, type, calcifications, borders, shape, and echogenicity. For SUS features, odds ratio (OR), confidence interval (CI), and P values are presented.

Results

Of 115 operated patients with solitary thyroid nodules, 53% (61/115) had DTC [papillary, 59%; follicular variant/papillary, 34%; Hürthle cell, 5%; and follicular, 2%] and 47% (54/115) had BD [hyperplastic, 56%; follicular adenoma, 31%; lymphocytic thyroiditis, 7%; and Hürthle cell adenoma, 6%]. Univariate analysis showed that hypoechogenicity, irregular borders, and microcalcifications were associated with an increased risk for DTC compared to hyper/isoechogenicity, regular borders, and coarse/no calcifications. Association strength was confirmed using a multivariate model, including the five SUS characteristics. Hypoechogenicity (OR = 4.27; 95% CI, 1.74–10.47; P < 0.002), irregular borders (OR = 3.10; 95% CI, 1.25–7.7; P < 0.015), and microcalcifications (OR = 2.65; 95%CI, 1.04–6.76; P < 0.05) had a greater association with DTC after adjustment for the other four SUS features. Additionally, the combination of hypoechogenicity, irregular borders, and microcalcifications had the strongest association with DTC (OR = 30.1; 95% CI, 7.76–119.2; P < 0.0001).

Conclusions

Hypoechogenicity, irregular borders, and microcalcifications were most strongly associated with an increased risk for DTC. These SUS characteristics may have additional clinical value in predicting DTC in patients with solitary thyroid nodules.

Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med. 1993;328:553–9.CrossRefPubMed

Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 1997;126(3):226–31.PubMed

Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295:2164–7.CrossRefPubMed

Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med. 1993;118:282–9.PubMed

Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16:109–42.CrossRefPubMed

AACE/AME Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2006;12:63–102.

Morgan JL, Serpell JW, Cheng MS. Fine-needle aspiration cytology of thyroid nodules: how useful is it? ANZ J Surg. 2003;73:480–3.CrossRefPubMed

Dwarakanathan AA, Ryan WG, Staren ED, et al. Fine-needle aspiration biopsy of the thyroid. Diagnostic accuracy when performing a moderate number of such procedures. Arch Intern Med. 1989;149:2007–9.CrossRefPubMed

Ramacciotti CE, Pretorius HT, Chu EW, et al. Diagnostic accuracy and use of aspiration biopsy in the management of thyroid nodules. Arch Intern Med. 1984;144:1169–73.CrossRefPubMed

10.

Tee YY, Lowe AJ, Brand CA, Rodney T. Judson RT. Fine-needle aspiration may miss a third of all malignancy in palpable thyroid nodules. Ann Surg. 2007;246:714–20.CrossRefPubMed

11.

Tyler DS, Shaha AR, Udelsman RA, et al. Thyroid cancer: 1999 update. Ann Surg Oncol. 2000;7:376–98.CrossRefPubMed

12.

Kouvaraki MA, Shapiro SE, Fornage BD, et al. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003;134:946–54.CrossRefPubMed

13.

Moon GH, Jung EJ, Park ST, et al. Role of ultrasonography in predicting malignancy in patients with thyroid nodules. World J Surg. 2007;31:1410–6.CrossRefPubMed

14.

Koike E, Noguchi S, Yamashita H, et al. Ultrasonographic characteristics of thyroid nodules: prediction of malignancy. Arch Surg 2001;136:334–7.CrossRefPubMed

15.

Kim EK, Park CS, Chung WY, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. Am J Roentgenol. 2002;178:687–91.

16.

Shimura H, Haraguchi K, Hiejima Y, et al. Distinct diagnostic criteria for ultrasonographic examination of papillary thyroid carcinoma: a multicenter study. Thyroid. 2005;15:251–8.CrossRefPubMed

17.

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.CrossRefPubMed

18.

Solorzano CC, Carneiro DM, Ramirez M, et al. Surgeon-performed ultrasound in the management of thyroid malignancy. Am Surg. 2004; 70:576–80.PubMed

19.

Mendez W, Rodgers SE, Lew JI, et al. Role of surgeon-performed ultrasound in predicting malignancy in patients with indeterminate thyroid nodules. Ann Surg. Oncol. 2008;15:2487–92.CrossRefPubMed

20.

Yeh MW, Demircan O, Ituarte P, et al. False-negative fine-needle aspiration cytology results delay treatment and adversely affect outcome in patients with thyroid carcinoma. Thyroid. 2004;14:207–15.CrossRefPubMed

21.

Lee YH, Lee NJ, Kim JH, et al. Sonographically guided fine-needle aspiration of thyroid nodule: discrepancies between cytologic and histopathologic findings. J Clin Ultrasound. 2008;36:6–11.CrossRefPubMed

22.

McHenry CR, Walfish PG, Rosen IB. Non-diagnostic fine needle aspiration biopsy: a dilemma in management of nodular thyroid disease. Am Surg. 1993;59:415–9.PubMed

23.

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.CrossRefPubMed

Title: Surgeon-Performed Ultrasound can Predict Differentiated Thyroid Cancer in Patients with Solitary Thyroid Nodules
Authors: Azad A. Jabiev, MD
Marcos H. Ikeda, MD
Isildinha M. Reis, DrPH
Carmen C. Solorzano, MD
John I. Lew, MD, FACS
Publication date: 01-11-2009
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 11/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-009-0652-9

At a glance: The STEP trials

Springer Medicine

Surgeon-Performed Ultrasound can Predict Differentiated Thyroid Cancer in Patients with Solitary Thyroid Nodules

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2009

Prognostic Relevance of Extracapsular Lymph Node Involvement in Pancreatic Ductal Adenocarcinoma

Reduction of Postoperative Complication Rate with the Use of Early Oral Feeding in Gynecologic Oncologic Patients Undergoing a Major Surgery: A Randomized Controlled Trial

Prognostic Effect of Diaphyseal Location in Osteosarcoma: A Cohort Case–Control Study at a Single Institute

Should Hepatic Metastatic Colorectal Cancer Patients with Extrahepatic Disease Undergo Liver Resection/Ablation?

Clinical Significance of Distinguishing Between Follicular Lesion and Follicular Neoplasm in Thyroid Fine-Needle Aspiration Biopsy

Lymph Node Evaluation of Colon Cancer and Its Association with Improved Staging and Survival in the Department of Defense Health Care System