4. Campanella, P., Ianni, F., Rota, C. A., Corsello, S. M. & Pontecorvi, A. Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: A systematic review and meta-analysis. Russ G, et al. The degree of hypoechogenicity was categorized as mild (hypoechoic relative to the thyroid parenchyma, but hyperechoic relative to the anterior neck muscles), moderate (similar echogenicity to the anterior neck muscles), and marked (hypoechoic relative to the anterior neck muscles) (Fig. Some suggest routine follow up every 6 to 24 months. Close more info about Thyroid nodules and thyroid cancer. Do you have sweats, diarrhea, heat intolerance, diarrhea, a feeling of shakiness? Cytology plays a key part in determining the most appropriate management and follow-up of thyroid nodules. About 2 or 3 in 20 are malignant, or cancerous. The C-TIRADS with the modified markedly hypoechoic achieved higher AUC and specificity than that with the classical markedly hypoechoic (p=0.01 and <0.001, respectively). The echogenicity of a thyroid nodule on ultrasonography (US) is an important descriptor for distinguishing malignancy from benign nodules1,2,3,4. We calculated the malignancy risk according to composition and suspicious features. However, there is insufficient evidence on hypoechoic nodules stratification because the previous work involved a single-center7. The higher prevalence of suspicious features in marked hypoechoic nodules might have caused confounding effects in the malignancy risks between these two groups. HHS Vulnerability Disclosure, Help Markedly hypoechoic nodules demonstrated a significantly higher malignancy risk than moderately (P<0.001) and mildly hypoechoic (P<0.001) nodules. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 24.0 (IBM Corporation, Armonk, NY, USA, https://www.ibm.com/kr-ko/analytics/spss-statistics-software), and MedCalc (version 20.009, MedCalc Software Ltd, Ostend, Belgium, https://www.medcalc.org; 2022). A P value<0.05 was considered statistically significant. 2. The echogenicity of a thyroid nodule on ultrasonography (US) is an important descriptor for distinguishing malignancy from benign nodules14. J. Endocrinol. The hypoechoic solid portion accounts for less than 50% of the nodule. Is the mass ever painful or has it enlarged rapidly recently? The prevalence of nodules ranges from 20 to 76% in the United States, and increases with age and female gender. All of the nodules were examined with US before surgery. On the contrary, heterogeneous hypoechoic nodules showed significantly higher malignancy risks than heterogeneous isoechoic nodules in all subgroups (P0.017) except partially cystic nodules. (A) Markedly hypoechoic nodule (hypoechoic relative to the anterior neck muscles) Diagnosis: Conventional papillary thyroid carcinoma (B) Moderately hypoechoic nodule (similar echogenicity to the anterior neck muscle). The prevalence of thyroid nodules is high, but only a subset of nodules are actually malignant. Diagnosis: Follicular variant papillary thyroid carcinoma. 1. J. Cytologic analysis may yield benign results (colloid nodule, macrofollicular adenoma, benign cyst, lymphocytic thyroiditis, or granulomatous thyroiditis). Shin JH, et al. The degree of hypoechogenicity could be stratified as mild versus moderate to marked hypoechogenicity. Is it cancer? Thyroid nodules are lumps that occur in the thyroid gland. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: Systematic review and meta-analysis. Thyroid nodules may be solid, cystic (fluid filled), or a combination of both and can develop in any location within the thyroid gland. In the 2021K-TIRADS, punctate echogenic foci were defined as punctate (1mm) hyperechoic foci within the solid component of a nodule, nonparallel orientation as the anteroposterior diameter of a nodule being longer than its transverse diameter in the transverse plane, and irregular margin as a non-smooth edge with spiculation or microlobulation. Thyroid nodules are solid or fluid-filled lumps that form within your thyroid, a small gland located at the base of your neck, just above your breastbone. CancerTherapyAdvisor.com is a free online resource that offers oncology healthcare professionals a comprehensive knowledge base of practical oncology information and clinical tools to assist in making the right decisions for their patients. CAS Kim PH, et al. There was no significant difference in malignancy risk in partially cystic nodules without suspicious features according to the degree of hypoechogenicity (P0.116). the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in