We calculated each nodule categorys frequency and malignancy risk based on its echotexture and degree of hypoechogenicity. 22, 160. Benign nodules were diagnosed based on the histopathological results after surgery (n=390), with at least two benign FNA or CNB results (n=594) and one benign FNA or CNB result (n=3528). Brito JP, et al. Ha EJ, et al. Malignant, suspicious, or persistently nondiagnostic results require surgical treatment. For nodules with heterogeneous echogenicity, guidelines adopt different strategies; the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and American College of Radiology (ACR) TIRADS classified them based on the predominant echogenicity11,14, but the European Thyroid Imaging Reporting and Data System (EU-TIRADS) classified heterogeneous nodules as mildly hypoechoic nodules when they possessed any hypoechoic portion10. Am. Article It is reported that up to 55% of benign nodules appear hypoechoic compared to thyroid parenchyma, making nodules not marked as hypoechogenicity less specific, . When we classified the nodules according to composition and the presence of suspicious features, there was no significant difference in malignancy risks between homogeneous hypoechoic and heterogeneous hypoechoic nodules in all subgroups (P0.086). The possibility of cancer is the overriding concern, but only about 5% prove to be malignant. Radiol. Korean J. Radiol. Ultrasound can help evaluate a thyroid nodule and determine the need for biopsy. Thus, clinicians are often faced with the task of deciding which nodules require further investigation for thyroid cancer with a biopsy, and which nodules can be followed by just observation. Biometrics 44:837845, Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Our study found that, compared with the original definition, modified markedly hypoechoic significantly improved the diagnostic performance in differentiating malignant from benign thyroid nodules and the predictive efficacy of the risk stratification systems. Note: Microfollicular adenomas are technically not considered follicular cancers because they lack capsular or vascular invasion. The datasets analyzed in the current study are available from the corresponding author on reasonable request. Liu, J., Luo, T., Zhang, H. et al. Google Scholar. Our study demonstrated no significant difference in malignancy risks between homogeneous vs. heterogeneous hypoechoic nodules in all subgroups and homogenous vs. heterogeneous iso- or hyperechoic nodules in all subgroups except partially cystic nodules without suspicious features. Demographic Data of 5601 Nodules in This Study. PubMed 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. aSuspicious US features include punctuate echogenic foci, nonparallel orientation (taller than wide) and irregular shape. Landis, J. R. & Koch, G. G. The measurement of observer agreement for categorical data. Flowchart of the study. The clinical signficance of thyroid nodules includes the possibility of cancer (approximately 5%), thyroid dysfunction, and in rare circumstances, development of local compression of structures in the neck. Compared with the classical markedly hypoechoic as a diagnostic criterion for malignancy, the modified markedly hypoechoic resulted in a significant increase in sensitivity and AUC. 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. The differential diagnosis for thyroid nodules can initially be divided into benign and malignant causes. Metab. JAMA 319:914924, Article PubMed Despite its. However, they otherwise microscopically look like follicular carcinoma and so are often treated like malignant lesions. FOIA Nodules with suspicious features and solid hypoechoic nodules 1 cm or larger require aspiration . Chang Yoon Lee. and JavaScript. Benign and malignant thyroid nodules: US differentiationmulticenter retrospective study. Russ G, et al. We speculate that this is because this cohort was mainly consisted of biopsy required nodules, and the majority of institutions were tertiary referral hospitals. https://doi.org/10.1590/2359-3997000000262 (2017). In this study, 59 isolated macrocalcifications and 48 purely cystic nodules were further excluded because of an inability to assess nodule echogenicity. Proceed with ultrasound assessment. Quantitative analysis of echogenicity for patients with thyroid nodules. The punctate echogenic foci with comet-tail artifact showed malignancy rate of 77.8% in solid and predominantly solid nodules. Introduction. Neck irradiation increases the risk of thyroid cancer. The predominant echogenicity effectively stratifies the malignancy risk of nodules with heterogeneous echotexture. Our mission is to provide practice-focused clinical and drug information that is reflective of current and emerging principles of care that will help to inform oncology decisions. If concern arises about the possibility of cancer, the doctor may simply recommend monitoring the nodule over time to see if it grows. Our recent study demonstrated that nodule hypoechogenicity could be stratified as mild versus moderate to marked, and nodules with heterogeneous echogenicity are stratified by the predominant echogenicity of the solid portion7. Heterogeneous hypoechoic nodules showed a significantly higher malignancy risk than heterogeneous isoechoic nodules (P0.017), except in partially cystic nodules. Patients with malignant nodules were significantly younger (P<0.001), included a smaller proportions of female patients (P<0.001), and smaller nodule size (P<0.001) than patients with benign nodules. Learn more about Institutional subscriptions, Thyroid Imaging Reporting and Data System, Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper DS (2018) The diagnosis and management of thyroid nodules: a review. PubMedGoogle Scholar. People