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Sonographic features of benign thyroid nodules: interobserver reliability and overlap with malignancy
Jeffrey R Wienke1, Wui K Chong, Julia R Fielding
1Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
Summary
Thyroid nodule ultrasound findings often mimic malignancy, with many benign nodules exhibiting suspicious characteristics. Interobserver reliability for these sonographic features is generally good to very good.
Area of Science:
- Radiology
- Endocrinology
- Oncology
Background:
- Thyroid nodules are common, and distinguishing benign from malignant ones is crucial.
- Sonography is a primary imaging modality for thyroid nodules.
- Certain sonographic features are traditionally associated with thyroid malignancy.
Purpose of the Study:
- To prospectively identify sonographic characteristics of benign thyroid nodular hyperplasia.
- To compare these findings with sonographic features indicative of malignancy.
- To evaluate the interobserver reliability of these sonographic assessments.
Main Methods:
- Prospective sonographic scanning of 70 thyroid nodules.
- Fine-needle cytologic analysis (FNAC) following sonographically guided biopsy.
- Review of sonographic images by two independent radiologists, assessing malignancy-associated findings.
- Statistical analysis of interobserver agreement using kappa statistics and Fisher exact test.
Main Results:
- Out of 70 nodules, 68 were benign and 2 were malignant.
- Benign nodules frequently displayed features associated with malignancy (69%).
- Common sonographic findings in benign nodules included solid composition (60%), hypoechogenicity (54%), lobulation (59%), central vascularity (47%), and calcifications (24%).
- High interobserver reliability was observed for calcifications (kappa=0.91) and vascularity (kappa=0.75).
Conclusions:
- Many benign thyroid nodules exhibit sonographic features previously considered indicative of malignancy.
- Sonographic assessment of thyroid nodules requires careful interpretation due to overlapping features.
- Interobserver agreement for key sonographic findings is reliable, supporting consistent diagnostic application.