Let us know if you'd like us to cover more on a particular topic. Approximately 12% of FDG-PET scans show focal thyroid uptake, and a recent meta-analysis showed that 35% of those were noted to be malignant. Make a tax-deductible donation to support the THANC Foundation, the creators of the Thyroid, Head & Neck Cancer Guide. National Library of Medicine High-resolution machines can detect nodules as small as 13 mm with sensitivity of approximately 95%. Thyroid nodules are lumps that can develop on the thyroid gland. A Closer Look at "Taller-Than-Wide" Thyroid Nodules: Examining Dimension Ratio to Predict Malignancy. Get the definition of cancer-related terms. Bookshelf Diagnostic accuracy of the ultrasonographic features for subcentimeter thyroid nodules suggested by the revised American Thyroid Association guidelines. Thyroid 2016;26(1):1133. Hammad AY, Noureldine SI, Hu T, Ibrahim Y, Masoodi HM, Kandil E. A meta-analysis examining the independent association between thyroid nodule size and malignancy. Lymphoma Data analysis of this study showed that only 3 ultrasound features were related with the risk of cancer: microcalcification, nodule size greater than 2 cm, and solid form. Endocrine. Practice, Formerly Australian Family Physician (AFP). LaFranchi SH. It is important to highlight that alone none of the previously mentioned features is indicative of thyroid cancer. Goksuluk D, Korkmaz S, Zararsiz G, Karaagaoglu AE. sharing sensitive information, make sure youre on a federal Grani G, Lamartina L, Biffoni M, Giacomelli L, Maranghi M, Falcone R, et al. In cases of indeterminate cytology, because of the increased risk of malignancy, referral to a thyroid surgeon for hemi-thyroidectomy is recommended over a repeated FNA.8,9. Of the 471 lesions, 125 (26.5%) were classified as malignant, and 346 (73.5%) were classified as benign. TALLER-THAN-WIDE SHAPED THYROID NODULES IN ANY PLANE HAVE AN INCREASED RISK OF THYROID CANCER and2011;21:1249-53.longitudinalHJ, Kwak JY, EpubultrasonographicATaller-than-wide shape in thyroid nodules in transverse planes and the prediction of malignancy . Many endocrinologists are now experienced in interpreting and performing thyroid ultrasonography and FNA and can offer expertise in interpreting indeterminate cytology. Maybe there's an aspect of the cancer journey you want to read more about? An ultrasound is a type of imaging study that uses ultrasonic sound waves to produce images of structures located inside the body. FNA, fine-needle aspiration; TSH, thyroid-stimulating hormone. Cystic thyroid nodules - UpToDate The .gov means its official. AACE/ACE/AME, American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi; ACR, American College of Radiology; ATA, American Thyroid Association; EU-TIRADS, European Thyroid Imaging Reporting and Data Systems; K-TIRADS, Korean Thyroid Imaging Reporting and Data Systems; TTW, taller-than-wide shape. They are discovered either clinically or using sensitive imaging techniques (3). The study was approved by the Institutional Scientific Committee (00/16.10.2017). J Clin Endocrinol Metab. Received 2019 Sep 12; Accepted 2019 Oct 17. The presence of a firm, fixed nodule or ipsilateral cervical lymphadenopathy are late features suggestive of malignancy and should notdelay further assessment. Sonographic features of medullary thyroid carcinomas--a systematic review and meta-analysis. Inclusion in an NLM database does not imply endorsement of, or agreement with, Haugen BR, Alexander EK, Bible KC, et al. Descriptive statistics are reported as the median and interquartile range (IQR) for continuous variables, and frequency and percentage for categorical variables. The study was funded by the Research Starter Grants of the University of Rome, Sapienza (to G.G., AR216154C9B479B2). The good news is that this is actually quite rare. Malignancy Risk Stratification of Thyroid Nodules: Comparison between the Thyroid Imaging Reporting and Data System and the 2014 American Thyroid Association Management Guidelines. Italian consensus for the classification and reporting of thyroid cytology. Bible KC, et al. Unresected nodules without surgical histology and cytologically classified as nondiagnostic, low-risk indeterminate (TIR3A), or high-risk indeterminate (TIR3B), similar to Bethesda classes I, III, and IV, respectively, were excluded due to