• Korean Journal of Head & Neck Oncology
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• v.13 no.1
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• pp.30-34
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• 1997

Objectives: Calcification of the thyroid nodule has been reported to have a close relationship with differentiated thyroid carcinoma, however there are limited studies on the relationship between the calcified thyroid nodule and thyroid malignancy. The authors studied the clinical significance of calcification within the thyroid nodule. Materials and Methods: There were total of 60 patients who underwent surgery for calcified thyroid nodules which were identified from plain neck X-ray, ultrasound and computed tomography during the period January 1991 to June 1996 at the Department of Otorhinolaryngology-Head and Neck Surgery of Korea University Hospital. Six patients were not included because of recurrence and previous thyroid surgery. Histopathologic and radiologic analysis was done on the remaining 54 patients. Results: Results showed that 25 of 54 cases(46%) to be malignant histopathologically. Of the 25 malignant cases, papillary carcinoma was the most common with 22 cases followed by 2 cases of undifferentiated carcinoma and I case of medullary carcinoma. Statistically high incidence of malignancy was observed when the consistency of calcified thyroid nodule was solid, shape of calcification was irregular and inhomogenous, and adhesion of calcified thyroid nodule to the regional structure was present. Conclusion: The probability that a thyroid nodule is malignant has been reported to be 3­20%. However, about half of the thyroid nodules with calcification found to be malignant on this study, calcification of the thyroid nodule can be used as a guideline for detecting thyroid malignancy.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.11
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• pp.6331-6335
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• 2013

Objective:To evaluate the performance of combined quantitative analysis of thyroid blood flow and static imaging data in the differential diagnosis of thyroid nodules. Method: Thyroid blood flow and static imaging were performed in 165 patients with thyroid nodules. Patients were divided into a benign thyroid nodule group (BTN, n=135) and a malignant thyroid nodule group (MTN, n=30) based on the results of post-surgical pathologic examination. Carotid artery thyroid transit times (CTTT), perfusion ratio of thyroid nodule blood/thyroid blood (TNB/TB), and perfusion ratio of thyroid nodule blood/carotid artery blood (TNB/CAB) were measured using thyroid blood flow imaging. The ratios between thyroid nodule and ipsilateral submandibular gland (TN/SG) and thyroid nodule and normal thyroid tissue (TN/T) were measured from thyroid static imaging. The differences between the BTN and MTN groups were compared. Results: 1) CTTT was markedly lower in the MTN group than the BTN group, the difference being statistically significant. 2) TNB/TB and TNB/CAB were both significantly higher in MTN than BTN groups. 3) TN/T was significantly lower in MTN group than BTN group. 4) TN/SG was lower in MTN group than BTN group, but the difference was not statistically significant. 5) Using the combination of CTTT and TN/T, the sensitivity, specificity and accuracy were 93.1%, 95.3% and 94.9% respectively for the diagnosis of MTN. Using the combination of CTTT, TNB/TB and TN/T, the sensitivity, specificity and accuracy changed to 89.7%, 100%, and 98.1% respectively. 6) Correlation analysis demonstrated a significant correlation between TN/T and TNB/TB (r=-0.384, P=0.036) and TNB/CAB (r=-0.466, P=0.009) in the MTN group. Conclusion: The combination of quantitative markers from thyroid blood flow and thyroid static imaging had high specificity and accuracy in differential diagnosis of benign and malignant thyroid nodules, thus providing an important imaging diagnostic approach.

• Korean Journal of Head & Neck Oncology
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• v.9 no.2
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• pp.234-243
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• 1993

