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Related Experiment Videos

Thyroid nodule shape suggests malignancy.

Carlo Cappelli1, Maurizio Castellano, Ilenia Pirola

  • 1Department of Medical and Surgical Sciences, Internal Medicine and Endocrinology Unit, University of Brescia, c/o 2 Medicina Spedali Civili di Brescia, Piazzale Spedali Civili no.1, 25100 Brescia, Italy. cappi.tsh@libero.it

European Journal of Endocrinology
|June 24, 2006
PubMed
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A nodule shape taller than wide (A/T > or = 1) is a strong indicator of malignancy, especially when combined with other ultrasound features. This combination improves cancer detection and reduces unnecessary fine needle aspiration cytology (FNAC) procedures.

Area of Science:

  • Endocrinology
  • Oncology
  • Radiology

Background:

  • Thyroid nodules are common, and distinguishing between benign and malignant types is crucial for appropriate management.
  • Ultrasound (US) is a primary imaging modality for evaluating thyroid nodules.

Purpose of the Study:

  • To determine if a nodule's shape, specifically being taller than wide (anteroposterior/transverse diameter ratio, A/T > or = 1), predicts malignancy independently of nodule size.
  • To identify optimal ultrasound (US) features for selecting patients for ultrasound-guided-fine needle aspiration cytology (US-FNAC).

Main Methods:

  • Retrospective analysis of cytological and histological results from 7455 nodules (5198 patients) undergoing US-FNAC.
  • Evaluation of nodule characteristics including size, microcalcifications, margins, echogenicity, vascular pattern, and A/T ratio in relation to malignancy.

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Main Results:

  • Malignant nodules were significantly more frequent with microcalcifications (72.2%), an A/T ratio > or = 1 (76%), blurred margins (52.8%), and solid hypo-echoic appearance (80.6%).
  • Nodule size was not significantly associated with extracapsular growth or lymph node metastasis.
  • An A/T ratio > or = 1 showed a high odds ratio (8.6) for malignancy.

Conclusions:

  • No single parameter, including nodule size, reliably identifies patients needing FNAC.
  • A combination of an A/T ratio > or = 1 with at least two other US features (microcalcification, blurred margins, hypo-echoic pattern) offers the best balance between detecting cancers and cost-effectiveness.