the absence of a conclusive diagnosis (online suppl. The final diagnosis was based on histopathology in 145 nodules in 120 patients, and cytology in the remaining patients. Would you like email updates of new search results? Necessary cookies are absolutely essential for the website to function properly. Hammad et al. In summary, all nodule sonographic features were collected: diameters, margins, composition, echogenicity, presence of calcifications and other hyperechoic foci, and suspected extrathyroidal extension. Furthermore, the Thyroid Imaging Reporting and Data System, which is applied primarily to exclude a thyroid malignant lesion, until now is not widely accepted to allow the clinicians for a proper therapeutic decision (18). Thyroid nodules can be solid, cystic (fluid-filled), or have mixed cystic/solid components. The cookie is used to store information of how visitors use a website and helps in creating an analytics report of how the website is doing. You also have the option to opt-out of these cookies. Kim HG, Moon HJ, Kwak JY, Kim EK. The anteroposterior nodule diameter might be suitable for assessing thyroid malignancy in microcarcinomas, with a critical value >0.7 cm (12). G.G., L.L., V.R., and R.F. Revised value of contrast-enhanced ultrasound for solid hypo-echoic thyroid nodules graded with thyroid imaging reporting and data system. They will then move a plastic probe around the area through the gel. Ultrasonography plays pivotal roles in the management of thyroid nodules [23] by identifying those requiring FNA cytology [1, 3] and guiding decisions on long-term follow-up strategies [1, 3]. Ultrasounds are almost always used to evaluate thyroid nodules, and are also often used to examine lymph nodes in the surrounding area. Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper DS. official website and that any information you provide is encrypted The US findings were re-evaluated and interpreted by two radiologists with more than 20-year experience who were blinded to the final pathology results. This is a pattern type cookie set by Google Analytics, where the pattern element on the name contains the unique identity number of the account or website it relates to. Copyright 2023 THANC Guide, THANC Foundation. Because of the increased risk of malignancy, the new recommendation is for patients to undergo ultrasound-based FNA for all focal nodules >1 cm detected on FDG-PET.1,7 Nodules <1 cm that do not meet FNA criteria should be monitored. Reduction in Thyroid Nodule Biopsies and Improved Accuracy with American College of Radiology Thyroid Imaging Reporting and Data System. Eun NL, Yoo MR, Gweon HM, Park AY, Kim JA, Youk JH, Moon HJ, Chang HS, Son EJ. 2014;65(4):314-8. doi: 10.5603/EP.2014.0043. High-resolution ultrasonography (US) is commonly used to evaluate the thyroid gland, but US is frequently misperceived as unhelpful for identifying features that distinguish benign from malignant nodules. eCollection 2022. While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous. WHAT ARE THE IMPLICATIONS OF THIS STUDY? The https:// ensures that you are connecting to the The site is secure. A taller-than-wide (TTW) shape is a suspicious feature of thyroid nodules commonly defined as an anteroposterior/transverse diameter (AP/T) ratio >1. Multiinstitutional Analysis of Thyroid Nodule Risk Stratification Using the American College of Radiology Thyroid Imaging Reporting and Data System. Under these circumstances, the clinical impact of inter- and/or intraobserver variability a well-documented limitation of ultrasound-based measurements is likely to be considerable: an intraobserver variability of up to 18% [9] and an interobserver variability of 20.9% were reported for AP diameter measurements [10]. official website and that any information you provide is encrypted Nardi F, Basolo F, Crescenzi A, Fadda G, Frasoldati A, Orlandi F, et al. Additionally, we found a strong negative correlation between size and taller-than-wide shape of a thyroid nodule (r=0.41, p<0.001). 1). The final cohort included 553 thyroid nodules (median maximum diameter 19.7 mm, interquartile range 14.527.5; online suppl. Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, Kim J, Kim HS, Byun JS, Lee DH Benign, malignant thyroid nodules. Our results showed that although this proposed definition would reduce the number of nodules with this feature by about 70%, it would not negatively influence the diagnostic performance of sonographic classification systems, additionally increasing the number of potentially avoidable biopsies. This proposed definition had an impact on the number of indicated biopsies and the diagnostic accuracy of the sonographic risk stratification systems, significantly increasing the number of deferrable biopsies for all classifications (up to 58.2% of the nodules would avoid FNA indication according to ACR TIRADS), as reported in Table Table2.2. Participants were recruited in the thyroid cancer unit of an academic healthcare center. 8 b) . Kilfoy BA, Zheng T, Holford TR, Han X, Ward MH, Sjodin A, Zhang Y, Bai Y, Zhu C, Guo GL, Rothman N, Zhang Y. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. 8600 Rockville Pike As the probability of a first diagnosed nodule being malignant is almost 7% (4), it is important for the clinician to be able to accurately distinguish between benign and malignant nodules in order to make the best clinical decision and minimize unnecessary surgical procedures. a This nodule would fulfill the current definition only (TTW ratio = 1.15); however, applying TIRADS, it would still be submitted to biopsy, being predominantly solid, partially hypoechoic, with lobulated margins. The quantitative evaluation, however, would avoid confusion about the TTW and taller-than-long shape (the latter is defined as an AP diameter longer than the longitudinal one) that some earlier studies considered a single entity (online suppl. 2Department of Endocrinology, Metabolism and Diabetes Mellitus, Nikea-Piraeus Agios Panteleimon General Hospital, Athens, Greece, 3Endocrine Unit, Alexandra Hospital, Athens, Greece. Gharib H, editor. TTW was defined according to the current definition (AP/T diameter ratio >1) and an arbitrary alternative definition (AP/T ratio >1.2). Prior to aspiration, each nodule was explored jointly in real time by two clinicians using HI VISION Avius equipment, and consensus decisions were reached to reduce interobserver variability, which has been documented in assessments of individual sonographic features of thyroid nodules [15, 16]. government site. The margins can be categorized as: smooth, ill-defined, lobulated or irregular. This study was conducted with institutional review board approval and written informed patient consent. A TallerThanWide Shape Is a Good Predictor of Papillary Thyroid Analyses were done with the IBM SPSS Statistics package, version 25.0 (IBM Corporation). The. Remonti LR, Kramer CK, Leito CB, Pinto LC, Gross JL. Use the tools and advice inside and adapt them for your family. As children and their thyroid glands are proportionally smaller, FNA should be based on clinical context and sonographic features rather than on the absolute size of the nodule. Colloid This site needs JavaScript to work properly. Is thyroid nodule location associated with malignancy risk? Univariate and multivariable logistic regression analyses were performed to determine the independent effects of sonographic variables associated with thyroid nodule malignancy using the Wald backward-selection method. Faquin WC, Fadda G, Cibas ES. Before fine-needle aspiration, two examiners jointly defined all sonographic features considered in risk stratification systems developed by the American Thyroid Association (ATA), the American Association of Clinical Endocrinologists (AACE), the American College of Radiology (ACR TIRADS), the European Thyroid Association (EU-TIRADS), and the Korean Society of Thyroid Radiology (K-TIRADS). Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. However, if the cancer is very small, sometimes you can get away with just taking out the side with the cancer. Grani G, Lamartina L, Ascoli V, Bosco D, Nardi F, D'Ambrosio F, et al. