thyroid nodule wider than tall cancer

The aim of this study was to estimate the impact of this definition on diagnostic performance. FNA, fine-needle aspiration; TSH, thyroid-stimulating hormone. Thyroid nodules size and prediction of cancer. In several studies, the main suspicious features indicating thyroid malignancy were found to have different diagnostic power among different cohorts, as demonstrated from the ORs in multivariate analysis (17,20,21). PMC Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, Panunzi C, Rinaldi R, Toscano V, Pacella CM. Finally, the visual assessment of TTW shape is commonly used in clinical practice: this study is not able to compare the performance of a quantitative evaluation to a qualitative one. High-resolution ultrasonography (US) is commonly used to evaluate the thyroid gland, but US is frequently misperceived as unhelpful for identifying features that distinguish benign from malignant nodules. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegeds L, et al.AACE/ACE/AME Task Force on Thyroid Nodules American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update. Thyroid nodules are increasingly encountered in general practice because of the widespread use of imaging. International patterns and trends in thyroid cancer incidence 1973-2002. The nodule in (b) is taller than wide. Hong MJ, Lee YH, Kim JH, Na DG, You SH, Shin JE, Kim SK, Yang KS; Korean Society of Thyroid Radiology. proposed a cut-off point of 6 cm where the incidence of carcinoma decreases with increasing size of thyroid nodules (26). 2022 Sep 13;2022:5056082. doi: 10.1155/2022/5056082. Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, Kim J, Kim HS, Byun JS, Lee DH Benign, malignant thyroid nodules. The likelihood that a nodule is malignant is indicated by the risk class it is assigned to on the basis of multiple sonographically defined features. They can travel through soft tissue and fluids, but they bounce back off of denser structures, such as bone. Nodules that are detected during pregnancy should be assessed on the basis of serum TSH levels. and transmitted securely. Methods: Larger or aggressive cancerous nodules require removal of the whole thyroid and sometimes subsequent radioactive iodine . With the exception of benign cytology, all other results should be referred to an endocrinologist or thyroid surgeon for further assessment. Large (3cm) thyroid nodules with benign cytology: Can Thyroid Imaging Reporting and Data System (TIRADS) help predict false-negative cytology? Currently available sonographic risk stratification systems for thyroid nodules were developed to more accurately identify those for which fine-needle aspiration cytology (FNAC) can safely be deferred [1, 2, 3, 4, 5]. PLUS one or more of the following: Irregular margins (infiltrative, microlobulated), Rim calcifications with small extrusive soft tissue component, FNA is a valuable tool in the assessment of benign and malignant nodules and has reduced the need for unnecessary thyroidectomies. The strong negative correlation between thyroid nodule size and the taller-than-wide shape (potential malignancy) needs additional studies including more larger nodules. Usefulness of ultrasonography in the management of nodular thyroid disease. Dry skin. This category only includes cookies that ensures basic functionalities and security features of the website. The THANC Foundation is a 501(c)(3) charitable organization. Join Hank the Monkey with his friends as they learn about cancer and how they cope with it. In conclusion, adopting an arbitrary definition of TTW as an AP/T diameter ratio 1.2 would reduce the number of indicated biopsies according to five widely used sonographic risk stratification systems and improve specificity without negatively influencing overall diagnostic performance. Management guidelines for both thyroid nodules and thyroid cancer have been published and updated by a number of societies internationally. The Cancer Basics section reveals things like how a diagnosis is reached, what treatments are available and what happens if there's a recurrence. McNemar chi2 test revisited: comparing sensitivity and specificity of diagnostic examinations. Background/aim: Previous studies have shown that there may be a diversity in the ultrasonographic (US) features discriminating a malignant from a benign thyroid nodule. Wang Y, Nie F, Liu T, Yang D, Li Q, Li J, Song A. ScoreLevelInterpretationSuggested Action0 pointsTIRADS 1Benignno FNA2 pointsTIRADS 2Not suspiciousno FNA3 pointsTIRADS 3Mildly suspiciousFNA if > 2.5 cm Follow if > 1.546 pointsTIRADS 4Moderately suspicious FNA if > 1.5 Follow if > 1 7 pointsTIRADS 5Highly suspiciousFNA if > 1 cm Follow if > 0.5. Predictive Value of Malignancy of Thyroid Nodule Ultrasound Classification Systems: A Prospective Study. Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. Marqusee E, Benson CB, Frater MC, Doubilet PM, Larsen PR, Cibas ES, Mandel SJ. 8600 Rockville Pike 2009; 94:1748-1751. doi: 10.1210/jc.2008-1724. Orientation of the ultrasound probe to identify the taller-than-wide sign of thyroid malignancy: a registry-based study with the Thyroid Imaging Network of Korea. If concern arises about the possibility of cancer, the doctor may simply recommend monitoring the nodule over time to see if it grows. This probe is responsible for producing the sound waves and taking pictures. Result: General Significance of ultrasound features in predicting malignant solid thyroid nodules: need for fine-needle aspiration. The nodule should be assessed for size, consistency and mobility. While the majority of patients will be euthyroid, a suppressed TSH level indicates a hyperfunctioning nodule, which t, if confirmed, has an exceedingly small risk of malignancy.1 Further evaluation of a patient with suppressed TSH levels is best managed by an endocrinologist. For the purposes of this study, nodules that could not be classified according to the ATA Guidelines (e.g., isoechoic nodules with other suspicious features such as microcalcification, irregular margins, and TTW shape) were considered intermediate-suspicion nodules. The other 3 nodules had cytological diagnoses of malignancy (TIR5, n = 1) or suspected malignancy (TIR4, n = 2) and were managed with active surveillance following patient preferences. In cases of indeterminate cytology, because of the increased risk of malignancy, referral to a thyroid surgeon for hemi-thyroidectomy is recommended over a repeated FNA.8,9. Feel free to download and print this page. Yeh MW, Demicran O, Ituarte P, Clark OH. All patients who are suspected of having a thyroid nodule or nodular goitre or in whom a nodule has been incidentally detected on another imaging modality should be referred for ultrasonography of the neck and thyroid. In nodules with echogenic foci, the taller than wide shape (p = 0.026), spiculated margin (p < 0.001), marked . Cappelli C, Castellano M, Pirola I, Gandossi E, De Martino E, Cumetti D, Agosti B, Rosei EA. The positive likelihood ratio was 1.61 (95% CI 0.932.78), the negative likelihood ratio was 0.88 (95% CI 0.7331.06), and the diagnostic odds ratio was 1.83 (95% CI 0.883.78). We included patients with a nodular goiter who underwent routine preoperative US followed by total thyroidectomy between January 2012 and December 2017. MeSH Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. They are discovered either clinically or using sensitive imaging techniques (3). As a library, NLM provides access to scientific literature. doi: 10.1089/thy.2012.0005. Federal government websites often end in .gov or .mil. Australian ajgp@racgp.org.au, Differentiating between benign and malignant thyroid nodules. Fig. However, none of the thyroid nodules in either the training or validation . Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, et al.Korean Society of Thyroid Radiology (KSThR) and Korean Society of Radiology Ultrasonography Diagnosis and Imaging-Based Management of Thyroid Nodules: Revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Regarding multinodular lesions, only nodules more than 6 mm were finally evaluated. This study was conducted with institutional review board approval and written informed patient consent. Ha EJ, Moon WJ, Na DG, Lee YH, Choi N, Kim SJ, et al. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, Orcutt J, Moore FD Jr, Larsen PR, Marqusee E, Alexander EK. The main challenge in the clinical management of thyroid nodules nowadays is to avoid overdiagnosis in patients with benign nodules (or low-risk disease) while promptly identifying those patients with clinically relevant malignancies: the reduction in the number of biopsies is a desirable goal, particularly because, applying sonographic risk-assessment systems, sensitivity is not significantly reduced (and the number of malignancy that would be missed is overall low, Table Table2).2). A little inspiration can go far. Statistical analysis. As a result, the term TTW can potentially be applied to nodules whose AP and T diameters differ by only a few millimeters. Ultrasounds cannot be used to image any areas hidden behind bone (such as inside the head) because the sound waves cannot travel through bone. Grey-Scale Analysis Improves the Ultrasonographic Evaluation of Thyroid Nodules. Proposal of the SIAPEC-IAP Italian Consensus Working Group Cytological classification of thyroid nodules. Research studies and new treatments available. This proposed definition had an impact on the number of indicated biopsies and the diagnostic accuracy of the sonographic risk stratification systems, significantly increasing the number of deferrable biopsies for all classifications (up to 58.2% of the nodules would avoid FNA indication according to ACR TIRADS), as reported in Table Table2.2. Use the tools and advice inside and adapt them for your family. The site is secure. Many are incidentally detected on imaging tests while examining for unrelated conditions. Results: We evaluated 254 thyroid nodules (malignant, n=131) from 205 patients. Serum TSH, ultrasonography and FNA remain the initial investigations in general practice, with radionuclide scans reserved for patients with low TSH. (20) and Moon et al. G.G., L.L., V.R., and R.F. Huang K, Gao N, Zhai Q, Bian D, Wang D, Wang X. Keywords: Thyroid; malignancy; microcalcifications; nodule . Tan GH, Gharib H. Thyroid incidentalomas: Management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. (21) found that microcalcifications were a stronger predictor of papillary carcinoma among other US features, following by nodule shape. Methods Let us know if you'd like us to cover more on a particular topic. However, since the sound waves cannot travel through bone, ultrasounds are not used for imaging of structures located deep in the chest, face, or head. Size [odds ratio (OR)=0.93, 95% confidence interval (CI)=0.89-0.98; p=0.002], taller-than-wide shape (OR=25.3; 95% CI=5.4-118.9; p<0.001), microcalcifications (OR=4.9, 95% CI=2.5-9.5; p<0.001), hypoechogenicity (OR=4.5, 95% CI=2-10.3; p<0.001) of thyroid nodules were the only variables independently associated with thyroid malignancy (Table II). However, the combination of several of these features increases the risk of malignancy of a thyroid nodule. Echogenic foci refer to the presence of bright spots within the thyroid nodule, which can be seen on ultrasound. 