Indeed, shape displayed variable interobserver agreement (online suppl. Thyroid nodules are lumps that can develop on the thyroid gland. Research studies and new treatments available. 2015 May;25(5):538-50. doi: 10.1089/thy.2014.0353. Diagnostic value of conventional ultrasound combined with contrast-enhanced ultrasonography in thyroid imaging reporting and data system (TI-RADS) 3 and 4 thyroid micronodules. PDF A taller-than-wide thyroid nodule shape on ultrasound imaging www The incidence of paediatric thyroid nodules that are palpable is approximately 1.85.1% with the use of ultrasonography.8 However, in a review of 1134 children, the overall malignancy rate was 26%, compared with 510% in adults.8 The ATA guidelines suggest paediatric nodules should be evaluated in a similar manner to those in adults, with some important exceptions. Faquin WC, Fadda G, Cibas ES. When the entire thyroid is removed it is termed a . Most are a lump in the neck that is noticed by either the patient or the GP without any associated symptoms. This cookie is set by Google and is used to distinguish users. Ultrasonography: is it useful in the diagnosis in thyroid nodules. 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. A pounding heart. Methods Rago T, Scutari M, Loiacono V, Santini F, Tonacchera M, Torregrossa L, Giannini R, Borrelli N, Proietti A, Basolo F, Miccoli P, Piaggi P, Latrofa F, Vitti P. Low elasticity of thyroid nodules on ultrasound elastography is correlated with malignancy, degree of fibrosis and high expression of galectin-3 and fibronectin-1. We evaluated 254 nodules from 205 patients (female, n=176) (Table I). doi: 10.1111/cen.12515. 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. It is important to recall that ours was a selected cohort of patients with thyroid nodules: all had been referred to our unit for FNAC, for reasons known only to the referring physician. Thyroid nodule shape suggests malignancy. Any symptom suggestive of invasion, including dysphonia or dysphagia, should raise the suspicion for an underlying malignancy. For the purposes of this study, nodules that could not be classified according to the ATA Guidelines (e.g., isoechoic nodules with other suspicious features such as microcalcification, irregular margins, and TTW shape) were considered intermediate-suspicion nodules. Since an intraobserver variability of up to 18% has been reported for the AP diameter evaluation, we proposed that the TTW shape be defined as an AP/T diameter ratio of 1.2 (i.e., the AP diameter is at least 20% greater than the T diameter). Outlook. The data collected including the number visitors, the source where they have come from, and the pages visted in an anonymous form. National Library of Medicine [Google Scholar] 7. . However, none of the thyroid nodules in either the training or validation . WHAT ARE THE IMPLICATIONS OF THIS STUDY? Huang K, Gao N, Zhai Q, Bian D, Wang D, Wang X. *Giorgio Grani, MD, PhD, Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, IT00161 Rome (Italy), E-Mail. The AUCs of shape, microcalcifications and the combination of both were 0.671, 0.721 and 0.649 respectively, demonstrating relatively good accuracy, showing the combination also to be as useful as the shape or the presence of microcalcifications alone in predicting malignancy. Thyroid nodules are also classified according to their shape, and are broken into categories: taller than wide or wider than tall. The presence of a firm, fixed nodule or ipsilateral cervical lymphadenopathy are late features suggestive of malignancy and should notdelay further assessment. All conventional and power color Doppler US of thyroid nodules were performed using a 6-12 MHz linear array transducer, logic 7 (KPI Healthcare Inc. Yorba Linda, CA, USA). The mean length of time between US and thyroidectomy was 2 months. Durante C, Costante G, Lucisano G, et al. Thyroid nodules are fourfold more frequent in women when compared to men. Australian Journal of General Practice published by the Royal Australian College of General Practitioners, 100 Wellington Parade, East Melbourne, Victoria 3002, Australia 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. Kilfoy BA, Zheng T, Holford TR, Han X, Ward MH, Sjodin A, Zhang Y, Bai Y, Zhu C, Guo GL, Rothman N, Zhang Y. When considering only technically satisfactory specimens, the diagnostic accuracy of FNA when performed by an experienced operator is approximately 95%, although this figure is dependent on how each cytology category is used in the calculation4 The decision to perform FNA of a nodule depends on the sonographic pattern and size (Figure1, Table 2). proposed a cut-off point of 6 cm where the incidence of carcinoma decreases with increasing size of thyroid nodules (26). Ha EJ, Moon WJ, Na DG, Lee YH, Choi N, Kim SJ, et al. A Closer Look at "Taller-Than-Wide" Thyroid Nodules: Examining Dimension Ratio to Predict Malignancy. Abstract. PDF Clinical THYROIDOLOGY TALLER-THAN-WIDE SHAPED THYROID NODULES IN ANY In summary, all nodule sonographic features were collected: diameters, margins, composition, echogenicity, presence of calcifications and other hyperechoic foci, and suspected extrathyroidal extension. sharing sensitive information, make sure youre on a federal The margins can be categorized as: smooth, ill-defined, lobulated or irregular. National Library of Medicine Serology for Nasopharyngeal & Thyroid Cancers, Thyroid Imaging, Reporting & Data System (TIRADS). A Closer Look at "Taller-Than-Wide" Thyroid Nodules: Examining We also calculated the areas under the receiver-operating characteristic (AUROC) curve that were compared using the DeLong approach [21], utilizing the easyROC package [22]. Nervousness or irritability. Currently, US-guided fine-needle aspiration biopsy (FNAB) remains the gold standard within the diagnostic procedures in the workup of thyroid nodules. 