Precision Medicine with 3D Ultrasound

Area of Science:

• Radiology
• Endocrinology
• Medical Imaging

Background:

• Thyroid nodules (TNs) are common, and accurate diagnosis is crucial for appropriate management.
• Conventional 2D ultrasound (US) has limitations in fully characterizing TNs, potentially affecting fine needle aspiration biopsy (FNAB) decisions.
• Distinguishing benign from malignant TNs often relies on subtle imaging features.

Purpose of the Study:

• To evaluate the utility of 3D US in enhancing the characterization of TNs compared to 2D US.
• To determine if 3D US improves the selection criteria for FNAB in cases of indeterminate nodules.
• To highlight the role of advanced imaging in diagnosing thyroid malignancy.

Main Methods:

• A case study involving a 56-year-old woman with a thyroid nodule detected on carotid ultrasonography.
• Comparison of conventional 2D US with advanced 3D US for visualizing TN characteristics, particularly margins.
• Fine needle aspiration biopsy (FNAB) guided by US, followed by molecular testing and surgical pathology for definitive diagnosis.

Main Results:

• 3D US revealed markedly irregular margins of the TN, which were less apparent on 2D US.
• Despite the nodule not meeting standard size criteria for FNAB, its irregular margins on 3D US prompted the procedure.
• Cytopathology indicated a follicular neoplasm (Bethesda category IV), and molecular testing showed an NRAS mutation (50% malignancy risk).
• Final surgical pathology confirmed a 12-mm follicular carcinoma.

Conclusions:

• 3D US provides superior visualization of TN margin irregularities compared to 2D US.
• The enhanced visualization offered by 3D US can improve nodule selection for FNAB, potentially leading to earlier diagnosis of malignancy.
• Advanced imaging techniques like 3D US are valuable adjuncts in the evaluation of thyroid nodules.