Heterogeneous iso- or hyperechoic nodules showed a significantly higher malignancy risk than homogeneous iso- or hyperechoic nodules (15.8 vs. 6.7%, P<0.001). J Am Coll Radiol 14:587595, Ha EJ, Chung SR, Na DG et al (2021) 2021 Korean thyroid imaging reporting and data system and imaging-based management of thyroid nodules: Korean Society of Thyroid Radiology consensus statement and recommendations. A thyroid colloid cyst (TCC) is a common, noncancerous nodule in the thyroid gland that is filled with colloid, a stored form of thyroid hormone. . In the 2021K-TIRADS, the nodule was defined as hypoechoic if it was hypoechoic relative to the normal thyroid parenchyma. The incidence of thyroid nodules has increased in recent years, with detection in up to 65% of the general population, which may be due in part to the increased use of US [1, 2].Approximately 7-15% of thyroid nodules are thyroid cancer, which accounts for approximately 3% of all cancers and is the most common endocrine malignancy [].Thyroid US has been recognized as the most useful tool for . Hypoechoic thyroid nodules with various degree of hypoechogenicity. Wu, M. H. et al. They are found in the body's tissues such as blood vessels, nerves, organs and other soft tissue. Gharib H, et al. https://doi.org/10.1007/s00330-023-09828-1, DOI: https://doi.org/10.1007/s00330-023-09828-1. If a patient has symptomatic hyperthyroidism this can be treated with medications initially, and the nodule itself with radioactive iodine or surgery. https://doi.org/10.2214/AJR.17.19192 (2018). Diagnosis: Follicular variant papillary thyroid carcinoma. Our study validated that classifying nodules by their predominant echogenicity is a reasonable form of risk stratification. Specifics including size of any palpated nodules and mobility should be noted. J. Radiol. (2023)Cite this article. The datasets analyzed in the current study are available from the corresponding author on reasonable request. Size itself is not a marker for or against malignancy. Major pitfalls can occur in failure to hand off and follow up a documented nodule seen incidentally on inpatient imaging or exam. Isthmus Thyroid Nodules: Risk for Cancer - Verywell Health Solid, marked (31.3%), moderate (25.9%), and mild hypoechoic nodules (17.4%) without suspicious features were stratified as intermediate risk. Risk of thyroid cancer based on thyroid ultrasound findings Assessment of thyroid lesions (ultrasound) - Radiopaedia.org, the peer Hypoechoic thyroid nodules with various degree of hypoechogenicity. The malignancy risk of solid homogeneous iso- or hyperechoic nodules ranged within the low-to-intermediate suspicion categories, depending on the presence of suspicious US features (7.5% in solid homogeneous iso- or hyperechoic nodules without suspicious features and 26.7% in solid homogeneous iso- or hyperechoic nodules with suspicious features). According to the results of this study, the 2021K-TIRADS revised the definition of marked hypoechogenicity as hypoechoic or similar echogenicity relative to the anterior neck muscles16. Thyroid cancers are associated with family history of thyroid cancer or Multiple Endocrine Neoplasia 2 (MEN2), prior irradiation to the head and neck, age <30 years or >70 years, and male gender. When we classified the nodules according to composition and the presence of suspicious features, there was no significant difference in malignancy risks between homogeneous hypoechoic and heterogeneous hypoechoic nodules in all subgroups (P0.086). Likelihood of malignancy in thyroid nodules according to a proposed Thyroid Imaging Reporting and Data System (TI-RADS) classification merging suspicious and benign ultrasound features. Marked or moderately hypoechoic nodules showed a significantly higher risk than mild hypoechoic (P0.016) nodules. Among them, 16,679 patients were excluded due to a lack of reference standard test (biopsy or surgery) (n=4304), thyroid nodules<1.0cm (maximal diameter, n=12,130), suboptimal image quality (n=245), or inconclusive/indeterminate biopsy results (Bethesda I; nondiagnostic or unsatisfactory or III; atypia of undetermined significance or follicular lesion of undetermined significance, n=1015 patients with 1102 nodules)23,24. In solid nodules, the malignancy risks of nodules with moderate (73.3%) or marked hypoechogenicity (78.6%) with suspicious features were within the high suspicion category. Yoon, S. J. et al. In the EU-TIRADS10 and ACR-TIRADS11, moderate hypoechogenicity was classified as a similar risk to mild hypochogenicity. Chung SR, et al. In conclusion, the malignancy risk of nodules with heterogeneous echotexture can be stratified based on predominant echogenicity. