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Updated: Jun 25, 2025

Author Spotlight: Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis

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Published on: February 9, 2024

Challenges in Risk Stratification of Solid Atypical Mixed Echogenicity Thyroid Nodules.

Evana Valenzuela-Scheker¹, David N Bimston¹, Hubert Golingan²

¹Department of Endocrine Surgery, Memorial Healthcare System, Hollywood, FL, USA.

Touchreviews in Endocrinology

|May 30, 2024

Summary

Solid atypical mixed echogenicity nodules (SAMENs) not classified by the 2015 ATA USRSS system have a high risk of malignancy (31%). These nodules, often presenting with microcalcifications or suspicious margins, warrant careful evaluation due to their concerning features.

Keywords:

Papillary thyroid cancer risk stratification solid atypical mixed echogenicity thyroid nodules thyroid neoplasms thyroid nodule ultrasound

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Published on: October 11, 2022

Area of Science:

Endocrinology
Radiology
Oncology
Pathology

Background:

The 2015 American Thyroid Association Ultrasound Risk Stratification System (ATA USRSS) classifies thyroid nodules (TNs) but may not categorize all solid atypical mixed echogenicity nodules (SAMENs).
Understanding the risk of malignancy (ROM) in these unclassifiable nodules is crucial for appropriate patient management.

Purpose of the Study:

To determine the prevalence and ROM of SAMENs that are not classifiable by the 2015 ATA USRSS.
To identify sonographic characteristics associated with malignancy in these unclassifiable nodules.
To compare the ROM of SAMENs to established ATA risk groups.

Main Methods:

Retrospective analysis of a prospectively collected endocrine surgery TN database.
Identification of solid nodules not classifiable by the 2015 ATA USRSS.
Categorization of these nodules using the 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and analysis of fine needle aspiration biopsy (FNAB) and surgical pathology results.

Main Results:

150 solid nodules were not classifiable by the 2015 ATA USRSS, all exhibiting atypical features (SAMENs).
The overall ROM for SAMENs was 31% (40 malignant by histology, 6 likely malignant by cytology).
The most common sonographic pattern in malignant SAMENs was an isoechoic solid component with microcalcifications (70%); 50% had follicular and 48% had papillary architecture.

Conclusions:

SAMENs with suspicious sonographic features (microcalcifications, irregular margins) have a significantly higher ROM (31%) compared to the 2015 ATA USRSS intermediate-risk group (10-20%).
These findings highlight the need for careful evaluation and potential further investigation of SAMENs that fall outside standard classification systems.