can develop thyroid nodules at any age, but they occur most commonly in older adults. Moon WJ, et al. Chung SR, et al. Treatment depends on the type of thyroid nodule you have. Before Korean J. Radio.l https://doi.org/10.3348/kjr.2021.0230 (2021). https://doi.org/10.1089/thy.2019.0752 (2020). Reviewers determined the nodule hypoechogenicity by assessing the echogenicity of the solid component in a nodule. To determine the contribution of a modified definition of markedly hypoechoic in the differential diagnosis of thyroid nodules. What Is the Hypoechoic Thyroid Nodule? - Verywell Health J. We assume that in partially cystic nodules, malignancy risk is mainly determined by the presence of suspicious features and the degree of hypoechogenicity had little impact. Nodules in the lower portion of the lobes are believed to be at least risk for cancer. However, considering that the majority of false-negative rates (FNR) occur in high suspicion nodules17, the rate of FNR might be negligible in this study (simulated false-negative rate in nodules with one benign biopsy result 1.4%). Note internal iso- or hyperechoic solid portions consisting less than 50% of the nodule. http://creativecommons.org/licenses/by/4.0/, https://www.ibm.com/kr-ko/analytics/spss-statistics-software. Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 200025, China, Juan Liu,Ting Luo,XiaoHong Jia,YiJie Dong,JingWen Zhang,WenWen Xu&JianQiao Zhou, Department of Ultrasound, The Anyang Tumor Hospital, 1 Huanbinbei Road, Anyang, 455001, China, Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, 25 TaiPing Street, Luzhou, 646000, China, Department of Ultrasound, The Affiliated Hospital of Guizhou Medical University, 28 Guiyijie Street, Guiyang, 550001, China, Department of Ultrasound, Gansu Provincial Cancer Hospital, 2 Xiaoxihu East Road, Qilihe District, Lanzhou, 730050, China, Department of Medical Ultrasound, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, 226001, China, Department of Ultrasound, Dalian Central Hospital Affiliated to Dalian Medical University, 42 Xuegong Street, Shahekou District, Dalian, 116033, China, Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, 1 Eastern Jianshe Road, Zhengzhou, 450052, China, You can also search for this author in A hypoechoic mass is tissue in the body that's more dense or solid than usual. Markedly hypoechoic: a new definition improves the diagnostic performance of thyroid ultrasound. Table Table33 lists the calculated malignancy risks of nodules categorized by their predominant degree of hypoechogenicity grouped by overall nodules and subgroups. There were 264 malignant nodules and 767 benign nodules. D. Nodule with homogeneous iso- or hyperechogenicity. 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. Based on our results, moderately hypoechoic nodules should be grouped with marked hypoechoic nodules for risk stratification. Haugen BR, et al. There was substantial interobserver agreement (=0.624) and perfect intraobserver agreement (=0.828) for the modified markedly hypoechoic. Overall, the homogeneous hypoechoic nodules malignancy risk was significantly higher than heterogeneous hypoechoic nodules (40.5 vs. 33.5%, P=0.022). your institution. Thyroid Nodule Overview - Thyroid Cancer Center 4. Home Decision Support in Medicine Hospital Medicine. Patients with malignant nodules were significantly younger (P<0.001), included a smaller proportions of female patients (P<0.001), and smaller nodule size (P<0.001) than patients with benign nodules. Ha, E. J. et al. 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. However, it is not known whether or not larger nodules have a higher risk of being cancerous then smaller ones. Third, although our study demonstrated this proposed classification of echogenicity showed good reproducibility, determination of US lexicons can be still affected by interobserver variability19. All of the reviewers, who were blind to the FNA results and final diagnoses, then assessed the US features of the thyroid nodules. 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. Heterogeneously echotextured nodules echogenicity was determined by their predominant echogenicity. Eur Radiol (2023). ADS Cancers in the thyroid isthmus are more likely to spread outside of the Contemporary Thyroid Nodule Evaluation and Management | The Journal of Thyroid nodules are small circumscribed masses found in the thyroid gland. Radiology 247:762770, Remonti LR, Kramer CK, Leitao CB, Pinto LC, Gross JL (2015) Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. The result of this study confirmed the validity of the revised definition of marked hypoechogenicity by 2021K-TIRADS. Cytology plays a key part in determining the most appropriate management and follow-up of thyroid nodules. From June to September 2015, 22,775 patients underwent thyroid US at the 26 participating institutions. aDetermined by the predominant echogenicity in nodules with heterogeneous echotexture. Register now at no charge to access unlimited clinical news, full-length features, case studies, conference coverage, and more. Malignancy risk stratification of thyroid nodules according to If an ultrasound finds a hypoechoic mass, you. First, the reference standards for some benign nodules were based on one biopsy result, which may cause false-negative results. Thyroid nodules classified according to the echotexture and echogenicity. Hypoechoic nodules are darker than the surrounding thyroid tissue, which suggests that the nodules are solid rather than fluid-filled. The datasets analyzed in the current study are available from the corresponding author on reasonable request. The term "hypoechoic" refers to the way the nodule appears on an ultrasound: dark.

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