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (Az) were compared among the three criteria. Indeed, shape displayed variable interobserver agreement (online suppl. Fadda G, Basolo F, Bondi A, Bussolati G, Crescenzi A, Nappi O, et al.SIAPEC-IAP Italian Consensus Working Group. Tan GH, Gharib H. Thyroid incidentalomas: Management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Solid hypoechoic nodule Liu Y, Wu H, Zhou Q, Gou J, Xu J, Liu Y, Chen Q. DeLong ER, DeLong DM, Clarke-Pearson DL. In conclusion, adopting an arbitrary definition of TTW as an AP/T diameter ratio 1.2 would reduce the number of indicated biopsies according to five widely used sonographic risk stratification systems and improve specificity without negatively influencing overall diagnostic performance. These nodules are relatively common and are usually harmless, but there is a very low risk of thyroid cancer. Taller-than-wide Thyroid Nodules With Microcalcifications Are at High As a result, the term TTW can potentially be applied to nodules whose AP and T diameters differ by only a few millimeters. doi: 10.1089/thy.2015.0275. Sonographic images of two nodules. An incidentaloma is a non-palpable, asymptomatic thyroid nodule that is detected via imaging and has the same malignancy risk as a palpable nodule.1 Computed tomography and magnetic resonance imaging scans cannot give precise structural details, and nodules detected using these techniques should be assessed further with ultrasonography. Australian Journal of General Practice published by the Royal Australian College of General Practitioners, 100 Wellington Parade, East Melbourne, Victoria 3002, Australia Also see your doctor if you have signs and symptoms that may mean your thyroid gland isn't making enough thyroid hormone (hypothyroidism), which include: Feeling cold. Sonographically Estimated Risks of Malignancy for Thyroid Nodules Computed with Five Standard Classification Systems: Changes over Time and Their Relation to Malignancy. The interpreting radiologist questioned microcalcifications resulting TI-RADS assessment of TR4. Again, many studies evaluated the US findings by comparison with the cytological results after FNAB (16-18) but several factors can affect the diagnostic accuracy of FNAB, such as the experience of physicians in its performance, sampling error, non-diagnostic reports or cytological atypia of undetermined significance (19). FOIA Please enable it to take advantage of the complete set of features! government site. A total of 471 thyroid nodules from 435 patients were studied. 8600 Rockville Pike When Should you Worry About Thyroid Nodules? 6 Signs to Know The current and proposed definitions have a sensitivity of 26.2 and 11.9% (p = 0.03) and a specificity of 83.8 and 95.5% (p < 0.001). Yeh MW, Demicran O, Ituarte P, Clark OH. In nodules with echogenic foci, the taller than wide shape (p = 0.026), spiculated margin (p < 0.001), marked . Grani G, Lamartina L, Cantisani V, Maranghi M, Lucia P, Durante C. Interobserver agreement of various thyroid imaging reporting and data systems. Solid hypoechoic component of a partially cystic nodule A thyroid-stimulating hormone (TSH) serum level should be obtained in all patients suspected as having a thyroid nodule on examination or in whom one was incidentally discovered. In our study, nodules with taller-than-wide shape or shape combined with microcalcifications were the best predictors of malignancy. Comparison of the current and proposed definition of TTW shape; McNemar test. Management of indeterminate cytology can be complex. Classification of a nodule as TTW alone predicted a reference diagnosis of malignancy with 26.2% sensitivity (95% CI 13.942.0) and 83.8% specificity (95% CI 80.386.8) when the current definition of TTW was used. The anteroposterior diameter of nodules in the risk assessment of papillary thyroid microcarcinoma. Video content with easy-to-digest information. When hypoechogenecity was evaluated in combination with microcalcifications and with the shape, our results showed no improvement of sensitivity or higher AUC (data not shown). Otherwise, the reference standard was FNA cytology. Niedziela M, Breborowicz D, Trejster E, Korman E. Hot nodules in children and adolescents in western Poland from 1996 to 2000: Clinical analysis of 31 patients. Partially cystic nodule with eccentric solid areas, Solid hypoechoic nodule with smooth margins. Moon JH, Hyun MK, Lee JY, Shim JI, Kim TH, Choi HS, Ahn HY, Kim KW, Park DJ, Park YJ, Yi KH. Ultrasound images of the thyroid gland tend to have specific characteristics that can convey information about the health of the thyroid and the presence of disease. A Multicenter Prospective Validation Study for the Korean Thyroid Imaging Reporting and Data System in Patients with Thyroid Nodules.
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