Thyroid scintigraphy: its place in preoperative diagnosis of thyroid nodules?

AIM OF THE STUDY: To evaluate the real contribution of the thyroid radionuclid scanning in the preoperative evaluation of the thyroid nodules. MATERIAL AND METHOD: The authors prospectively studied 369 patients who underwent surgical intervention: 160 (43.4%) for isolated nodules and 209 (56.6%) for multinodular goiters. RESULTS: The scintigraphy of the thyroid was performed in 281 (76.2%) patients: 39 (13.8%) patients with nodules less than 1.5 cm in diameter and 242 (86.2%) patients with nodules more than 1.5 cm in diameter. In 234 patients (83.3%) the scintigraphic evaluation did not bring any utile information for the therapeutic decision. The scintigraphy proved its utility only in 47 patients, which represents 16.7% from the scintigraphic exams performed, or 12.7% from the patients that underwent a surgical procedure. CONCLUSIONS: In the presence of thyroid nodule or multinodular goiter, the scintigraphy is indicated only in decreased TSH level, suspicion of ectopic thyroid or retrosternal goiter.     

Ultrasonographic characteristics of thyroid nodules: prediction of malignancy

BACKGROUND: High-resolution real-time ultrasonography (US) can detect characteristics of thyroid nodules, but the US differentiation between malignant nodules and benign nodules is not well described. HYPOTHESIS: Ultrasonography is useful for predicting malignancy of thyroid nodules. DESIGN: A retrospective study of 329 thyroid nodules (> or =5 mm) in 309 patients comparing US characteristics and pathological results. SETTING: A center for the treatment of thyroid diseases where about 1400 thyroid operations are performed per year. PATIENTS: Between January 1 and June 30, 1999, 309 patients were examined by US before thyroidectomy. MAIN OUTCOME MEASURE: The US characteristics to predict malignancy for both follicular and nonfollicular neoplasms by means of multiple logistic regression analysis. RESULTS: The sensitivity of preoperative US diagnosis was 86.5% for nonfollicular neoplasms and 18.2% for follicular neoplasms. The specificity was 92.3% and 88.7%, respectively. According to multiple logistic regression analysis, margin, shape, echo structure, echogenicity, and calcification were reliable indication of malignancy in nonfollicular neoplasms. According to a receiver operating characteristic curve constructed from this multiple logistic regression analysis, the best point not to overlook malignancy is the point at which sensitivity is 94% and specificity is 87%. The probability of malignancy at this point is greater than 0.2. For follicular neoplasms, ultrasonographic diagnosis was unreliable, even when multiple logistic regression analysis was applied. CONCLUSION: We can predict malignancy of nonfollicular neoplasms of the thyroid by using multiple logistic regression analysis based on only 5 features: margin, shape, echo structure, echogenicity, and calcification.     

Ultrasonographic Assessment of Differential Diagnosis Between Degenerating Cystic Thyroid Nodules and Papillary Thyroid Microcarcinomas

Purpose

To enhance the diagnostic accuracy of conventional ultrasonography in differentiating papillary thyroid microcarcinomas (PTMCs) from degenerating cystic thyroid nodules mimicking malignancy (under 10 mm in diameter).

Methods

A retrospective analysis of hypoechoic thyroid nodules under 10 mm between 162 cases of degenerating cystic thyroid nodules confirmed by ultrasound-guided fine-needle aspiration (US-FNA) and 150 cases of PTMCs confirmed by both US-FNA and postoperative pathology were performed in the aspects of shape, margin, calcification, and vascularity.

Results

Significant differences were observed in the aspects of shape, rim calcification, and vascularity (P < 0.05) between two groups in condition of solid hypoechogenicity. An ovoid-to-round regular shape, rim calcification, and no intrinsic blood flow were the statistically significant features for the depiction of a benign degenerating cystic nodule, while a taller-than-wide shape and peripheral or intranodular blood flow were that of a malignancy. Multiple stepwise logistic regression analysis demonstrated each of them as an independent predictor of malignancy (P < 0.05).