US images were retrospectively reviewed by one of 17 experienced radiologists with 822years of experience performing thyroid US using an online program (AIM AiCRO; http://study.aim-aicro.com). PubMed Central PubMed Thyroid imaging reporting and data system risk stratification of thyroid nodules: Categorization based on solidity and echogenicity. ACR thyroid imaging, reporting and data system (TI-RADS): White paper of the ACR TI-RADS committee. Russ, G. et al. Similarities and differences between thyroid imaging reporting and data systems. Eur. 1). Ha, E. J. et al. Thyroid Nodule Overview - Thyroid Cancer Center hypoechoic solid nodule. https://doi.org/10.1530/eje-13-0995 (2014). When we categorized nodules according to composition and presence of suspicious features, there was no significant difference in malignancy risk between markedly and moderately hypoechoic nodules in all subgroups, regardless of composition and the presence of suspicious features (P0.48). While the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi9, ACR11, EU-TIRADS10, and the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS)12 distinguished between marked and mild hypoechogenicity, the American Thyroid Association15 and K-TIRADS14 did not for nodule risk stratification. To obtain Am. If the TSH is normal, no further lab testing is necessary. If the nodule is found to be hyperfunctioning, the risk of cancer is very low and patient likely does not need FNA. Among them, 16,679 patients were excluded due to a lack of reference standard test (biopsy or surgery) (n=4304), thyroid nodules<1.0cm (maximal diameter, n=12,130), suboptimal image quality (n=245), or inconclusive/indeterminate biopsy results (Bethesda I; nondiagnostic or unsatisfactory or III; atypia of undetermined significance or follicular lesion of undetermined significance, n=1015 patients with 1102 nodules)23,24. Thyroid cancer presents as a thyroid nodule. Article Springer Nature or its licensor (e.g. The good news is that most nodules are NOT cancerous and there are certain signs and symptoms, if present, that do increase the chance that your nodule may be harboring cancer. ABBREVIATIONS & DEFINITIONS. Google Scholar, Gharib H, Papini E, Garber JR et al (2016) American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules2016 update. All of the reviewers, who were blind to the FNA results and final diagnoses, then assessed the US features of the thyroid nodules. In conclusion, the malignancy risk of nodules with heterogeneous echotexture can be stratified based on predominant echogenicity. Quantitative analysis of echogenicity for patients with thyroid nodules. https://doi.org/10.1089/thy.2015.0460 (2016). D. Over-utilized or wasted diagnostic tests associated with the evaluation of this problem. The predominant echogenicity effectively stratifies the malignancy risk of nodules with heterogeneous echotexture. If a patient has signficant airway problems from compression from a large goiter then work up should be expedited. Korean J Radiol 22:20942123, Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L (2017) European thyroid association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. Markedly hypoechoic: a new definition improves the diagnostic performance of thyroid ultrasound. National Library of Medicine The demographic data are summarized in Table Table1.1. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: Systematic review and meta-analysis. The 1089 malignant nodules included 989 papillary thyroid carcinomas (90.8%), 62 follicular carcinomas (5.7%), 12 (1.1%) medullary carcinomas, 7 (0.6%) poorly differentiated carcinomas, 6 (0.6%) anaplastic carcinomas, 5 (0.5%) metastases, 4 (0.4%) unspecified malignancies, 3 (0.3%) lymphomas, and 1 (0.1%) squamous cell carcinoma. They are typically benign and are often discovered incidentally. Before The interobserver agreement on nodule echogenicity and echotexture was assessed on 1400 (25%) of 5601 nodules by another radiologist (J.Y.L, with eight years of experience in thyroid imaging). In solid nodules, markedly or moderately hypoechoic nodules showed a significantly higher malignancy risk than mild hypoechoic (P0.016) and iso- or hyperechoic (P<0.001) nodules, regardless of suspicious features. The requirement for patient informed consent was waived. The malignancy risks of all partially cystic nodules without suspicious features ranged within the low-to-intermediate suspicion category (3.613.3%), regardless of echogenicity and echotexture. The Licensed Content is the property of and copyrighted by DSM. Despite its importance, the US definition of nodule echogenicity shows discrepancies across risk stratification systems (RSS)13. We calculated each nodule categorys frequency and malignancy risk based on its echotexture and degree of hypoechogenicity. 