Related Experiment Video
Updated: Jun 25, 2025
05:41
Author Spotlight: Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis
Published on: February 9, 2024
583
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.
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.