1). Table 1), and because it depends on the measurement (or at least the estimate) of nodule diameters, it is subjected to inter- and even intraobserver variability. Dry skin. A TallerThanWide Shape Is a Good Predictor of Papillary Thyroid Thyroid ultrasound demonstrated a 1.6 cm mostly solid, isoechoic, wider-than-tall right thyroid lobe nodule on grayscale (Case 5A) and color Doppler (Case 5B). Brauer VF, Eder P, Miehle K, Wiesner TD, Hasenclever H, Paschke R. Interobserver variation for ultrasound determination of thyroid nodule volumes. Thyroid nodules size and prediction of cancer. 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]. Table 2) and has been demonstrated to be one of the features that frequently causes variation in the estimated malignancy risk of nodules over time [11]. Bible KC, et al. FOIA The 2015 ATA guidelines take a new approach to risk stratification. Values are percentages. Hong MJ, Lee YH, Kim JH, Na DG, You SH, Shin JE, Kim SK, Yang KS; Korean Society of Thyroid Radiology. 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. For each system, we compared the results obtained with the current and alternative definitions of TTW; more specifically, the percentage of nodules classified as FNAC-deferrable and the appropriateness of this classification based on the reference standard. 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. Assessment of thyroid lesions (ultrasound) - Radiopaedia.org Clinical examination should involve inspection and palpation of the thyroid gland and examination of the cervical lymph nodes. WHAT ARE THE IMPLICATIONS OF THIS STUDY? Most cysts recur after fine-needle aspiration (FNA). Thyroid nodules can be solid, cystic (fluid-filled), or have mixed cystic/solid components. Nodules that are detected during pregnancy should be assessed on the basis of serum TSH levels. 2Department of Endocrinology, Metabolism and Diabetes Mellitus, Nikea-Piraeus Agios Panteleimon General Hospital, Athens, Greece, 3Endocrine Unit, Alexandra Hospital, Athens, Greece. The vast majority more than 95% of thyroid nodules are benign (noncancerous). In our work, the combination of microcalcifications and taller-than-wide shape was an independent predictor of malignancy and although the sensitivity was only approximately 30%, the specificity was 100%, since none of the benign nodules with taller-than-wide shape were found to have microcalcifications. Rago T, Vitti P, Chiovato L, Mazzeo S, De Liperi A, Miccoli P, Viacava P, Bogazzi F, Martino E, Pinchera A. Hoang JK, Middleton WD, Farjat AE, Langer JE, Reading CC, Teefey SA, et al. Reduction in Thyroid Nodule Biopsies and Improved Accuracy with American College of Radiology Thyroid Imaging Reporting and Data System. 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. Analytical cookies are used to understand how visitors interact with the website. Finally, the visual assessment of TTW shape is commonly used in clinical practice: this study is not able to compare the performance of a quantitative evaluation to a qualitative one. Thyroid nodules - Symptoms and causes - Mayo Clinic This website uses cookies to ensure you get the best experience on our website. Statistical analysis. 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. Metastasis. Get notified of updates, news and upcoming events sent to your inbox! Using a subset of this cohort, we previously conducted a study to compare the diagnostic performance of 5 sonographic stratification systems and to evaluate the role of nodule location, and those results have already been reported [18, 19]. Inflammatory, Papillary A little inspiration can go far. A taller-than-wide shape was defined as a ratio of 1, calculated by dividing the anteroposterior diameter by the transverse diameter. Thyroid cancer had a 2.9 times higher rate in women (female: male proportion 16.3 : 5.7) . single center analysis in a large cohort. Larger or aggressive cancerous nodules require removal of the whole thyroid and sometimes subsequent radioactive iodine . Orientation of the ultrasound probe to identify the taller-than-wide sign of thyroid malignancy: a registry-based study with the Thyroid Imaging Network of Korea. Background Make a tax-deductible donation to support the THANC Foundation, the creators of the Thyroid, Head & Neck Cancer Guide. On the other hand, the sensitivity of each sonographic system and the overall diagnostic accuracy, evaluated according to the AUROC, did not significantly change. 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 . Only statistically significant variables (p<0.05) from univariable analysis were entered the multivariable analysis. Thyroidectomy: surgery to remove the entire thyroid gland. Considering the final histology or follow-up, the presence of microcalcifications or taller-than-wide shape was strongly related with malignancy (43.5% in malignant vs. 25.2% in benign), whilst the combination of solid, isoechoic/hyperechoic, wider-than-tall, and smooth margins without calcifications was prevalent in benign cases (37.2% in . For those assigned to high-risk classes, FNAC is generally recommended if the maximum diameter is 1 cm [1, 2, 3, 4, 5]. Cancers in the thyroid isthmus are more likely to spread outside of the Kusi Z, Becker DV, Saenger EL, et al. In fact, even if 66 nodules would lose the TTW shape designation, no more than 35 would have deferred biopsy for this reason, while the remaining are still candidates for immediate biopsy due to other suspicious features. Sonographic features of medullary thyroid carcinomas--a systematic review and meta-analysis. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. official website and that any information you provide is encrypted Grey-Scale Analysis Improves the Ultrasonographic Evaluation of Thyroid Nodules. For example, Liu et al. The frequency of the ultrasonic sound waves cannot be heard by humans. A total of 471 thyroid nodules from 435 patients were studied. Taller-than-wide nodule shape had a much higher OR than microcalcifications (33.8 vs. 6.7), whereas intranodular vascularity or ill-defined margins were not enough to determine a high risk of malignancy, as previously described (22). This means that the coexistence of microcalcifications in taller-than-wide nodules provides strong evidence of malignancy, although the absence of this profile cannot exclude malignancy. Hence malignant nodules can be taller than they are wide (Fig. The .gov means its official. Support the THANC Foundation, the creators of this resource. A practical trial to use Thyroid Imaging Reporting and - SpringerOpen 1). The .gov means its official. Nodules classified as very low risk and <1cm have been shown to grow very little over five years and do not require routine ultrasonographic follow-up.1,6. sharing sensitive information, make sure youre on a federal For example, marked hypoechogenicity, microcalcifications, irregular margins, intranodular vascular images and low elasticity have been associated with malignancy (4,9-13). Grani G, Lamartina L, Cantisani V, Maranghi M, Lucia P, Durante C. Interobserver agreement of various thyroid imaging reporting and data systems. Browse a list of devices for patients undergoing cancer treatment. Predictive Value of Malignancy of Thyroid Nodule Ultrasound Classification Systems: A Prospective Study. Epub 2023 Apr 11. Thyroid ultrsound features and risk of carcinoma: A systematic review and meta-analysis of observational studies. Larger nodules can cause compressive symptoms including dyspnoea, globus and dysphagia. When the alternative definition of TTW was used (AP/T ratio >1.20), the specificity rose to 95.5% (95% CI 93.397.1, p < 0.001), whereas sensitivity dropped even lower to 11.9% (95% CI 425.6; p = 0.03). Received 2020 Mar 14; Accepted 2020 Apr 8. Did you know you can now log your CPD with a click of a button? Establishment of an Ultrasound Malignancy Risk Stratification Model for Patients and Methods: This was a retrospective single-center study investigating the association of the morphological characteristics of nodular goiters from preoperative US and color Doppler images with malignancy based on pathology. The other 3 nodules had cytological diagnoses of malignancy (TIR5, n = 1) or suspected malignancy (TIR4, n = 2) and were managed with active surveillance following patient preferences. 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. Anaplastic DeLong ER, DeLong DM, Clarke-Pearson DL. The final cohort included 553 thyroid nodules (median maximum diameter 19.7 mm, interquartile range 14.527.5; online suppl. Echogenic foci in thyroid nodules: diagnostic performance with Keywords: comparative study , CT , sonography , thyroid cancer , thyroid nodule Update on Thyroid Nodule Management - touchENDOCRINOLOGY doi: 10.1001/jama.2015.0956. Women are three times more likely to develop thyroid cancer than men. Any malignancy or suspected malignancy should be referred directly to a high-volume thyroid surgeon.1, A significant proportion of thyroid nodules do not meet FNA criteria, and ultrasound features guide follow-up. Conclusion: Among the important indicators of thyroid malignancy, taller-than-wide nodules with microcalcifications are most likely to be malignant. To apply these systems, an essential prerequisite is the adoption of a uniform language and definition of suspicious features [6]. If we looked at the population of the world we would find that about 20 to 70% of people (1) have a thyroid nodule! This cookie is installed by Google Analytics. An intraobserver variability of up to 18% in AP diameter evaluations has been described, which may lead to overreporting of this feature. A taller-than-wide shape was a useful US feature for predicting thyroid malignancy. Int J Clin Pract. AACE/ACE/AME, American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi; ACR, American College of Radiology; ATA, American Thyroid Association; AUROC, area under the receiver-operating characteristic curve; EU-TIRADS, European Thyroid Imaging Reporting and Data Systems; K-TIRADS, Korean Thyroid Imaging Reporting and Data Systems; TTW, taller-than-wide shape. Thyroid nodules are discrete lesions present within the thyroid gland that are radiologically distinct from the adjacent parenchyma (Table 1).1 They are palpable in 47% of the population and have been detected using ultrasonography in up to 67% of adults.2 While the majority of nodules are benign, the risk of malignancy reaches approximately 715%.1 Given the prevalence of thyroid nodules and their underlying risk, it is imperative that general practitioners (GPs) are able to appropriately assess thyroid nodules. In some studies, a nodule is called a cyst only if it is predominantly cystic on ultrasonography, but in others, the term is applied to nodules that have any areas of cystic degeneration, which may include up to 50 percent of thyroid nodules. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. None of the benign nodules with taller-than-wide shape had microcalcifications, increasing the specificity to 100%.
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