The thyroid nodules are the most common endocrine disease requiring surgical management. Up to date, various diagnostic techniques and surgical management have been developed. Authors analysed 2285 cases of thyroid nodules who were treated at Department of Surgery, Pusan National University for the duration of 10 years from January 1980 to December 1989 and the results obtained were summerized as follows: 1) Patients were composed of 1727 cases(75.8%) of benign nodule and 558 cases(24.5%) of malignant nodule. Benign nodule was prevalent in forth and fifth decade comparing with malignant nodule was sixth and fifth decade. The sexual distribution revealed female preponderance with 1:10.8 in benign nodule and 1:9.3 in malignant nodule. 2) The histopathologic classfication of benign nodule in decreasing order of frequency were follicular adenoma 1009 cases(54.8%), adenomatous goiter 573 cases(33.3%), simple cyst 65 cases(3.8%), and Hashimoto's thyroiditis 52 cases(3.0%). The malignant disease were papillary adenocarcinoma 460 cases(82.4%), follicular adenocarcinoma 69 cases(12.4%), undifferentiated carcinoma 13 cases (2.0%), and medullary carcinoma 7 cases(1.0%). 3) Fine needle aspiration cytology was performed in 1758 cases and it showed 80.5% of sensitivity, 96.5% of specificity, 19.5% of false negative and 80% of accuracy. 4) The location of nodule was 87.7%, in unilateral, 12.2% in bilateral. 5) On the radioiodine scanning, the incidence of benign nodule with cold nodule was 83.9% and the incidence of benign nodule with hot nodule was 7.5%. The incidence of thyroid carcinoma with cold nodule was 88.3% and the incidence of thyroid carcinoma with hot nodule was 4.6%. 6) Most cases of benign nodules were treated with lobectomy 82.6%, subtotal thyroidectomy 10.1% and subtotal lobectomy 3.0%. Malignant nodules were treated with lobectomy and/or isthmusectomy 37.6%, total thyroidectomy 17.7%, subtotal thyroidectomy 15.4%, and any thyroidectomy and neck dissection 13.5%. 7) Postoperative complications were developed in 3.8% of benign nodules and 13.8% of malignant nodules.

• Korean Journal of Head & Neck Oncology
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• v.10 no.2
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• pp.91-101
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• 1994

Nodular thyroid disease is a common clinical problem. The problem in clinical practice is to distinguish malignant or potentially malignant tumor from harmless nodules. The cases of thyroid nodule surgically managed at Department of General Surgery, Soon Chun Hyang Univ. Hospital during the period Jan. 1985 to July. 1992 were reviewed retrospectively. To assess method of distinguishing malignant from benign lesions of the thyroid gland, we reviewed 162 patients with thyroid nodule. There were 61(37.7%) malignant nodules and 101(62.3%) benign nodules. According to the review, distinguishing the benign from the malignant nodule with history, physical examination, clinical manifestation, and duration of illness was not suggested sufficiently. In ultrasonogram of 73 cases, 57.5% of nodules were solid, 20.6% were cystic, 21.9% were mixed solid and cystic. Of these, 28.5% of the operated solid lesions, 12.5% of the mixed lesions, and only 6.7% of the cystic lesions were malignant. Thyroid scanning of 82 cases revealed cold nodules in 60 patients(73.2%), of which 26 cases were malignant(36.6%) 137 patients underwent fine needle aspiration cytology(FNAC), and these results were as follow: sensitiviey was 70.6%, specificity was 93.0%, false-positive rate was 14.3%, and false-negative rate was 15.8%. 41 patients underwent frozen biopsy, and the results as follow: sensitivity was 80.0%, specificity was 89.7%. Neither scintigraphy nor ultrasonogram has sufficient specificity to distinguish benign from malignant nodule. But FNAC and frozen biopsy have sufficient accuracy to differentiate benign from malignant nodule. In the benign nodules, the most common type of operation was total lobectomy (60.4%). Of the malignant nodules, total thyroidectomy with or without modified radical neck dissection was performed in 30 cases(49.2%). We conclude that the single technique used to determine the differential diagnosis of a thyroid nodule are unrealiable. It is therefore essential to combine all avaiable clinical and laboratory information.

