DOI QR코드

DOI QR Code

Impact of Nodule Size on Malignancy Risk Differs according to the Ultrasonography Pattern of Thyroid Nodules

  • Hong, Min Ji (Department of Radiology, Gachon University Gil Medical Center) ;
  • Na, Dong Gyu (Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine) ;
  • Baek, Jung Hwan (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sung, Jin Yong (Department of Radiology, Thyroid Center, Daerim St. Mary's Hospital) ;
  • Kim, Ji-Hoon (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2017.07.17
  • Accepted : 2017.11.06
  • Published : 2018.06.01

Abstract

Objective: To test whether the impact of thyroid-nodule size on the malignancy risk differs according to the ultrasonography (US) patterns of nodules. Materials and Methods: This study is a post hoc analysis using data from the Thyroid Imaging Reporting and Data System (TIRADS) multicenter retrospective study which included 2000 consecutive thyroid nodules (${\geq}1cm$) with final diagnoses. A total of 2000 consecutive thyroid nodules from 1802 patients (1387 women and 613 men; mean age, $51.2{\pm}12.2years$) were enrolled in this study. The malignancy risk of the nodules was assessed according to the nodule size and US patterns (Korean-TIRADS). Results: Overall, the malignancy risk did not increase as nodules enlarged. In high-suspicion nodules, the malignancy rate had no association with nodule size (p = 0.467), whereas in intermediate- or low-suspicion nodules there was a trend toward an increasing malignancy risk as the nodule size increased (p = 0.004 and 0.002, respectively). The malignancy rate of large nodules (${\geq}3cm$) was higher than that of small nodules (< 3 cm) in intermediate-suspicion nodules (40.3% vs. 22.6%, respectively; p = 0.001) and low-suspicion nodules (11.3% vs. 7.0%, respectively; p = 0.035). There was a trend toward a decreasing risk and proportion of papillary carcinoma and an increasing risk and proportion of follicular carcinoma or other malignant tumors as nodule size increased (p < 0.001, respectively). Conclusion: The impact of nodule size on the malignancy risk differed according to the US pattern. A large nodule size (${\geq}3cm$) showed a higher malignancy risk than smaller nodules in intermediate- and low-suspicion nodules.

