QJM Advance Access published online on December 17, 2006
QJM, doi:10.1093/qjmed/hcl121
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The predictive value of ultrasound findings in the management of thyroid nodules
Department of Medical and Surgical Sciences, Internal Medicine and Endocrinology Unit, University of Brescia, Brescia, Italy
Address correspondence to Dr C. Cappelli, Department of Medical and Surgical Sciences, Internal Medicine and Endocrinology Unit, University of Brescia, c/o 2 Medicina Spedali Civili di Brescia, Piazzale Spedali Civili no. 1, 25100 Brescia, Italy. e-mail: cappelli{at}unibs.med.it
Received 7 April 2006 and in revised form 12 July 2006
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Abstract |
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Background: Thyroid nodules are a common medical problem, but whether fine-needle aspiration cytology (FNAC) is mandated for smaller non-palpable nodules, is controversial.
Aim: To evaluate whether ultrasonographic features of thyroid nodules are associated with histological malignancy, and to identify useful criteria for clinical decision-making.
Design: Prospective observational study.
Methods: From January 1991 to September 2004, 5198 patients were referred to our hospital for ultrasound evaluation of thyroid nodules. Overall, 7455 nodules (diameters from 6 to 100 mm) were examined; 2865 (38.4%) were <10 mm in diameter. All patients with suspicious or malignant cytology underwent surgery.
Results: Of the 349 nodules undergoing surgery, 284 were malignant. The prevalence of cancer was slightly higher in nodules 
10 mm in diameter vs. those <10 mm (5.5% vs. 3.0%, p < 0.01). However, histological type and local aggressiveness were largely independent of nodule size. Microcalcifications (72.2% vs. 28.7%; p < 0.001; OR 6.4, 95%CI 4.9–8.4), blurred margins (52.8% vs. 18.8%; p < 0.001; OR 4.8, 95%CI 3.8–6.1), solid hypoechoic appearance (80.6% vs. 52.4%; p < 0.001; OR 3.8, 95%CI 2.8–5.1), size 10 mm (77.4% vs. 64.9%; p < 0.001; OR 1.9, 95%CI 1.4–2.5) and intranodular vascular pattern type 2 (61.6% vs. 49.7%; p < 0.001; OR 1.6, 95%CI 1.2–2.0) were all significantly more frequent in malignant than in benign nodules. These associations were similar when large and small nodules were analysed separately.
Discussion: No single parameter, including nodule size, satisfactorily identifies a subset of patients to be electively investigated by FNAC, although several may be useful in this regard.
* Drs Cappelli and Castellano contributed equally to this paper.
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