Conclusions

Shape, rim calcification, and vascularity are efficient criteria to distinguish degenerating cystic thyroid nodules mimicking malignancy from PTMCs in cases of solid hypoechogenic nodules under 10 mm. Such criteria should be acknowledged in cases of solid hypoechogenic thyroid nodules to help guide for the need of US-FNA.

     

Predictive Value of Sonographic Features in Preoperative Evaluation of Malignant Thyroid Nodules in a Multinodular Goiter

BACKGROUND: The primary goal of ultrasonography (US) in the evaluation of a thyroid nodule is to determine its malignancy, although the diagnosis of a malignant nodule on the basis of US alone is nearly impossible. The aim of this prospective study was to evaluate the predictive value of sonographic features in the preoperative diagnosis of malignant thyroid nodules, and to determine the important features of sonography. METHODS: This prospective study included 550 consecutive patients with , thyroid nodules. Nodules were divided into two groups on the basis of pathological diagnosis: group 1 consisted of 1,633 nodules with a benign pathology, and group 2 consisted of 293 nodules with a malignant pathology. RESULTS: Microcalcifications, blurred nodular margins, and solid and hypoechoic appearance were more common in malignant nodules compared to benign nodules (89.1% versus 5%; 64.5% versus 4.7%; 81.6% versus 30.6% ; and 62.5% versus 43.1%, respectively; p < 0.001). There was a positive correlation between the detection of malignant thyroid nodules and microcalcification (rs = 0.791, p = 0.0001), blurred nodular margin (rs = 0.625, p = 0.0001), solid appearance (rs = 0.376, p = 0.0001), and hypoechoic appearance (rs = 0.141, p = 0.0001). Microcalcifications, blurred nodular margins, and solid and hypoechoic appearance were independent determinants of malignancy upon US examination of thyroid nodules (OR: 159, OR: 37, OR: 9.9, and OR: 2.2, respectively). CONCLUSION: Although we did not identify a single feature indicative of malignancy in the sonographic examination of nodules, microcalcification and blurred margin were the strongest correlates for malignancy.     

Bethesda III Thyroid Nodules: The Role of Ultrasound in Clinical Decision Making

Background

Assessment for thyroid nodules includes ultrasound (US) and cytology according to the Bethesda classification. There is no firm consensus regarding clinical management for nodules classified as Bethesda III. Our aim was investigate the value of US to predict malignancy in these nodules.

Methods

Patients with Bethesda III nodules who underwent thyroid surgery from July 2011 to July 2013 were included. Inclusion criteria mandated that US were available for review by two observers blinded to each other’s results and histological outcome. The nodules were scrutinized with six US criteria: hypoechoic attenuation (HA), irregular margins (IM), taller than wide, microcalcifications (MC), loss of halo, and increased central vascularity. Disagreements between observers were solved by consensus.

Results

There were 141 patients (121 women) with a mean age of 55 years. Mean nodule size was 25 mm. The malignancy rate was 13 %. Interobserver ratios were moderate to very strong for all six predictors (kappa = 0.60–0.94). However, only HA, IM, and MC were predictors of malignancy by univariate analysis (all p < 0.002). Logistic regression revealed an odds ratio of malignancy versus no malignancy for HA 4.8, IM 3.3, and MC 4.0 (all p < 0.05). The positive and negative predictive value for malignancy when having one or more of these three criteria was 22 % and 98 %, respectively.

Conclusion

HA, IM, and MC were predictors of malignancy in Bethesda III nodules. In addition, the negative predictive value for any of these three criteria was high; a nodule that lacks all of these three criteria is thus unlikely to be malignant.     