Keywords

References

  1. Machens A, Holzhausen HJ, Dralle H. The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma. Cancer 2005;103:2269-2273 https://doi.org/10.1002/cncr.21055
  2. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994;97:418-428 https://doi.org/10.1016/0002-9343(94)90321-2
  3. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 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. Thyroid 2016;26:1-133 https://doi.org/10.1089/thy.2015.0020
  4. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedus L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules--2016 update. Endocr Pract 2016;22:622-639
  5. Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol 2016;17:370-395 https://doi.org/10.3348/kjr.2016.17.3.370
  6. Kamran SC, Marqusee E, Kim MI, Frates MC, Ritner J, Peters H, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab 2013;98:564-570 https://doi.org/10.1210/jc.2012-2968
  7. Kuru B, Gulcelik NE, Gulcelik MA, Dincer H. Predictive index for carcinoma of thyroid nodules and its integration with fineneedle aspiration cytology. Head Neck 2009;31:856-866 https://doi.org/10.1002/hed.21049
  8. Carrillo JF, Frias-Mendivil M, Ochoa-Carrillo FJ, Ibarra M. Accuracy of fine-needle aspiration biopsy of the thyroid combined with an evaluation of clinical and radiologic factors. Otolaryngol Head Neck Surg 2000;122:917-921 https://doi.org/10.1016/S0194-5998(00)70025-8
  9. Cavallo A, Johnson DN, White MG, Siddiqui S, Antic T, Mathew M, et al. Thyroid nodule size at ultrasound as a predictor of malignancy and final pathologic size. Thyroid 2017;27:641-650 https://doi.org/10.1089/thy.2016.0336
  10. Magister MJ, Chaikhoutdinov I, Schaefer E, Williams N, Saunders B, Goldenberg D. Association of thyroid nodule size and bethesda class with rate of malignant disease. JAMA Otolaryngol Head Neck Surg 2015;141:1089-1095 https://doi.org/10.1001/jamaoto.2015.1451
  11. Albuja-Cruz MB, Goldfarb M, Gondek SS, Allan BJ, Lew JI. Reliability of fine-needle aspiration for thyroid nodules greater than or equal to 4 cm. J Surg Res 2013;181:6-10 https://doi.org/10.1016/j.jss.2012.06.030
  12. McHenry CR, Huh ES, Machekano RN. Is nodule size an independent predictor of thyroid malignancy? Surgery 2008;144:1062-1068; discussion 1068-1069 https://doi.org/10.1016/j.surg.2008.07.021
  13. Park JW, Kim DW, Kim D, Baek JW, Lee YJ, Baek HJ. Korean Thyroid Imaging Reporting and Data System features of follicular thyroid adenoma and carcinoma: a single-center study. Ultrasonography 2017;36:349-354 https://doi.org/10.14366/usg.17020
  14. Jeh SK, Jung SL, Kim BS, Lee YS. Evaluating the degree of conformity of papillary carcinoma and follicular carcinoma to the reported ultrasonographic findings of malignant thyroid tumor. Korean J Radiol 2007;8:192-197 https://doi.org/10.3348/kjr.2007.8.3.192
  15. Na DG, Baek JH, Sung JY, Kim JH, Kim JK, Choi YJ, et al. Thyroid imaging reporting and data system risk stratification of thyroid nodules: categorization based on solidity and echogenicity. Thyroid 2016;26:562-572 https://doi.org/10.1089/thy.2015.0460
  16. Lee YH, Baek JH, Jung SL, Kwak JY, Kim JH, Shin JH. Ultrasound-guided fine needle aspiration of thyroid nodules: a consensus statement by the Korean Society of Thyroid Radiology. Korean J Radiol 2015;16:391-401 https://doi.org/10.3348/kjr.2015.16.2.391
  17. Sung JY, Na DG, Kim KS, Yoo H, Lee H, Kim JH, et al. Diagnostic accuracy of fine-needle aspiration versus coreneedle biopsy for the diagnosis of thyroid malignancy in a clinical cohort. Eur Radiol 2012;22:1564-1572 https://doi.org/10.1007/s00330-012-2405-6
  18. Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Thyroid 2009;19:1159-1165 https://doi.org/10.1089/thy.2009.0274
  19. Jung CK, Min HS, Park HJ, Song DE, Kim JH, Park SY, et al. Pathology reporting of thyroid core needle biopsy: a proposal of the Korean endocrine pathology thyroid core needle biopsy study group. J Pathol Transl Med 2015;49:288-299 https://doi.org/10.4132/jptm.2015.06.04
  20. Hammad AY, Noureldine SI, Hu T, Ibrahim Y, Masoodi HM, Kandil E. A meta-analysis examining the independent association between thyroid nodule size and malignancy. Gland Surg 2016;5:312-317 https://doi.org/10.21037/gs.2015.11.05
  21. Shin JJ, Caragacianu D, Randolph GW. Impact of thyroid nodule size on prevalence and post-test probability of malignancy: a systematic review. Laryngoscope 2015;125:263-272 https://doi.org/10.1002/lary.24784
  22. Meko JB, Norton JA. Large cystic/solid thyroid nodules: a potential false-negative fine-needle aspiration. Surgery 1995;118:996-1003; discussion 1003-1004 https://doi.org/10.1016/S0039-6060(05)80105-9
  23. Shrestha M, Crothers BA, Burch HB. The impact of thyroid nodule size on the risk of malignancy and accuracy of fineneedle aspiration: a 10-year study from a single institution. Thyroid 2012;22:1251-1256 https://doi.org/10.1089/thy.2012.0265
  24. Bohacek L, Milas M, Mitchell J, Siperstein A, Berber E. Diagnostic accuracy of surgeon-performed ultrasound-guided fine-needle aspiration of thyroid nodules. Ann Surg Oncol 2012;19:45-51 https://doi.org/10.1245/s10434-011-1807-z
  25. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab 2006;91:3411-3417 https://doi.org/10.1210/jc.2006-0690
  26. Deveci MS, Deveci G, LiVolsi VA, Gupta PK, Baloch ZW. Concordance between thyroid nodule sizes measured by ultrasound and gross pathology examination: effect on patient management. Diagn Cytopathol 2007;35:579-583 https://doi.org/10.1002/dc.20714
  27. Vaccarella S, Dal Maso L, Laversanne M, Bray F, Plummer M, Franceschi S. The impact of diagnostic changes on the rise in thyroid cancer incidence: a population-based study in selected high-resource countries. Thyroid 2015;25:1127-1136 https://doi.org/10.1089/thy.2015.0116
  28. Yeh MW, Demircan O, Ituarte P, Clark OH. False-negative fine-needle aspiration cytology results delay treatment and adversely affect outcome in patients with thyroid carcinoma. Thyroid 2004;14:207-215 https://doi.org/10.1089/105072504773297885