22, 160. Table Table33 lists the calculated malignancy risks of nodules categorized by their predominant degree of hypoechogenicity grouped by overall nodules and subgroups. Yoon, S. J. et al. B. High diagnostic accuracy AI observed potential lung cancer in the radiograph with an 89% CI as indicated by the nodule localization map (B) (as the color changes from blue to red, the probability . Arch. Heterogeneous echotexture was defined as the nodules solid component showing two different portions of echogenicity (iso- or hyperechoic vs. hypoechogenicity). Both nodule and lymph nodes were proven to contain papillary thyroid cancer. III. The degree of hypoechogenicity could be stratified as mild versus moderate to marked hypoechogenicity. Echogenic foci in thyroid nodules: diagnostic - BMC Medical Imaging Summary. We would like to express our gratitude to all doctors from 26 different hospitals who provided ultrasound data on thyroid nodules for Thyroid Imaging Network of Korea registry. In solid nodules, the malignancy risks of nodules with moderate (73.3%) or marked hypoechogenicity (78.6%) with suspicious features were within the high suspicion category. Of the 5601 thyroid nodules, 4512 (80.6%) were diagnosed as benign and 1089 (19.4%) as malignant. Thyroid 27, 953959. Despite its. Malignancy risks were not significantly different between homogeneous versus heterogeneous nodules in both hypoechoic (P0.086) and iso- hyperechoic nodules (P0.05). There was no overlap with any themes from previously published works. Future in-depth studies are needed to validate the reproducibility of this US lexicon in multiple readers. Nodules in the lower portion of the lobes are believed to be at least risk for cancer. All US examinations were performed with a 1014MHz linear probe. The echogenicity of a thyroid nodule on ultrasonography (US) is an important descriptor for distinguishing malignancy from benign nodules 1 - 4.Previous studies have consistently reported that the malignancy risk of hypoechoic nodules was higher than that of iso- or hyperechoic nodules 1, 3 - 5.Marked hypoechogenicity is related to an increased risk of malignancy in thyroid . Irregular margins (RR 16.83), intranodular vascular spots (RR 14.29), and microcalcifications (RR 4.97) were independent risk factors of malignancy. The hypoechoic solid portion accounts for less than 50% of the nodule. In patients who are asymptomatic diagnostic work up can be started in the outpatient setting after the patient has been discharged. most papillary thyroid carcinomas; nearly all medullary thyroid carcinomas 3; benign nodules can be hypoechoic; if no other malignant features (e.g. ; Supervision: all authors; Writingoriginal draft preparation: J.Y.L. This study aimed to determine the malignancy risk of thyroid nodules according to their echotexture and degree of hypoechogenicity. Previous studies have consistently reported that the malignancy risk of hypoechoic nodules was higher than that of iso- or hyperechoic nodules1,3,4,5. J Am Coll Radiol 14:587595, Ha EJ, Chung SR, Na DG et al (2021) 2021 Korean thyroid imaging reporting and data system and imaging-based management of thyroid nodules: Korean Society of Thyroid Radiology consensus statement and recommendations. If there are symptoms, evidence of thyroid dysfunction, worrisome ultrasound characteristics, or questions as to how frequently to follow up, patients should be referred to an endocrinologist. Cite this article. Google Scholar, Trigo JM, Capdevila J, Grande E, Grau J, Lianes P, Spanish Society for Medical O (2014) Thyroid cancer: SEOM clinical guidelines. 98, 1419. Previous studies have consistently reported that the malignancy risk of hypoechoic nodules was higher than that of iso- or hyperechoic nodules1,35. Endocr. A solid nodule is more likely to be cancerous than other nodules. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. Hoang, J. K. et al. ; Funding acquisition: D.G.N., J-h.K. They are found in the body's tissues such as blood vessels, nerves, organs and other soft tissue. Thyroid Nodules: Advances in Evaluation and Management | AAFP Brito, J. P. et al. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. Early detection of thyroid cancer: Self neck check, symptoms, and more There was substantial interobserver agreement (=0.624) and perfect intraobserver agreement (=0.828) for the modified markedly hypoechoic. Quantitative analysis of echogenicity for patients with thyroid nodules. Patient data were retrospectively collected from 26 different hospitals in Korea (Thyroid Imaging Network of Korea registry, THINK). Received 2022 Mar 11; Accepted 2022 Sep 23. Neck irradiation increases the risk of thyroid cancer. Heterogeneous iso-hyperechoic nodules without suspicious features showed a low malignancy risk. Second, we retrospectively assessed the nodules US features, which may limit the accuracy of interpretation. In 311 iso- or hyperechoic malignant nodules, 271 (87.1%) were PTCs, including 69 (21.9%) follicular variant PTCs, and 32 (10.3%) were follicular carcinomas. Thyroid cancers are associated with family history of thyroid cancer or Multiple Endocrine Neoplasia 2 (MEN2), prior irradiation to the head and neck, age <30 years or >70 years, and male gender. 17, 370395. Compared with classical markedly hypoechoic as a diagnostic criterion for malignancy, using modified markedly hypoechoic as the criterion resulted in a significant increase in sensitivity (28.03% vs. 63.26%) and AUC (0.598 vs. 0.741), despite a significant decrease in specificity (91.53% vs. 84.88%) (p<0.001 for all). J. Clin. PubMed Please try refreshing the page. Korean thyroid imaging reporting and data system and imaging-based management of thyroid nodules: Korean society of thyroid radiology consensus statement and recommendations. Zhou, J. et al. Proceed with ultrasound assessment. If not, appropriate communication with the patient regarding need to follow up as outpatient should occur and be documented routinely. Overall, the homogeneous hypoechoic nodules malignancy risk was significantly higher than heterogeneous hypoechoic nodules (40.5 vs. 33.5%, P=0.022). Have you noticed this nodule in your neck before? Article Thyroid nodules - Diagnosis and treatment - Mayo Clinic We calculated the malignancy risk according to composition and suspicious features. cSolid isoechoic versus partially cystic isoechoic. Regarding echogenicity, subtle echo changes could be misclassified in prerecorded US images. Marked or moderately hypoechoic nodules showed a significantly higher risk than mild hypoechoic (P0.016) nodules. Landis JR, Koch GG. For nodules with heterogeneous echogenicity, the EU-TIRADS suggested that nodules with any hypoechoic component should be regarded as hypoechoic nodules and classified as intermediate risk10. 2). Impact of the Hypoechogenicity Criteria on Thyroid Nodule Malignancy The primary goal of a GP is to differentiate between a benign and a malignant nodule. Nodules that produce too much thyroid hormone are almost always benign. The malignancy risk of solid homogeneous iso- or hyperechoic nodules ranged within the low-to-intermediate suspicion categories, depending on the presence of suspicious US features (7.5% in solid homogeneous iso- or hyperechoic nodules without suspicious features and 26.7% in solid homogeneous iso- or hyperechoic nodules with suspicious features). The four categories combined with nodule echotexture and echogenicity of homogeneous hypoechoic, heterogeneous hypoechoic, heterogeneous isohyperechoic, and homogeneous isohyperechogenicity also showed a substantial agreement (k=0.77, 0.75, 0.81). Specifics including size of any palpated nodules and mobility should be noted. https://doi.org/10.2214/AJR.17.19192 (2018). If the TSH is high, the patient should get a free T4 and thyroid peroxidase antibodies checked to evaluate for hypothyroidism. Management. PubMed Central The institutional review boards (IRB) of the 26 participating centers (CHA Gangnam Medical Center, Chung-Ang University Hospital, Konkuk University Medical Center, Gyeongsang National University Hospital, Korea University Anam Hospital, Kosin University Gospel Hospital, Daejeon St. Marys Hospital, Dongguk University Ilsan Hospital, Seoul National University Hospital, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Soonchunhyang University Seoul Hospital, Nowon Eulji Medical Center, Busan Paik Hospital, Inje University Haeundae Paik Hospital, Hanyang University Guri Hospital, Asan Medical Center, Ajou University Hospital, GangNeung Asan Hospital, Korea University Ansan Hospital, Seoul National University Bundang hospital, National Cancer Center, Soonchunhyang University Bucheon Hospital, Gangwon University Hospital, Chonnam National University Hwasun Hospital, Gachon University Gil Medical Center and Seoul St. Marys Hospital) approved this study.
