The utility of thyroid ultrasonography in the management of thyroid nodules

• Published in: Canadian Journal of Surgery Vol. 60; no. 2; pp. 134 - 139
• Main Authors: Gamme, Gary, MD, Williams, David C., MD, McMullen, Todd P.W., MD, PhD, Wiebe, Edward, MD, Ghosh, Sunita, PhD, Litt, Brendan, MD, Parrington, Tyler, MD
• Format: Journal Article
• Language: English
• Published: Canada Joule Inc 01-04-2017; CMA Impact, Inc
• Subjects: Accuracy; Adult; Aged; Care and treatment; Development and progression; Family medical history; Female; Humans; Lymphoma; Male; Medical referrals; Methods; Middle Aged; Pathology; Patients; Retrospective Studies; Sensitivity and Specificity; Studies; Surgery; Thyroid cancer; Thyroid Nodule - diagnostic imaging; Thyroid Nodule - surgery; Thyroidectomy; Ultrasonography - standards; Ultrasound imaging; Variables
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.010316

Background Ultrasonography for thyroid nodules is one of the most common imaging tests performed in the general population. Details from ultrasound reports guide biopsies and surgery. This study quantifies the completeness of these reports based on Thyroid Imaging and Reporting System (TI-RADS) criteria and considers their utility in predicting malignant disease. Methods We retrospectively reviewed ultrasound reports for 329 thyroidectomy patients and extracted data elements using the TI-RADS criteria: nodule size, echogenicity, margins, vascularity, solid/cystic composition and the presence or absence of microcalcifications and the halo sign. We assessed the reports to determine whether individual or multiple criteria were associated with malignancy. Results More than 97% of reports document nodule size; however, more than 90% of the reports noted only 3 or fewer of the 6 remaining TI-RADS criteria. The presence of microcalcifications was the most sensitive marker of malignancy (> 90%), whereas the documentation of irregular margins was the most specific indicator of malignancy (88%). Overall it was clear that microcalcifications, hypoechogenicity, irregular margins and solid nodules were significantly more likely to be found in malignant neoplasms; their absence predicted benign disease. Because so few reports consistently documented all criteria, the overall ability of thyroid ultrasonography to discriminate between lower-and higher-risk nodules is limited. Conclusion Although the accuracy of thyroid ultrasonography is good, few ultrasound reports contain the necessary information, as defined by TI-RADS, to predict malignancy and guide management. When reported, microcalcifications and/or irregular margins are the best predictors of malignancy.