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. High diagnostic accuracy AI observed potential lung cancer in the radiograph with an 89% CI as indicated by the nodule localization map (B) (as the color changes from blue to red, the probability . If there are symptoms, evidence of thyroid dysfunction, worrisome ultrasound characteristics, or questions as to how frequently to follow up, patients should be referred to an endocrinologist. For nodules with heterogeneous echogenicity, the EU-TIRADS suggested that nodules with any hypoechoic component should be regarded as hypoechoic nodules and classified as intermediate risk10. The interobserver agreement for the degree of echogenicity and echotexture was calculated using the Cohen statistic. Malignant, suspicious, or persistently nondiagnostic results require surgical treatment. https://doi.org/10.3348/kjr.2021.0713 (2021). https://doi.org/10.1089/thy.2020.0305 (2021). In these RSSs including the 2016K-TIRADS, nodules with a similar echogenicity to the anterior neck muscles (i.e., moderate hypoechogenicity) were grouped with nodules with mild hypoechogenicity9,10,11,12,14,15. and JavaScript. To view unlimited content, log in or register for free. The site is secure. If the nodule is found to be hyperfunctioning, the risk of cancer is very low and patient likely does not need FNA. Frontline providers should determine if patient needs immediate diagnosis and management. Is there a cancer risk? https://doi.org/10.1590/2359-3997000000262 (2017). The suggested malignancy risk in the 2021K-TIRADS is as follows16: high suspicion,>60%; intermediate suspicion, 1040%; low suspicion 30%; and benign,<3%. Interobserver variability of sonographic features used in the American college of radiology thyroid imaging reporting and data system. https://doi.org/10.1530/eje-13-0995 (2014). JAMA 319:914924, Article Table Table22 shows the malignancy risks of nodules classified according to their echogenicity and echotexture. Sign up for the Nature Briefing newsletter what matters in science, free to your inbox daily. Hypoechoic Mass: What This Ultrasound Result Means - WebMD Am. bPartially cystic hypoechoic versus Solid isoechoic. In the 2021K-TIRADS, punctate echogenic foci were defined as punctate (1mm) hyperechoic foci within the solid component of a nodule, nonparallel orientation as the anteroposterior diameter of a nodule being longer than its transverse diameter in the transverse plane, and irregular margin as a non-smooth edge with spiculation or microlobulation. In the evaluation of thyroid nodules, many factors can increase the risk of cancer. Solid, marked (31.3%), moderate (25.9%), and mild hypoechoic nodules (17.4%) without suspicious features were stratified as intermediate risk. Future in-depth studies are needed to validate the reproducibility of this US lexicon in multiple readers. Am. J Ultrasound Med 34:1926, American Institute of Ultrasound in M, American College of R, Society for Pediatric R, Society of Radiologists in U (2013) AIUM practice guideline for the performance of a thyroid and parathyroid ultrasound examination. Moderately (P=0.008) and mildly hypoechoic (P=0.017) nodules showed significantly higher malignancy risk than iso- or hyperechoic nodules in partially cystic nodules without suspicious features. Rep. 6, 35632. https://doi.org/10.1038/srep35632 (2016). 213, W76W84. The result of this study confirmed the validity of the revised definition of marked hypoechogenicity by 2021K-TIRADS. Correspondence to This study aimed to validate thyroid nodules malignancy risk according to their echotexture and degree of hypoechogenicity in a multicenter cohort. https://doi.org/10.1016/j.jacr.2017.01.046 (2017). Diagnosis: Benign follicular nodule in core needle biopsy. To obtain PubMed Moreover, focal suspicious features could be missed when archiving images during dynamic exploration and these points could potentially impact nodule categorization. In some cases, surgical removal may be recommended. This research was supported by research fund from the Korean Society of Radiology through Radiology Imaging Network of Korea for Clinical Research (RINK-CR). In