• Korean Journal of Head & Neck Oncology
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• v.8 no.2
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• pp.82-90
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• 1992

A pathologic review was made of 1547 cases of thyroid nodule during the 20 years from 1970 to 1989 at the department of Head and Neck surgery of Presbyterian Medical Center in Chonju. 1547 cases were analysed in regard to cancer incidence of thyroid nodule, correlation of preoperative diagnosis with pathology and of frozen section diagnosis with final pathology, surgical procedures employed in managing thyroid itself, location of metastatic nodes, further definite procedure in cnacer cases, effectiveness of prophylactic neck dissection with lymph node pathology. The results are summarized as follows: 1) The cancer incidence of thyroid nodule was 21.7%. 2) The incidence of thyroid cnacer in total neoplasms increased from 1.6% to 2.9%. 3) The thyroid cancer was prevalent in female(5.9:1) and in fifth, fourth and sixth decade of life. 4) The incidence of solitary cold nodule in thyroid cancer was 72.7% (210/289). S) The incidence of thyroid cancer in solitary cold nodule was 28.7% (210/782). 6) The false negative of frozen section (1240 cases) was 19.8%. 7) Histologically, well differentiated carcinoma comprises about 94% of all cases and papillary carcinoma was 78.5% of all cases 8) The most frequent lymphatic metastasis was pre- & paratrachel nodes(63.3%), followed by Level III(50%) and Level II(47.7%). 9) 47.7% among 130 cases of papillary adenocarcinoma and 12.5% among 16 cases of follicular adenocarcinoma, each group treated with prophylactic neck dissection, were confirmed to be occult cervical node metastasis.

• Korean Journal of Head & Neck Oncology
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• v.15 no.1
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• pp.66-69
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• 1999

Background and Objectives: It is critical to distinguish benign from malignant thyroid nodule and to select a patient for surgery. Even though the U/S study dose not make great contribution to diagnose a malignant thyroid nodule, it is widely used in the evaluation of anatomic feature of thyroid. The authors tried to estimate the efficacy of the U/S study in preoperative diagnosis of malignant thyroid nodule. Materials and Method: At the department of General Surgery of Ajou University, 75 patients who were operated after diagnosis with thyroid nodule by U/S study between July 1996 to June 1997 were retrospectively analyzed. By comparing the U/S impression that implies malignant thyroid nodule to FNAC and post-operative pathologic results ware as follows. Results: 1) Absence of cystic change, presence of internal hypoechogenicity, lobulation, calcification, thick and irregular halo, and nodule more than 4cm in diameter on U/S were considered significant statistically for the diagnosis of malignancy(Chi-square test, p<0.05) 2) Presence of internal hypoechogenicity or thick and irregular halo has the validity in Logistic regression analysis. 3) FNAC was done in 65 case. 19 case were malignant, 11 case were suspicious and 46 patients were benign (sensitivity 52.6%, specificity 87%). 4) The findings of U/S which are hypoechogenic and thick and irregular halo show 82% sensitivity and 97% specificity. In combination with the findings of FNAC that imply benign or suspicious lesions, the sensitivity was 100% and the specificity was 97%. Conclusion: This study suggest that the hypoechogenicity and thick and irregular halo on U/S are important information for the diagnosis of thyroid malignancy which were considered benign or suspicious after FNAC.

• Investigative Magnetic Resonance Imaging
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• v.19 no.4
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• pp.224-230
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• 2015

Purpose: To determine whether we should recommend ultrasonography (US) for an incidental thyroid nodule identified by additional cervicothoracic sagittal T2-weighted image (C-T sag T2WI) of lumbar spine magnetic resonance imaging (MRI). Materials and Methods: A retrospective study of 61 patients who underwent both lumbar spine MRI and thyroid US between December 2011 and April 2015 was conducted. For all US-found thyroid nodules > 1 cm, investigators evaluated whether there was any correlation between thyroid nodule detectability by C-T sag T2WI and US features such as echogenicity, composition, or suspicion of malignancy. Results: Solid hypoechoic (2/4; 50%) or mixed echoic nodules (4/8; 50%) appeared to be found relatively more easily by C-T sag T2WI than more benign-looking solid isoechoic (1/4; 25%) or spongiform nodules (0/6; 0%). Among six nodules with ultrasonographic suspicion for malignancy, only one nodule was detected by C-T sag T2WI. Conclusion: If an incidental thyroid nodule is seen by C-T sag T2WI, it would be better to recommend thyroid US for identifying malignancy.

