Abstract:
BACKGROUND:The management of large thyroid nodules remains unclear. Ultrasonography is a central tool in the assessment of thyroid nodules, yet its role in risk stratification of large thyroid nodules has been studied only seldomly. OBJECTIVE:The aim of this study was to determine the utility of ultrasonography in characterizing and risk-stratifying thyroid nodules ≥3.0 cm. METHODS:We performed 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 with nodules <3.0 cm. All nodules were assessed by a single high-volume thyroid surgeon. Data collected included size (cm), texture, echogenicity, shape, calcifications, border, spongiform appearance, and vascularity. RESULTS:A total of 537 nodules were included in the study, with 137 nodules (25.5%) ≥3.0 cm comprising the study group, and 400 nodules (74.5%) as the control group. No differences were found between the 2 groups regarding age, sex, and risk factors. Nodules ≥3.0 cm were associated with an increased risk for malignancy (odds ratio 2.41 [1.08-5.38]). Microcalcifications (26.3% vs 17.5%, P = .039), hypoechogenicity (40.8% vs 23.4%, P < .001), and irregular borders (14.3% vs 3.6%, P = .001) were more prevalent in nodules <3.0 cm. Among the large nodules, hypoechogenicity (50% vs 22.8%, P = .043) and irregular margins (28.6% vs 0%, P < .001) were associated with malignancy. The specificity of irregular borders was greater in nodules ≥3.0 cm (100% vs 89.6%, P = .011). CONCLUSION:Sonographic appearances of large nodules differ from those of smaller nodules. Hypoechogenicity and irregular borders were associated with malignancy and should direct management towards a more aggressive policy of fine needle aspiration and consideration of operative resections in large thyroid nodules.
journal_name
Surgeryjournal_title
Surgeryauthors
Cohen O,Lahav Y,Halperin D,Yehuda Mdoi
10.1016/j.surg.2019.06.011subject
Has Abstractpub_date
2019-12-01 00:00:00pages
1148-1153issue
6eissn
0039-6060issn
1532-7361pii
S0039-6060(19)30350-2journal_volume
166pub_type
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