2023 Apr 19. doi: 10.1007/s00117-023-01137-4. K.D.P: study concept and design, data analysis and interpretation, statistical analysis and article writing; H.J.K: study concept design, data analysis and interpretation and critical revision of the article; C.C.E., I.A.I., K.S.M., N.I.K. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. Women are three times more likely to develop thyroid cancer than men. Liu J, Zheng D, Liq Q, Tang X, Luo Z, Yuan Z, Gao L, Zhao J. Our blog addresses the unique hurdles each person faces. A taller-than-wide (TTW) shape is a suspicious feature of thyroid nodules commonly defined as an anteroposterior/transverse diameter (AP/T) ratio >1. The cookie is used to store information of how visitors use a website and helps in creating an analytics report of how the website is doing. Na DG, Baek JH, Sung JY, Kim JH, Kim JK, Choi YJ, Seo H. Thyroid reporting and data system risk stratification of thyroid nodules: Categorization based on solidity and echogenicity. When considering only technically satisfactory specimens, the diagnostic accuracy of FNA when performed by an experienced operator is approximately 95%, although this figure is dependent on how each cytology category is used in the calculation4 The decision to perform FNA of a nodule depends on the sonographic pattern and size (Figure1, Table 2). 1 They are palpable in 4-7% of the population and have been detected using ultrasonography in up to 67% of adults. reported an OR for malignant nodules of 8.6 for those with taller-than-wide shape (17). There are 4 variants of papillary thyroid cancer: classic, follicular, tall-cell and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). In two meta-analyses [7, 8], the thyroid nodule feature with the highest odds ratio for malignancy was a taller-than-wide (TTW) shape also referred to as non-parallel orientation although the results across the studies included in the analysis were quite heterogeneous. For nodules classified as benign, the diagnoses were cytological: thus, false-negative cases are possible, with a false-negativity rate of 3.7% reported in this setting [35]. We also calculated the areas under the receiver-operating characteristic (AUROC) curve that were compared using the DeLong approach [21], utilizing the easyROC package [22]. A composite reference standard was applied. Diagnostic performance of artificial intelligence-based computer-aided diagnosis system in longitudinal and transverse ultrasonic views for differentiating thyroid nodules. They are usually harmless but, in some cases, they may be a sign of thyroid cancer. Mendes GF, Garcia MR, Falsarella PM, Rahal A, Cavalcante Junior FA, Nery DR, et al. Bethesda, MD 20894, Web Policies The site is secure. Fadda G, Basolo F, Bondi A, Bussolati G, Crescenzi A, Nappi O, et al.SIAPEC-IAP Italian Consensus Working Group. Study on diagnosis of thyroid nodules based on convolutional neural network. Eun NL, Yoo MR, Gweon HM, Park AY, Kim JA, Youk JH, Moon HJ, Chang HS, Son EJ. Disclaimer. A study directly comparing the results of the two types of scintiscans showed a high degree of correlation, particularly when differentiating between hot and cold nodules.3 In general practice, radionuclide scans should not be routinely ordered to evaluate thyroid nodules unless indicated by a low TSH result, and 99mTc should be the imaging modality of choice. The incidence of paediatric thyroid nodules that are palpable is approximately 1.85.1% with the use of ultrasonography.8 However, in a review of 1134 children, the overall malignancy rate was 26%, compared with 510% in adults.8 The ATA guidelines suggest paediatric nodules should be evaluated in a similar manner to those in adults, with some important exceptions. This cookie is installed by Google Analytics. The purpose of this study was to evaluate whether a nodule with a taller-than-wide shape (ie, an anteroposterior diameter that is longer than the transverse diameter on a transverse or longitudinal plane [anteroposterior-to-transverse ratio] >1) is a good predictor of papillary thyroid carcinoma (PTC) according to nodule size. Conclusion: Among the important indicators of thyroid malignancy, taller-than-wide nodules with microcalcifications are most likely to be malignant. Papillary thyroid cancer: the most common type of thyroid cancer. Moreover, most (but not all) malignancy rates of diagnoses were surgical, but the possibility of false positives cannot be excluded for the 3 patients with cytological evidence of malignancy who opted for nonsurgical management. The alternative proposed was chosen arbitrarily based on reported variability in the sonographic measurement of thyroid nodule diameters [9, 10]. We determined the reliability of the specific nodule shape in combination with other US features in predicting thyroid carcinomas. Furthermore, the Thyroid Imaging Reporting and Data System, which is applied primarily to exclude a thyroid malignant lesion, until now is not widely accepted to allow the clinicians for a proper therapeutic decision (18). Prior to aspiration, each nodule was explored jointly in real time by two clinicians using HI VISION Avius equipment, and consensus decisions were reached to reduce interobserver variability, which has been documented in assessments of individual sonographic features of thyroid nodules [15, 16]. Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, et al. Setting: All study information was collected from a single academic tertiary care hospital.

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