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Is ultrasonography really useful in distinguishing between benign and malignant thyroid nodules? The reality facing many physicians, say researchers from the University of Alberta, is that ultrasonography reports originate from multiple sites and are dictated by physicians of varying experience, practice volumes, and styles of documentation. The researchers say although thyroid ultrasonography provides accurate results, few ultrasound reports contain the necessary information to predict malignancy and guide management.
The Thyroid Imaging and Reporting System (TI-RADS) was developed to standardize risk stratification according to nodule characteristics: size, marked hypoechogenicity, taller-than-wide shape, microcalcifications, irregular margins, and solid component. The researchers reviewed ultrasound reports using TI-RADS criteria for 329 patients who had undergone thyroidectomy and then assessed whether individual or multiple criteria were associated with malignancy.
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About 42% of the nodules were malignant. The most common carcinoma was papillary thyroid cancer. Benign disease was predominantly cases of multinodular goiter. The difference in size between benign and malignant neoplasms was not significant. About 11% of the specimens exhibited incidental microcarcionomas.
Nearly all the reports documented nodule size. But > 90% noted ≤ 3 of the remaining TI-RADS criteria. In fact, nearly 40% included 1 or no criterion beyond the description of size. The number of features reported did not reflect an increased risk of malignancy. The researchers found no associations among reporting criteria—for example, the presence of microcalcifications did not trigger targeted comments about any other factor—and this was true for all of the criteria, they note.
Half of the reports with a comment noted solid or cystic nodules and echogenicity. The description of a hypoechoic nodule or a solid nodule was significantly more likely to be identified in malignant neoplasms. The presence of microcalcifications was the most sensitive marker of malignancy (90%), and documentation of irregular margins was the most specific indicator.
Overall, the researchers say, it was clear that microcalcifications, hypoechogenicity, irregular margins, and solid nodules were significantly more likely to be found in malignant neoplasms. The absence of these nodules predicted benign disease. But because so few reports consistently documented all criteria, the overall ability of thyroid ultrasonography to discriminate between lower- and higher-risk nodules is limited.
Source:
Gamme G, Parrington T, Wiebe E, et al. Can J Surg. 2017;60(2):134-139
doi:10.1503/cjs.010316