Evaluation and management of incidental thyroid nodules in patients with another primary malignancy

BACKGROUND: Studies indicate that incidentally discovered thyroid nodules >or=1 cm in size may have a higher rate of malignancy (7% to 29%) than traditionally discovered nodules (5%). We sought to determine the rate of malignancy in incidental thyroid nodules in patients with other malignancies, and examine the accuracy of ultrasound (US) versus computed tomography (CT) in determining nodule size. METHODS: We evaluated 41 patients with history of another known malignancy (gastrointestinal, 23; breast, 11; other, 7) referred with an incidental thyroid nodule. Patients underwent office-based US and biopsy of nodules >or=1 cm. Surgical intervention was based on biopsy results. We compared nodule size at pathology with size seen on CT or US. RESULTS: Thirty-five patients met criteria for biopsy. Of the 35, 20 (57%) had atypical biopsy results warranting resection. Sixteen of those 20 underwent surgery. Pathology yielded 4 papillary thyroid cancers (PTC), 4 microPTC, 2 metastatic cancers, and 7 benign lesions. Ultrasound measurement of nodules compared to size measured at pathology had an r2 correlation value of 0.90 with P value <.0001. CT scan had an r2 value of 0.83 and P value of .005. CONCLUSIONS: Incidental thyroid nodules in patients with another primary malignancy warranted resection in 57%. The rate of malignancy in incidental thyroid nodules was 24%, which is above the expected rate of 5% seen in traditionally discovered nodules. US correlation with nodule size at pathology was excellent and superior to CT scan. Incidentally discovered thyroid nodules >or=1 cm, seen in patients with another malignancy, warrant further evaluation.     

Cytological and Ultrasound Findings in Indeterminate Lesions of the Thyroid Gland

Objectives

Thyroid nodules are common, and the majority are discovered incidentally on physical examination or imaging studies. Certain features on ultrasound (US) have been traditionally associated with malignant lesions and others with benign lesions. The aim of this study was to investigate the efficacy of US in determining malignancy in thyroid lesions diagnosed as indeterminate or malignant according to the cytological findings on fine needle aspiration biopsy (FNAB).

Methods

The records of 270 patients, referred to a single clinic with multinodular goiter were evaluated retrospectively, and 400 thyroid nodules sized larger than 5 mm in diameter were selected for the study. After exclusion of nodules classified as benign according to the FNAB findings, 203 thyroid nodules were included in this study. The nodules were divided into two groups on the basis of the FNAB findings: group 1 consisted of 82 nodules with indeterminate cytology and group 2 consisted of 121 nodules with cytological findings of malignancy or suspicious for malignancy.

Results

The diagnostic accuracy of ill-defined borders was 69.5% in group 1 (indeterminate) and 56% in group 2 (p=0.04). The diagnostic accuracy of solid composition was 50% in group 1 and 73% in group 2 (p=0.01). Positive correlation was demonstrated between ill-defined margins and malignant histology in group 1 (r=0.411, p=0.001), and between microcalcifications and malignant histology in group 2 (r=0.247, p=0.002).

Conclusions

In this study, the only US finding shown to be correlated with malignant histology in thyroid nodules of indeterminate cytology on FNAB was ill-defined margins. More precise US criteria are needed to decide on surgery in patients with thyroid nodules of indeterminate cytology.

     

Endoscopic thyroidectomy. A preliminary report including 40 patients

AIM OF THE STUDY: To demonstrate the feasibility of endoscopic thyroidectomy for unilateral lobectomy and isthmectomy. MATERIAL [corrected] AND METHODS: This prospective study included 40 patients operated on between January 1999 and March 2005 by a total endoscopic approach. Only lobectomies and isthmectomies were performed for nodules inferior to 3 cm in diameter. RESULTS: Forty patients (36 females, 4 males) underwent 35 lobectomies and five isthmectomies. Twenty-four patients were operated on without ultrasonic shears (US) the rate of conversion in this group was 33%. Sixteen patients were operated on with US: the rate of conversion was 0%. In the second group, the operative time was decreasing to the half, range 45 to 90 minutes. In both the two groups, there were no morbidity: no extensive emphysema, no hematoma, no wound abscess, no cord vocal palsy. The median hospital stay was 1,75 days. After three months of follow up, all the patients were satisfied, especially concerning the cosmetic results and the short recovery time. CONCLUSIONS: Endoscopic thyroidectomy is feasible and safe for performing lobectomies and isthmectomies. In the near future, it could be extended to bilateral goitres in selected patients.     

