Central echogenic areas in thyroid nodules: Diagnostic performance in prediction of papillary cancer

To determine the diagnostic performance of the "central echogenic area" sonographic finding in differentiating papillary carcinomas from benign nodules and to how this finding may be used to improve fine needle aspiration(FNA) technique/utilization.

We retrospectively analyzed ultrasound guided FNAs of thyroid nodules between 1 and 3 cm for central echogenic areas. 92 patients (evenly distributed benign vs papillary carcinoma) were evaluated by a blinded reader for areas of non-shadowing homogenously echogenic centers within the nodules and correlated with FNA proven pathologic diagnosis. A selection of nodules with the central echogenic area finding were selected for further slide review to establish a pathologic basis for the finding.

Diagnostic performance of the "central echogenic area" feature in papillary thyroid cancers was 52.2% sensitive and 91.3% specific for papillary thyroid carcinoma with a PPV of 85.7% and NPV of 65.6%. There was a significant correlation with a p < 0.01 between the central echogenic area finding and papillary carcinoma. On pathologic slide review, nodules with central echogenic areas consistently demonstrated a central scar with conglomerate fibrosis and very few viable cells.

Despite its relatively low sensitivity, the central echogenic area finding is highly specific for papillary carcinoma of the thyroid and can be a useful sonographic finding in decisions regarding FNA. Additionally, due to the paucity of cells and high density of conglomerate fibrosis, central echogenic areas should be avoided during FNA to decrease the chance of an inadequate sample collection.