the 2021K-TIRADS, the nodule was defined as hypoechoic if it was hypoechoic relative to the normal thyroid parenchyma. Ha, E. J. et al. They are typically benign and are often discovered incidentally. Yoon SJ, et al. Eur. Moon, W. J. et al. A hypoechoic thyroid nodule suggests that the lesion is solid and not fluid filled as most of thyroid lesions are. If a biopsy shows that you have a noncancerous thyroid nodule, your doctor may suggest simply watching your condition. How Does an Ultrasound Work? Diagnostic performance of the modified Korean thyroid imaging reporting and data system for thyroid malignancy: A multicenter validation study. By submitting a comment you agree to abide by our Terms and Community Guidelines. Malignancy Risk Stratified by Degree of Hypoechogenicity and Predominant Echogenicity According to Composition and suspicious Features. Heterogeneous hypoechoic nodules showed significantly higher malignancy risk than heterogeneous isoechoic nodules in all subgroups except partially cystic nodules. This reader randomly selected and blindly assessed the nodules. 3)5,7. The malignancy risks differed significantly between these groups in the following decreasing order: solid hypoechoic, partially cystic hypoechoic, solid iso- or hyperechoic, and partially cystic iso- or hyperechoic. Google Scholar, Trigo JM, Capdevila J, Grande E, Grau J, Lianes P, Spanish Society for Medical O (2014) Thyroid cancer: SEOM clinical guidelines. For large nodules or MNG, surgery is sometimes pursued. Neck irradiation increases the risk of thyroid cancer. We designed a multicenter study to determine if this revised definition of nodule hypoechogenicity could effectively stratify the malignancy risk of thyroid nodules. The punctate echogenic foci with comet-tail artifact showed malignancy rate of 77.8% in solid and predominantly solid nodules. Diagnosis: Conventional papillary thyroid carcinoma (B) A nodule with heterogeneous, predominant hypoechogenicity. This study aimed to determine the malignancy risk of thyroid nodules according to their echotexture and degree of hypoechogenicity. Regarding a recent meta-analysis, the average malignancy rate of published thyroid nodule cohorts was 27.815.3 (range 3.956.2)22. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The modified definition of markedly hypoechoic resulted in a significantly improved diagnostic efficacy in determining malignant thyroid nodules and may improve the diagnostic performance of the C-TIRADS. Among 778 hypoechoic malignant nodules, 718 (92.3%) were PTCs, including 58 (7.5%) follicular variant PTCs, and 30 (3.9%) were follicular carcinomas. The suggested malignancy risk in the 2021K-TIRADS is as follows16: high suspicion,>60%; intermediate suspicion, 1040%; low suspicion 30%; and benign,<3%. Update on the Evaluation of Thyroid Nodules | Journal of Nuclear Medicine The malignancy risk of solid homogeneous iso- or hyperechoic nodules ranged within the low-to-intermediate suspicion categories, depending on the presence of suspicious US features (7.5% in solid homogeneous iso- or hyperechoic nodules without suspicious features and 26.7% in solid homogeneous iso- or hyperechoic nodules with suspicious features). The malignancy risks were not significantly different between heterogeneous iso- or hyperechoic nodules and homogeneous isoechoic nodules in all subgroups except in the partially cystic nodules subgroup without suspicious features (P0.05). Comparison of the diagnostic performance of the modified Korean thyroid imaging reporting and data system for thyroid malignancy with three international guidelines. Ultrasound can help identify the number of nodules, their size and location, and any evidence of worrisome sonographic signs. Youve read {{metering-count}} of {{metering-total}} articles this month. There was no significant difference in malignancy risk in partially cystic nodules without suspicious features according to the degree of hypoechogenicity (P0.116). Other pitfalls in diagnostic workup are assuming that small nodules are not cancerous. The clinical signficance of thyroid nodules includes the possibility of cancer (approximately 5%), thyroid dysfunction, and in rare circumstances, development of local compression of structures in the neck. Kim, J. H., Na, D. G. & Lee, H. Ultrasonographic echogenicity and histopathologic correlation of thyroid nodules in core needle biopsy specimens. Thyroid