Abstract
Background: Nodular thyroid disease is detected in 3–7% of the adult population worldwide. Thyroid cancer is rare and accounts for <1% of all malignant neoplasms. The high prevalence of thyroid nodules in the general population calls for a clear strategy to identify patients in whom surgical excision is genuinely indicated as opposed to those who can be managed conservatively.
Materials: The study was carried out on 102 patients. Patients were examined in supine position with pillow underneath the shoulders to slightly extend the neck. GE LOGIQ P5 Ultrasound, SIEMENS ACUSON X300 were used for examination. On Gray Scale, each nodule was assessed for margins, Peripheral halo, echogenicity, composition, calcification, shape, and Lymph nodes were assessed for the loss of fatty hilum. All nodules were examined by Color Doppler to describe the vascular patterns. Each ultrasound diagnosis was matched with the histopathology/FNAC results and labelled as True Positive, True Negative, False Positive and False Negative. The pathology result was considered as the final diagnosis
Results: Of the 102 nodules examined, 9 were found to be malignant on pathology. Nodular thyroid disease was more common in female population as compared to male population. The malignant nodules demonstrated solid composition (sensitivity 100%, specificity 64.5%); presence of microcalcification (sensitivity 33.3%, specificity 95.7%); ill defined margins (sensitivity 33.3%, specificity 89.4%); loss of central hilum in lymph nodes(sensitivity 77.8%, specificity 71.4%) and markedly hypoechoic character (sensitivity 77.8%, specificity 95.6%). The sensitivity and specificity of Intranodular vascularity as a predictor for malignancy was 66.6% and 72.0 %.
Conclusion: Since Gray scale and Colour Doppler have their own strengths and weaknesses, they are complementary rather than competitive modalities in diagnosing benign from malignant thyroid nodules. Combinations of Gray Scale, Color Doppler improve the detection of malignancy in thyroid nodules.
Keywords: thyroid, FNAC, Ultrasound, Nodule.
References
- Bonavita JA, Mayo J, Babb J, Bennet G, Oweity T, Macari M et al.; Pattern recognition of benign nodules at ultrasound of the thyroid: Which nodules can be left alone? Neuroradiology/Head and Neck Imaging Original Research, 2009; 193(1): 207-213.
- Moon WJ, Baek JH, Jung SL, Kim DW, Kim EK, Kim JY, et al. Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean J Radiol. 2011;12:1-14.
- Moon HJ, Kwak JY, Kim MJ, Son EJ, Kim EK. Can vascularity at power Doppler US help predict thyroid malignancy? Radiology. 2010;255:260-9.
- Roti E, degliUberti EC, Bondanelli M, Braverman LE. Thyroid papillary microcarcinoma: a descriptive and meta-analysis study. Eur J Endocrinol. 2008;159:659–73.
- Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295:2164–7. doi:10.1001/jama.295.18.2164.
- Jonklaas J, Sarlis NJ, Litofsky D, et al. Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid. 2006;16:1229–42.
- Lyshchik A, Drozd V, Demidchik Y, Reiners C. Diagnosis of thyroid cancer in children: value of gray-scale and power doppler US. Radiology [Internet]. 2005 May;235(2):604–13. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/ 15770036
- Kim JY, Lee CH, Kim SY, Jeon WK, Kang JH, An SK, et al. Radiologic and pathologic findings of nonpalpable thyroid carcinomas detected by ultrasonography in a medical screening center. Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine [Internet]. 2008 Feb;27(2):215–23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18204012
- Popli MB, Rastogi A, Bhalla P, Solanki Y. Utility of gray-scale ultrasound to differentiate benign from malignant thyroid nodules. The Indian Journal of Radiology & Imaging. 2012;22(1):63-68.
- Weslley RP, Lemos da Silva A, Ribeiro Borges MA, Regina CM. Is Doppler ultrasound of additional value to gray-scale ultrasound in differentiating malignant and benign thyroid nodules?. Arch. Endocrinol. Metab. [Internet]. 2015 Feb; 59( 1 ): 79-83.
- Kim SY, Kim EK, Moon HJ, Yoon JH, Kwak JY. Application of Texture Analysis in the Differential Diagnosis of Benign and Malignant Thyroid Nodules: Comparison With Gray-Scale Ultrasound and Elastography. AJR Am J Roentgenol. 2015 Sep;205(3):W343-51.
- Avinash B, Ahmed N, Sreedevi T, Swapna Ch, Latha RM, Babu J. Role of Ultrasonography to Differentiate Benign and Malignant Thyroid Nodules in Correlation with Fine-needle Aspiration Cytology. Int J Sci Stud 2016;4(5): 81-87.
- Palaniappan MK, Aiyappan SK, Ranga U. Role of Gray Scale, Color Doppler and Spectral Doppler in Differentiation Between Malignant and Benign Thyroid Nodules. Journal of Clinical and Diagnostic Research : JCDR. 2016;10(8): TC01-TC06.
- Jena A, Patnayak R, Prakash J, Sachan A, Suresh V, Lakshmi AY. Malignancy in solitary thyroid nodule: A clinicoradiopathological evaluation. Indian J Endocrinol Metab. 2015;19(4):498-503.
- Dhanadia A, Shah H, Dave A. Ultrasonographic and FNAC correlation of thyroid lesions. Gujarat Medical Journal. 2014, Vol. 69 No. 1
- Singh D, Makwana M, Verma GL, Lal K. Evaluation of thyroid nodules by Gray scale and Doppler sonography and correlation with fine needle aspiration cytology. IntSurg J 2017;4:2197-204.
- Solbiati L, Volterrani L, Rizzatto G. The thyroid gland with low uptake lesions: Evaluation by ultrasound. Radiol. 1985;155:187-91.
- Gorman B, Charboneau JW, James EM. Medullary thyroid carcinoma. Role of high resolution ultrasound. Radiol. 1987;162: 147-50.
- Wunderbaldinger P, Harisinghani MG, Hahn PF. Cystic lymph node Metastases in papillary thyroid carcinoma. AJR Am J Roentgenol. 2002;178:693-7.
- Yeh HC, Futterweit W. Gilbert P. Micro nodulation: Ultrasonographic sign of Hashimoto’s thyroiditis. J Ultrasound Med. 1996;15:813-9.
Corresponding Author
Dhruv Aggarwal
Department of Radiodiagnosis, Krishna Institute of Medical Sciences,
Karad, Maharashtra, India-415110
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Phone No- + 91 7057803035
DOI: https://dx.doi.org/10.18535/jmscr/v5i12.135