Cited by

  1. A Glimpse on Trends and Characteristics of Recent Articles Published in the Korean Journal of Radiology vol.20, pp.12, 2019, https://doi.org/10.3348/kjr.2019.0928
  2. Diagnostic performance of thyroid imaging reporting and data system (TI-RADS) alone and in combination with contrast-enhanced ultrasonography for the characterization of thyroid nodules vol.72, pp.1, 2018, https://doi.org/10.3233/ch-180457
  3. Similarities and Differences Between Thyroid Imaging Reporting and Data Systems vol.213, pp.2, 2018, https://doi.org/10.2214/ajr.18.20510
  4. Impact of thyroid nodule sizes on the diagnostic performance of Korean thyroid imaging reporting and data system and contrast-enhanced ultrasound vol.72, pp.3, 2019, https://doi.org/10.3233/ch-180545
  5. A Cohort Analysis of Clinical and Ultrasound Variables Predicting Cancer Risk in 20,001 Consecutive Thyroid Nodules vol.104, pp.11, 2019, https://doi.org/10.1210/jc.2019-00664
  6. Clinical and Ultrasound Thyroid Nodule Characteristics and Their Association with Cytological and Histopathological Outcomes: A Retrospective Multicenter Study in High-Resolution Thyroid Nodule Clinic vol.8, pp.12, 2018, https://doi.org/10.3390/jcm8122172
  7. Characteristics of Recent Articles Published in the Korean Journal of Radiology Based on the Citation Frequency vol.21, pp.12, 2020, https://doi.org/10.3348/kjr.2020.1322
  8. Accuracy of thyroid imaging reporting and data system category 4 or 5 for diagnosing malignancy: a systematic review and meta-analysis vol.30, pp.10, 2018, https://doi.org/10.1007/s00330-020-06875-w
  9. A Prospective Observational Study Assessing the Relationship Between Solitary Thyroid Nodule Size and Incidence of Malignancy vol.12, pp.11, 2020, https://doi.org/10.7759/cureus.11422
  10. Korean Thyroid Imaging Reporting and Data System: Current Status, Challenges, and Future Perspectives vol.22, pp.9, 2018, https://doi.org/10.3348/kjr.2021.0106
  11. 2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations vol.22, pp.None, 2021, https://doi.org/10.3348/kjr.2021.0713
  12. Diagnostic performance of core needle biopsy as a first‐line diagnostic tool for thyroid nodules according to ultrasound patterns: Comparison with fine needle aspiration using propensity score m vol.94, pp.3, 2018, https://doi.org/10.1111/cen.14321
  13. Incidence of microcarcinoma and non‐microcarcinoma in ultrasound‐found thyroid nodules vol.21, pp.1, 2018, https://doi.org/10.1186/s12902-021-00700-1
  14. Can sonographic features of microcalcification predict thyroid nodule malignancy? a prospective observational study vol.52, pp.1, 2021, https://doi.org/10.1186/s43055-021-00498-x