• The Korean Journal of Nuclear Medicine
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• v.35 no.4
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• pp.286-287
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• 2001

A 44 year-old male patient was undergoing diagnosis and therapy for acute myelogenous leukemia (AML, M2). On physical examination a thyroid mass was palpated in the left lower lobe. He had palpitation and intolerance to heat. Thyroid function tests revealed hyperthyroidism; T3: 150ng/dl (N:60-90), fT4: 2.26 ng/dl (N:0.70-1.80), TSH: 0.01 ulU/ml (N:0.25-5.00). Ultrasonography demonstrated a hypoechoic mass with scattered calcifications measuring 2.55 2.03 3.64 cm in size. F-18 FDG camera-based PET scan performed as a follow-up study of AML revealed a focal increased uptake in the left neck, where an autonomous nodule was detected on Tc-99m thyroid scan. After the diagnosis of toxic autonomous nodule, Goetz disease, he underwent surgical nodulectomy. Microscopically, the nodule contained follicular proliferation with degenerative change but without evidence of thyroid carcinoma. Focal uptake in autonomous thyroid nodules is due to increased glycolysis within the nodules.

• Journal of radiological science and technology
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• v.42 no.3
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• pp.201-207
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• 2019

The purpose of this study was to evaluate the prevalence of thyroid nodules and malignant findings of thyroid nodules in 1,954 patients (654 males and 1,300 females) aged 20 years or older who underwent thyroid ultrasound from January 2018 to December 2018. Examination of the thyroid gland was performed, and fine needle aspiration cytology was performed on the thyroid nodule. As a result, 108 (16.5%) out of 654 males and 368 (28.3%) out of 1,300 females showed higher prevalence than males. The prevalence of single nodules and multiple nodules in gender and age groups was significantly higher for women and for ages (male p=.001, female p=.001). There was a significant difference in males in the nodule size (p=.001) and no significant difference in females (p=.069). Fine - needle aspiration cytology of 476 patients with nodules was diagnosed as malignant in 46 patients (9.6%). Based on pathologic results, 383 benign and 93 malignant groups were analyzed. Ultrasonographic findings were as follows single nodule (p=.000), solid(p=.004), hypoechoic (p=.000), ill-defined peripheral boundary (p=.000), and calcification (p=.000), respectively. In the diagnosis of thyroid nodule, primary ultrasonographic findings through morphological classification of the nodules may reduce indiscriminate fine needle aspiration cytology in benign and malignant nodules.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.2
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• pp.855-860
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• 2014

Background: The purpose of this study was to assess the relationship between different sonographic features of papillary thyroid carcinoma (PTC) on high-frequency ultrasound and cervical lymph node metastasis (CLNM). Materials and Methods: We enrolled 548 patients who underwent initial surgery for PTC between May 2011 and December 2012 in our hospital at diagnosis. The sonographic features of 513 PTC nodules in 513 eligible patients, who had single PTC nodules in their thyroid glands, were retrospectively investigated. All patients with a suspect malignant nodule (d<0.5cm) among multiple nodules were initially diagnosed by fine-needle aspiration biopsy (FNAB) to ascertain if the suspect nodule was PTC. The final diagnosis of all the thyroid nodules and existence of CLNM were based on postoperative pathology. Patients were divided into two groups: a positive group with CLNM (224 nodules) and a negative group without CLNM (289 nodules). The following factors were investigated: gender, age, echogenicity, echotexture, size, shape, location, margin, contour, calcification morphology, distance between the nodule and pre- or post-border of the thyroid capsule, vascularity and the differences between the two groups. Results: Correlation analysis showed that shorter distances between the nodule and pre- or postborder of thyroid capsule resulted in greater risk of CLNM (Spearman correlation coefficient=-0.22, p<0.0001). The significant factors in multivariate analysis were age<45yrs, larger size (d>1cm), "wider than tall" shape, extrathyroid extension and mixed flow (internal and peripheral) (p<0.05, OR=0.406, 2.093, 0.461, 1.610, 1.322). Conclusions: Significant sonographic features of PTC nodules in preoperative high-frequency ultrasound are crucial for predicting CLNM.