Surgeon-Performed Ultrasonographic Evaluation and Predication for Large Thyroid Nodules-A Case-Control Study.
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
29
01
2019
revised:
26
05
2019
accepted:
10
06
2019
pubmed:
4
8
2019
medline:
23
2
2020
entrez:
4
8
2019
Statut:
ppublish
Résumé
The management of large thyroid nodules remains unclear. Ultrasonography is a central tool in the assessment of thyroid nodules, yet its role in risk stratification of large thyroid nodules has been studied only seldomly. The aim of this study was to determine the utility of ultrasonography in characterizing and risk-stratifying thyroid nodules ≥3.0 cm. We performed a retrospective, case-control study of all thyroid nodules aspirated between January 2010 and May 2014. Sonographic features of nodules ≥3.0 cm were compared with nodules <3.0 cm. All nodules were assessed by a single high-volume thyroid surgeon. Data collected included size (cm), texture, echogenicity, shape, calcifications, border, spongiform appearance, and vascularity. A total of 537 nodules were included in the study, with 137 nodules (25.5%) ≥3.0 cm comprising the study group, and 400 nodules (74.5%) as the control group. No differences were found between the 2 groups regarding age, sex, and risk factors. Nodules ≥3.0 cm were associated with an increased risk for malignancy (odds ratio 2.41 [1.08-5.38]). Microcalcifications (26.3% vs 17.5%, P = .039), hypoechogenicity (40.8% vs 23.4%, P < .001), and irregular borders (14.3% vs 3.6%, P = .001) were more prevalent in nodules <3.0 cm. Among the large nodules, hypoechogenicity (50% vs 22.8%, P = .043) and irregular margins (28.6% vs 0%, P < .001) were associated with malignancy. The specificity of irregular borders was greater in nodules ≥3.0 cm (100% vs 89.6%, P = .011). Sonographic appearances of large nodules differ from those of smaller nodules. Hypoechogenicity and irregular borders were associated with malignancy and should direct management towards a more aggressive policy of fine needle aspiration and consideration of operative resections in large thyroid nodules.
Sections du résumé
BACKGROUND
The management of large thyroid nodules remains unclear. Ultrasonography is a central tool in the assessment of thyroid nodules, yet its role in risk stratification of large thyroid nodules has been studied only seldomly.
OBJECTIVE
The aim of this study was to determine the utility of ultrasonography in characterizing and risk-stratifying thyroid nodules ≥3.0 cm.
METHODS
We performed a retrospective, case-control study of all thyroid nodules aspirated between January 2010 and May 2014. Sonographic features of nodules ≥3.0 cm were compared with nodules <3.0 cm. All nodules were assessed by a single high-volume thyroid surgeon. Data collected included size (cm), texture, echogenicity, shape, calcifications, border, spongiform appearance, and vascularity.
RESULTS
A total of 537 nodules were included in the study, with 137 nodules (25.5%) ≥3.0 cm comprising the study group, and 400 nodules (74.5%) as the control group. No differences were found between the 2 groups regarding age, sex, and risk factors. Nodules ≥3.0 cm were associated with an increased risk for malignancy (odds ratio 2.41 [1.08-5.38]). Microcalcifications (26.3% vs 17.5%, P = .039), hypoechogenicity (40.8% vs 23.4%, P < .001), and irregular borders (14.3% vs 3.6%, P = .001) were more prevalent in nodules <3.0 cm. Among the large nodules, hypoechogenicity (50% vs 22.8%, P = .043) and irregular margins (28.6% vs 0%, P < .001) were associated with malignancy. The specificity of irregular borders was greater in nodules ≥3.0 cm (100% vs 89.6%, P = .011).
CONCLUSION
Sonographic appearances of large nodules differ from those of smaller nodules. Hypoechogenicity and irregular borders were associated with malignancy and should direct management towards a more aggressive policy of fine needle aspiration and consideration of operative resections in large thyroid nodules.
Identifiants
pubmed: 31375320
pii: S0039-6060(19)30350-2
doi: 10.1016/j.surg.2019.06.011
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1148-1153Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.