Utility of elastography for differential diagnosis of benign and malignant thyroid nodules

Objective

1) To classify the appearance of thyroid nodules displayed on ultrasound elastography; 2) to explore the sensitivity and specificity of this examination for differentiating benign and malignant nodules, with histopathologic analysis as the reference standard; and 3) to evaluate its utility for avoiding unnecessary procedures.

Study Design

Diagnostic test assessment.

Setting

Community hospital.

Subjects and Methods

Forty-seven thyroid nodules in 44 consecutive patients were examined with ultrasound elastography. The images we obtained were classified into four patterns. In addition, the mean strain index of the thyroid nodule and that of the sternocleidomastoid muscle were measured, and the nodule-to-muscle strain ratio was calculated. As the reference findings, the presence or absence of calcification, irregular margins, and hypoechogenicity of the thyroid nodules were examined using B-mode ultrasound.

Results

Elastography patterns 3 and 4 were predictive of malignancy, with 73 percent sensitivity (95% confidence interval [CI]: 39%-94%) and 64 percent specificity (95% CI: 46%-79%). Additionally, all nodules without calcification and those that presented with patterns 1 or 2 were benign. A strain ratio greater than 1.5 was set as the predictor of thyroid malignancy. This criterion showed 90 percent sensitivity (95% CI: 59%-100%) and 50 percent specificity (95% CI: 33%-67%).

Conclusion

Although elastography can assist in the differential diagnosis of thyroid nodules, its diagnostic performance is not ideal at present. Further improvements in the technique and the diagnostic criteria are necessary for this examination to provide a useful contribution to diagnosis.     

Abrikossoff tumor of the proximal esophagus misdiagnosed as a thyroid nodule

The diagnosis of thyroid nodules is straightforward and rarely mistaken. We present a case of a paraesophageal granular cell tumor, discovered incidentally during surgery for what it was diagnosed as a suspicious thyroid nodule by ultrasound and FNA. Complete resection was achieved without disruption of the esophageal mucosa. A terminal branch of the recurrent laryngeal nerve had to be resected en bloc with the tumor. Morphological and immunohistochemical diagnosis was established postoperatively. A review of the literature is presented.     

Role of Surgeon-Performed Ultrasound in Predicting Malignancy in Patients with Indeterminate Thyroid Nodules

Background  Certain ultrasound features can predict malignancy in patients with thyroid nodules. The purpose of this study was to determine the value of surgeon-performed ultrasound (SUS) in predicting thyroid malignancy in patients with indeterminate fine-needle aspiration (FNA) cytology. Methods  477 consecutive patients with dominant thyroid nodules were referred to our institution from 2002 to 2007. Of these, 180/477(38%) were judged to have indeterminate cytology: follicular neoplasm (FN, n = 108), Hürthle neoplasm (HN, n = 29), and suspicious for papillary thyroid cancer (SPTC, n = 43). SUS characteristics for thyroid nodules were recorded in a prospective database prior to thyroidectomy. Variables analyzed included patients’ age and sex, nodule size, shape, echogenicity, consistency, borders, multiplicity/multicentricity, and presence of microcalcifications. SUS features of thyroid nodules were correlated with final pathology. The accuracy of individual SUS features as well as the presence of two or more adverse features in predicting malignancy was also examined. Results  There were 144 females and 36 males. Mean age was 52 years (range 17–87 years). Mean tumor size was 2.7 cm (range 0.65–6.6 cm). Overall, final pathology revealed cancer in 92/180 (51%) patients. Malignancy was present in 40/108 (37%) FN, 12/29 (41%) HN, and 40/43 (93%) SPTC. Nodule borders (irregular), shape (height > width), hypoechogenicity, and presence of microcalcifications were significantly associated with malignancy. The presence of 2 or ≥3 adverse SUS thyroid nodule features was associated with a ≥55% or ≥78% risk of malignancy, respectively. Conclusion  Adverse thyroid nodule features seen on SUS may predict malignancy and help determine the initial extent of thyroidectomy in patients with indeterminate FNA cytology. Presented at the 61^st Annual Cancer Symposium of the Society of Surgical Oncology, March 14, 2007.     

