Predicting Malignancy in a Solitary Thyroid Nodule: A Prospective Study on the Role of Color Doppler Ultrasonography
01 Apr 2014-Vol. 6, Iss: 1, pp 9-14
TL;DR: A study from a hospital from Indian west coast shows that vascular flow pattern of extensive peripheral and central flow or a central flow only and a resistive index of >0.75 on power Doppler sonography shows a healthy sensitivity and excellent specificity for pre dicting malignancy.
Abstract: Palpable thyroid nodules are fairly common. While many are benign, the clinician faces the challenge of detecting the 4 to 14% of malignant lesions. Fine needle aspiration cyto logy (FNAC) of thyroid nodules seems to have eclipsed all other techniques for diagnosis of thyroid cancer, but has its limi tations when a nodule is inaccessible or in the case of folli cular neoplasm. This study from a hospital from Indian west coast shows that vascular flow pattern of extensive peripheral and central flow (Type-3) or a central flow only (Type-4) and a resistive index (RI) of >0.75 on power Doppler sonography shows a healthy sensitivity and excellent specificity for pre dicting malignancy. The utility becomes even more apparent among follicular neoplasms where FNAC can offer little help in distinguishing malignancy.
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TL;DR: Color Doppler is a valuable non-invasive method for evaluating thyroid nodules, and it is a high-sensitivity diagnostic tool for assessing thyroid nodule sensitivity and specificity and should be included in the standard clinical protocol.
Abstract: Today, the color Doppler ultrasonography is used to further evaluate suspected malignant tumors. This study investigates the malignant thyroid nodules using color Doppler. After extracting true positive, false positive, false negative, and true negative among included studies, a quality was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (with 95% confidence interval) were found using a random effect model. Summary receiver operating characteristic curves (SROC) were used to assess relationship between sensitivity and specificity. The area under the curve of the SROC was calculated to estimate the performance of color Doppler ultrasound to distinguish malignant thyroid nodules. Our registration code in PROSPERO is CRD42018111198. Of 1125 articles, 288 articles were selected for the further investigation. After excluding irrelevant and poor articles, 20 studies were included for the meta-analysis. According to a random effect model, the pooled sensitivity and specificity of color Doppler ultrasound to distinguish malignant thyroid nodules were estimated as 0.74 (95% CI 0.62–0.83; $$ I^{2} = 89.94\% $$) and 0.70 (95% CI 0.56–0.81; $$ I^{2} = 97.79\% $$), respectively. The SROC curve consists of representing the paired results for sensitivity and specificity. According to SROC, AUC = 0.78 (95% CI 0.74–0.81) is between 0.75 and 0.92, so that color Doppler ultrasound has a good accuracy. Color Doppler is a valuable non-invasive method for evaluating thyroid nodules, and it is a high-sensitivity diagnostic tool for assessing thyroid nodules. Resistive index > 0.75 and a pattern III or more in color Doppler predicts malignant with the confidence. Due to its precision, cost-efficiency, easy access, and non-invasive nature, color Doppler should be included in the standard clinical protocol for the decision-making period and the treatment evaluation.
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TL;DR: Thyroid nodules are common, with up to 8% of the adult population having palpable nodules, and surgery followed by radioactive iodine ablation is the mainstay of treatment for differentiated thyroid cancers, and the majority of patients can expect high cure rates.
Abstract: Thyroid nodules are common, with up to 8% of the adult population having palpable nodules. With the use of ultrasound, up to 10 times more nodules are likely to be detected. Increasing numbers of nodules are being detected serendipitously because of the rising use of imaging to investigate unrelated conditions. The primary aim in investigating a thyroid nodule is to exclude the possibility of malignancy, which occurs in about 5% of nodules. This begins with a thorough history, including previous exposure to radiation and any family history of thyroid cancer or other endocrine diseases. Clinical examination of the neck should focus on the thyroid nodule and the gland itself, but also the presence of any cervical lymphadenopathy. Biochemical assessment of the thyroid needs to be followed by thyroid ultrasound, which may demonstrate features that are associated with a higher chance of the nodule being malignant. Fine-needle aspiration biopsy is crucial in the investigation of a thyroid nodule. It provides highly accurate cytologic information about the nodule from which a definitive management plan can be formulated. The challenge remains in the management of nodules that fall under the "indeterminate" category. These may be subject to more surgical intervention than is required because histological examination is the only way in which a malignancy can be excluded. Surgery followed by radioactive iodine ablation is the mainstay of treatment for differentiated thyroid cancers, and the majority of patients can expect high cure rates.
476 citations
TL;DR: The objective of this study was to determine whether the routine use of ultrasonography in all patients with suspected thyroid nodules changed clinical management compared with palpation alone.
Abstract: Ultrasonography altered clinical management for 63% of patients referred to a thyroid nodule clinic after abnormal results on thyroid physical examination. The results suggest that routine thyroid ...
382 citations
TL;DR: The color characteristics of a thyroid nodule, however, cannot be used to exclude malignancy, because 14% of solid nonhypervascular nodules were malignant, and solid hypervascular thyroid nodules have a high likelihood of malignancies.
Abstract: Objective. To determine whether color Doppler interrogation of a thyroid nodule can aid in the prediction of malignancy. Methods. We obtained color Doppler images of thyroid nodules undergoing sonographically guided fine-needle aspiration. The color Doppler appearance of each nodule was graded from 0 for no visible flow through 4 for extensive internal flow. The size, sonographic appearance, results of fine-needle aspiration, and surgical pathologic findings, if available, were recorded for each nodule. Results. There were 254 nodules sampled, of which 32 were malignant (all confirmed at surgery) and 177 were benign. Fourteen (43.8%) of the 32 malignant nodules were color type 4, compared with only 26 (14.7%) of the 177 benign nodules (P = .0004, Fisher exact test). Thirteen (40.1%) of the 32 malignant nodules were solid, as were 18 (10.2%) of the 177 benign nodules (P = .006, Fisher exact test). Among solid nodules, the prevalence of malignancy was greater when the nodule was hypervascular (13 [41.9%] of 31) than when the color type was less than 4 (11 [14.7%] of 77; P = .004, Fisher exact test). Condusions. Solid hypervascular thyroid nodules have a high likelihood of malignancy (nearly 42% in our series). The color characteristics of a thyroid nodule, however, cannot be used to exclude malignancy, because 14% of solid nonhypervascular nodules were malignant.
301 citations
292 citations
TL;DR: Specific FNB tissue diagnoses provide the best guidelines for management decisions on when to operate and what operation to perform, however, each institution must generate its own FNB statistics.
Abstract: FNB can be as good as you make it, and vice versa. Most worrisome to physicians and patients is the false negative diagnosis. The stringent criterion that I have advised for adequate sampling to exclude cancer can reduce the potential for false negative diagnoses to about 1%. Specific FNB tissue diagnoses provide the best guidelines for management decisions on when to operate and what operation to perform. However, each institution must generate its own FNB statistics. Management of follicular neoplasms requires integration of FNB findings with clinical features that relate to the probability of cancer and the risks thereof as well as the risks of operation. When FNB provides inadequate numbers of benign-appearing cells to exclude malignancy, unless there are compelling clinical features suggesting cancer, it may be suitable to observe as long as the course and subsequent FNBs fail to suggest cancer.
185 citations