Should we reconsider high-risk features in thyroid ultrasonography?

Area of Science:

• Endocrinology
• Radiology
• Oncology

Background:

• Current thyroid nodule guidelines suggest round shapes reduce malignancy risk.
• However, some studies indicate a higher risk of malignancy in spherical thyroid nodules.

Purpose of the Study:

• To evaluate the malignancy risk of solid, round, isoechoic thyroid nodules.
• To compare this risk with solid, ovoid, isoechoic nodules using thyroid ultrasonography.

Main Methods:

• Retrospective analysis of 457 solitary solid isoechoic nodules (2017-2022).
• Nodules measured 10-25 mm in diameter.
• Data collected included patient demographics, nodule characteristics, and cytopathological/histopathological results.

Main Results:

• Of 457 nodules, 203 were round and 254 were ovoid.
• 31 malignancies were detected among 54 surgical operations.
• Round nodules accounted for 25 malignancies, while ovoid nodules accounted for 6 (p<0.025).

Conclusions:

• Solid, round, isoechoic thyroid nodules exhibit higher malignancy rates compared to ovoid ones.
• Nodule sphericity should be considered as a parameter in risk stratification and biopsy decisions.
• Ultrasonographic risk stratification systems may benefit from incorporating nodule shape.