2017版甲状腺影像报告和数据系统诊断甲状腺良恶性结节的价值

目的探讨2017版美国放射学院甲状腺影像报告和数据系统(TI-RADS)在评估甲状腺良恶性结节中的价值。方法采用2017版TI-RADS分类诊断标准,回顾性分析1 039例患者共1 109个甲状腺结节的声像图特征;以粗针穿刺活检或手术病理学结果为金标准,评价2017版TI-RADS对不同类别结节的诊断效能。结果良性结节551个,恶性结节558个;良恶性结节的成分、回声类型、纵横比、边界、有无钙化差异均有统计学意义(P均0.05)。TI-RADS 2～5类结节中,恶性率分别为0、5.45%(3/55)、22.29%(39/175)和58.84%(516/877),差异有统计学意义(P0.001)。以TI-RADS分类≥4为标准,诊断甲状腺恶性结节的敏感度、特异度、准确率、阳性预测值和阴性预测值分别为99.46%(555/558)、9.80%(54/551)、54.91%(609/1 109)、52.76%(555/1 052)和94.74%(54/57)。结论根据2017版TI-RADS分类评估恶性甲状腺结节具有临床应用价值,但特异度较低,分类标准尚需进一步完善。     

Selection of patients with solitary thyroid nodules for operation.

OBJECTIVE: To improve the preoperative selection for operation of patients with solitary thyroid nodules. DESIGN: Prospective cohort study. SETTING: University hospital, France. PATIENTS: 155 consecutive patients who presented with solitary thyroid nodules and were operated on. INTERVENTIONS: Clinical examination, ultrasound examination, fine needle aspiration biopsy, followed by total thyroid lobectomy with frozen section and final histological examination. MAIN OUTCOME MEASURE: Correct prediction of thyroid carcinoma or benign adenoma. RESULTS: A logistic regression analysis indicated that absence of rim (p < 0.002), solid and hypoechoic feature (p < 0.003) and malignant or suspicious fine needle aspiration biopsy results (p < 0.0001) were significantly associated with malignancy. Selection for operation by the logistic model would save 40 of 73 patients from operation and 40 of 59 from unnecessarily radical operation. It would detect a similar number of cancers as a strategy based solely on fine needle aspiration cytology. CONCLUSIONS: A combination of the available diagnostic methods provides substantial benefit in the preoperative selection of patients with an isolated thyroid nodule.     

Evidence-Based Assessment of the Role of Ultrasonography in the Management of Benign Thyroid Nodules

BACKGROUND: Although ultrasonographic (US) evaluation is currently recommended for the workup of all palpable thyroid nodules, little guidance exists regarding the manner in which US data are to be used. Herein, we examine the available evidence and recommend how US can be used most effectively to predict malignancy. We discuss the role of US-guided fine needle aspiration (FNA) and other special topics regarding US evaluation and management of benign nodules. METHODS: We also present a systematic review of the literature using evidence-based criteria. RESULTS: US features alone cannot predict malignancy or benignity, but techniques that combine US features and FNA cytology are most effective and most accurate for predicting malignancy (Level III and IV evidence). US features suggesting malignancy include a blurred or ill-defined margin, irregular shape, solid echo structure, hypoechogenicity, absent halo, fine calcifications, and intranodular vascular pattern. Most patients with malignancies have more than two US features characteristic of malignancy. US-guided FNA has nonsignificantly higher sensitivity, specificity, and accuracy than the palpation-guided technique (Level III and IV evidence). US guidance is particularly beneficial in patients with nonpalpable, multiple, or heterogeneous nodules for preferentially aspirating a specific segment of the nodule (large or partially cystic nodule) or when nodule palpation is difficult (patients with diffuse glandular disease or obesity). CONCLUSIONS: US is an essential component of thyroid nodule evaluation and management. Techniques that combine US features and FNA cytology for thyroid nodule workup are more accurate than either technique alone. US-guided FNA can decrease the rate of nondiagnostic aspirates.     

Is radionuclide imaging still usefull for thyroid nodule management? A surgical point of view

Preoperative management of thyroid nodule is still controversial. Since 25 years ago, preoperative evaluation of thyroid nodule has been modified and improved. The aim of this study was to review, from a surgical point of view, the role of radionuclide imaging results in the management of patients with thyroid nodules.     