nodules are solid or fluid-filled lumps that form within your thyroid, a small gland located at the base of your neck, just above your breastbone. (F) Interrupted (or fenestrated) eggshell calcification pattern in nodule with papillary thyroid cancer. Initially . Thyroid 26:1133, Article At US cancers presented a solid hypoechoic appearance in 87% of cases, irregular or blurred margins in 77.4%, an intranodular vascular pattern in 74.2%, and microcalcifications in 29.0%. PubMed The prevalence of nodules ranges from 20 to 76% in the United States, and increases with age and female gender. Laboratory, radiographic and other tests that are likely to be useful in diagnosing the cause of this problem. Risk of Malignancy in Nonpalpable Thyroid Nodules: Predictive Value of Thyroid nodules - Symptoms and causes - Mayo Clinic The clinical signficance of thyroid nodules includes the possibility of cancer (approximately 5%), thyroid dysfunction, and in rare circumstances, development of local compression of structures. Marked hypoechogenicity is related to an increased risk of malignancy in thyroid nodules 1, 5, 6, 7, 8 and has been adopted in several risk stratification systems (RSS) 9, 10, 11, 12. Endocrinol. calcifications) then hypoechoic nodules are typically biopsied after reaching size criteria isoechoic solid nodule: 25% (follicular and medullary) hyperechoic solid nodule: 5% chance of being malignant ; Writingreview and editing: D.G.N. A comparative analysis of two machine learning-based diagnostic patterns with thyroid imaging reporting and data system for thyroid nodules: Diagnostic performance and unnecessary biopsy rate. Treatment depends on the type of thyroid nodule you have. Thyroid nodules and thyroid cancer - Cancer Therapy Advisor Patient data were retrospectively collected from 26 different hospitals in Korea (Thyroid Imaging Network of Korea registry, THINK). The majority of thyroid nodules encountered in general practice will have benign cytology and can be monitored with a repeat ultrasound scan . In patients who are asymptomatic diagnostic work up can be started in the outpatient setting after the patient has been discharged. However, in this study, moderate hypochogenicity showed a similar malignancy risk to marked hypochogenicity. Recent research has found that nodules in the thyroid isthmus pose a greater risk of malignancy than nodules in the lobes. Bae JM, Hahn SY, Shin JH, Ko EY. Endocr Pract 22:622639, Grant EG, Tessler FN, Hoang JK et al (2015) Thyroid ultrasound reporting lexicon: white paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. Quantitative analysis of echogenicity for patients with thyroid nodules. We included a total of 5,601 thyroid nodules in 4989 patients in this study (4101 women, 888 men; age range: 1976years) (Fig. cSolid isoechoic versus partially cystic isoechoic. Do you have sweats, diarrhea, heat intolerance, diarrhea, a feeling of shakiness? Nodules were stratified according to the echotexture (homogeneous vs. heterogeneous) and degree of hypoechogenicity (mild, moderate, or marked). Patient data were retrospectively collected from 26 different hospitals in Korea (Thyroid Imaging Network of Korea registry, THINK). Echogenic foci in thyroid nodules: diagnostic - BMC Medical Imaging Despite its importance, the US definition of nodule echogenicity shows discrepancies across risk stratification systems (RSS)13. Korean J. Radiol. 99, 12531263. https://doi.org/10.1089/thy.2015.0020 (2016). 1). D. Nodule with homogeneous iso- or hyperechogenicity. Thyroid cancer presents as a thyroid nodule. Diagnosis: Conventional papillary thyroid carcinoma. Malignancy risk stratification of thyroid nodules according to echotexture and degree of hypoechogenicity: a retrospective multicenter validation study. Logan Health brings in new robotic-assisted platform for lung biopsies They insisted that echogenic foci with small comet-tail artifact in solid hypoechoic nodule should be distinguished from the large comet-tail artifacts in the cystic components of a . If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Thyroid Nodules: Advances in Evaluation and Management benign nodules can be hypoechoic if no other malignant features (e.g. Previous studies have consistently reported that the malignancy risk of hypoechoic nodules was higher than that of iso- or hyperechoic nodules1,3,4,5.
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