Surgeon Preformed Sonographic Evaluation and Predication for Large Thyroid Nodules: A Case-Control Study

  • Background: The management of large thyroid nodules remains unclear. Ultrasound (US) is a central tool in the assessment of thyroid nodules, yet its role in risk stratification of large thyroid nodules has been seldom studied. The aim of this study was to determine the utility of US in characterizing and risk stratifying thyroid nodules ? 3.0 cm.

    Methods: 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 to nodules < 3.0 cm. All nodules were assessed by a single high volume thyroid surgeon. Data collected included: size (mm), texture, echogenicity, shape, calcifications, border, spongiform appearance and vascularity.

    Results: A total of 537 nodules were included in the study, 137 nodules (25.5%) were ? 3.0 cm and comprised the study group, while 400 nodules (74.5%) were the control group. No differences were found between the two groups regarding age, gender and risk factors. Microcalcifications (26.3% vs. 17.5%, p-value=0.039); hypoechogenicty (40.8% vs. 23.4%, p-value<0.001) and irregular borders (14.3% vs. 3.6%, p-value=0.001) were significantly more prevalent in nodules<3.0 cm. Among the large nodules, hypoechogenicity (50% vs. 22.8%, p=0.043) and irregular margins (28.6% vs. 0%, p<0.001) were significantly associated with malignancy. The specificity of irregular borders was significantly higher in nodules ?3.0 cm (100% vs. 89.6%, p-value=0.011, respectively).

    Conclusions:  Sonographic appearances of large nodules differ from those of smaller nodules. Hypoechogenicty and irregular borders were associated with malignancy and should select towards diagnostic surgery in large thyroid nodules.  


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