Contribution of ultrasonography in the evaluation of subacute thyroiditis

Ultrasonography is a useful tool in diagnosing and monitoring thyroid pathology. The aim of this study was to evaluate the value of thyroid ultrasonography in the follow-up of subacute thyroiditis (SAT). The study group included 48 subjects with clinical and biological diagnosis of subacute thyroiditis. All patients were evaluated by ultrasonography and followed-up for a mean period of 12 months. The evaluation protocol included biological data (TSH, T4, erythrocyte sedimentation rate--ESR) and ultrasonography, performed at 1, 2, 3, 6, and 12 months. Initially, all patients had an enlarged thyroid volume (median = 30.5 ml, range 23-90) and a low echogenicity, with an inhomogeneous aspect in 54.1% cases. After a mean period of 3 months thyroid volume had a significant reduction (median volume = 20.2 ml, range 7-36, p < 0.0001). Echogenicity was also significantly improved, with a decrement, on a semi-quantitative scale of 4 degrees (1 = normal, 4 = intense hypoechogenicity), from 3.25 to 2.48 (p < 0.0001). Almost half of the patients (45.8%) presented persistent (although slighter) hypoechoic/inhomogeneous pattern. Ultrasonographic abnormalities were not correlated with the intensity of the inflammatory syndrome and/or the thyroid status. Recurrence appeared in 10 (20.8%) patients. All patients presented a new thyroid enlargement (from a median = 16.1 ml to 31.5 ml, p = 0.056) and an extension of hypoechoic regions. The risk of recurrence could not be correlated with thyroid function, inflammatory syndrome or ultrasonographic aspect. There were not significant differences between the subgroups of patients with and without recurrence concerning the initial thyroid volume (p = 0.889), echogenicity (p = 0.735), TSH (p = 0.321) or ESR (p = 0.1332). Thyroid ultrasonography is useful not only for the initial diagnosis but also for the follow-up of patients with subacute thyroiditis. Remission and recurrence can be appreciated and monitored by the ultrasonographic pattern of the thyroid.     

Surgical intervention in cold nodules of the thyroid gland (author's transl)

In statistical analyses the rate of malignancy of solitary cold thyroid nodules is estimated between 3 to 50%. In our records the incidence of malignancy is 6,6%. Concerning the pathogenicity of these thyroid nodules no conclusions can be drawn which are only based on the results of such analyses. Each thyroid nodule has to be classified either according to its clinical and morphological characteristics or to its morphology alone. The condition for an optimal diagnosis and therapy is provided by the surgeon and pathologist being acquainted with the criteria for morphological classification or clinical data respectively.     

Implications of follicular neoplasms, atypia, and lesions suspicious for malignancy diagnosed by fine-needle aspiration of thyroid nodules

OBJECTIVE: To break out subcategories of atypical and suspicious cytologic interpretations of thyroid aspirations and correlate those with final histologic diagnosis. SUMMARY BACKGROUND DATA: Fine-needle aspiration (FNA) of thyroid nodules has become the primary diagnostic tool in the initial evaluation of thyroid nodules. Management of thyroid nodules is based on statistical data correlating a specific cytologic reading with the probability of malignancy. Two particular cytologic readings that frustrate both cytopathologists and surgeons are follicular neoplasms and cells that show atypia. In most reported series, follicular neoplasms and cells showing atypia are included in a broad "suspicious" category, with reported overall malignancy rates generally between 20% and 30%. However, there is interest in determining whether these suspicious lesions can be subcategorized, allowing a more accurate assessment of the risk of malignancy. In addition, there is recent evidence that the incidence of follicular cancer may be declining in this country, possibly decreasing the probability that a "follicular neoplasm" will prove to be a follicular cancer. METHODS: From January 1994 through December 2000, 709 thyroid FNAs were performed at a single institution. Those interpreted as suspicious and the subsequent histologic reports were reviewed. From this set, four specific categories were defined, and the clinical records for patients whose cytology matched these categories form the subject of this study. These four categories are follicular neoplasms without atypia, follicular neoplasms with atypia, atypia, and suspicious for malignancy. In addition, lesions with nondiagnostic cytology were reviewed. Only lesions for which there was histologic follow-up were considered. RESULTS: Ninety-eight aspirates were categorized as follicular neoplasms without atypia, follicular neoplasms with atypia, or atypia alone. Of 74 follicular neoplasms without atypia, only 5 (6.8%) were malignant, and none of these were follicular thyroid cancers. Nine of the lesions were follicular neoplasms with atypia, and four (44.4%) of these were malignant, including two that were invasive follicular cancers. Of 15 lesions showing atypia alone, 3 (20%) were malignant, all of which were papillary thyroid cancers. Twenty-five additional patients had lesions highly suspicious for malignancy. Twenty-one (84%) of these lesions were malignant, the majority being papillary thyroid cancers. Only one was a follicular cancer. Fifty patients with nondiagnostic cytology had subsequent action taken. Thirty-one of these lesions were resected, with five (16.1%) proving to be malignant. CONCLUSIONS: Thyroid nodules whose FNA is diagnosed as highly suspicious for malignancy should be resected unless there are significant contraindications to a surgical procedure. The extremely low rate (2%) of invasive follicular cancers among all follicular neoplasms may reflect changing histologic criteria for follicular carcinoma, a true change in the disease frequency, or both. For thyroid nodules whose cytology shows a follicular neoplasm without atypia, malignancy rates of 8% or less may allow nonsurgical options, including reevaluation in selected populations. Continued efforts to correlate malignancy rates to specific cytologic criteria will allow patients to make more informed decisions regarding their medical care.     

超声探测甲状腺结节钙化的临床诊断价值

目的：探讨超声探测甲状腺结节钙化对甲状腺结节良恶性的诊断价值。 方法：回顾性分析2005年1月—2010年1月经手术治疗的4 011例甲状腺疾病患者的超声资料和临床病理结果,分析钙化与否及不同钙化类型与甲状腺结节良恶性的关系,比较单发和多发钙化结节的恶性率以及不同年龄组甲状腺结节伴钙化的恶性率。 结果：甲状腺结节伴钙化的恶性率明显高于非钙化结节,微小钙化结节的恶性率明显高于非微小钙化,单发钙化结节恶性率均明显高于多发钙化结节,年龄<45岁钙化结节者的恶性率明显高于年龄≥45岁者,组间差异均有统计学意义（均P<0.05）。钙化、微小钙化、粗大钙化和环状钙化对诊断甲状腺恶性肿瘤的敏感度分别为80.42%、51.65%、26.52%、2.25%,特异度分别为67.53%、93.19%、76.79%、97.55%。39例颈部淋巴结钙化者中,37例为甲状腺乳头状癌淋巴结转移。 结论：甲状腺结节钙化和微小钙化对甲状腺癌的诊断具有重要意义。单发结节伴钙化、微小钙化、年龄<45岁钙化结节患者以及淋巴结钙化者具有更高的恶性率。

     

意外甲状腺癌的临床病理特点及预测因素：附523例报告

目的:通过超声影像和病理特征探讨意外甲状腺癌预测因素。方法:回顾性分析2014年1月—2014年10月期间于哈尔滨医科大学附属第一医院收治的523例甲状腺癌患者的临床病理资料,其中意外甲状腺癌患者108例(观察组),非意外甲状腺癌患者415例(对照组),比较两组患者之间临床病理特点的差异。结果:两组在年龄、病灶数量、病理分型、病变结构、是否合并良性甲状腺疾病、是否钙化、癌灶颜色、纵横比、弹性评分、边界情况、回声强度、是否清扫中央组淋巴结的构成比均有统计学差异(均P0.05);Logistic回归分析显示,滤泡状癌、无钙化、纵横比1、边界清晰、非低回声、弹性评分3、癌灶直径与癌灶所在结节的直径比值30%是意外甲状腺癌发生的预测因素(均P0.05)。结论:滤泡状甲状腺癌、无钙化、纵横比1、边界清晰、非低回声、弹性评分3、癌径比30%等是意外甲状腺癌的预测因素。