thyroid nodule wider than tall cancerstricklin-king obituaries

The Journey is a blog that addresses the unique hurdles each person faces. Previous studies have examined the correlation between malignancy and nodule size (25,26). Thyroid nodules can be solid, cystic (fluid-filled), or have mixed cystic/solid components. Using a subset of this cohort, we previously conducted a study to compare the diagnostic performance of 5 sonographic stratification systems and to evaluate the role of nodule location, and those results have already been reported [18, 19]. government site. The 2015 American Thyroid Association (ATA) guidelines recommend that only patients with a TSH level below the normal range should undergo a radionuclide test to establish whether there is an overactive gland or a hyperfunctioning nodule.1 Iodine-123 (123I) is the recommended radionuclide; however, in Australia, imaging with technetium-99m pertechnetate(99mTc) is more accessible, easier, faster and less expensive to perform. Patients with very low suspicion of thyroid malignancy based on ultrasound features are only considered candidates for a biopsy when a nodule is greater than or equal to 2cm in size. These studies included large nodules (>3 cm) and size correlated with the FNAB results and other US findings but not with the shape as evaluated in our study. Different classification systems have been developed to predict a thyroid nodules risk of malignancy based on the nodules characteristics on ultrasound imaging. J Nucl Med 1990;31(4):39399. Revised value of contrast-enhanced ultrasound for solid hypo-echoic thyroid nodules graded with thyroid imaging reporting and data system. Bethesda, MD 20894, Web Policies Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. The purpose of this study was to evaluate whether a nodule with a taller-than-wide shape (ie, an anteroposterior diameter that is longer than the transverse diameter on a transverse or longitudinal plane [anteroposterior-to-transverse ratio] >1) is a good predictor of papillary thyroid carcinoma (PTC) according to nodule size. Overview Over time, we have seen an increase in the detection of thyroid nodules; much of this can be attributed to the increased use of sensitive imaging modalities for unrelated conditions that capture the neck and thyroid region. On the other hand, the sensitivity of each sonographic system and the overall diagnostic accuracy, evaluated according to the AUROC, did not significantly change. A thyroid biopsy is called fine-needle . The majority of thyroid nodules encountered in general practice will have benign cytology and can be monitored with a repeat ultrasound scan at a time interval determined by the sonographic features (Figure 2). The medical records of these patients were reviewed for demographics and thyroid nodule imaging and pathology results. government site. Univariate and multivariable logistic regression analyses were performed to determine the independent effects of sonographic variables associated with thyroid nodule malignancy using the Wald backward-selection method. Zheng LL, Ma SY, Zhou L, Yu C, Xu HS, Xu LL, Li SY. These cookies will be stored in your browser only with your consent. Methods: (21) found that microcalcifications were a stronger predictor of papillary carcinoma among other US features, following by nodule shape. Analytical cookies are used to understand how visitors interact with the website. Study design: Retrospective cohort study. Websites, online advocacy groups and forums. General Lamartina L, Deandreis D, Durante C, Filetti S. ENDOCRINE TUMOURS: Imaging in the follow-up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach. 2022 Sep 13;2022:5056082. doi: 10.1155/2022/5056082. 8 b) . The authors have no conflicts of interest to declare. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The shape thus obtained was entered into each of the five risk stratification systems to estimate each nodule's likelihood of malignancy and whether or not it required FNAC. If concern arises about the possibility of cancer, the doctor may simply recommend monitoring the nodule over time to see if it grows. Diagnostic performance of artificial intelligence-based computer-aided diagnosis system in longitudinal and transverse ultrasonic views for differentiating thyroid nodules. The good news is that this is actually quite rare. However, since the sound waves cannot travel through bone, ultrasounds are not used for imaging of structures located deep in the chest, face, or head. This article is an overview of ultrasonographic features of thyroid nodules, which are used to determine the need for biopsy with fine needle aspiration. Its free for personal use and to share with others you think might benefit from the information provided. The new recommendation is that all cytology results should be reported using the Bethesda system for classification of thyroid nodules, which aligns with the Thy classification system adopted by the Royal College of Pathologists in the UK.5 This classification provides an estimate of the malignancy risk for each category and provides a recommended management plan. A non-diagnostic or unsatisfactory test should have a repeat ultrasound-guided FNA or be referred onfor further assessment. New York: Humana Press, 2018. Accuracy of Ultrasound Diagnosis of Benign and Malignant Thyroid Nodules: A Systematic Review and Meta-Analysis. An intraobserver variability of up to 18% in AP diameter evaluations has been described, which may lead to overreporting of this feature. Thus, as a single feature, the arbitrary definition has a lower sensitivity and a higher specificity. Patients and Methods: This was a retrospective single-center study investigating the association of the morphological characteristics of nodular goiters from preoperative US and color Doppler images with malignancy based on pathology. 2015 May;25(5):538-50. doi: 10.1089/thy.2014.0353. Taller-than-wide nodule shape had a much higher OR than microcalcifications (33.8 vs. 6.7), whereas intranodular vascularity or ill-defined margins were not enough to determine a high risk of malignancy, as previously described (22). Inflammatory, Papillary Participants were recruited in the thyroid cancer unit of an academic healthcare center. ScoreLevelInterpretationSuggested Action0 pointsTIRADS 1Benignno FNA2 pointsTIRADS 2Not suspiciousno FNA3 pointsTIRADS 3Mildly suspiciousFNA if > 2.5 cm Follow if > 1.546 pointsTIRADS 4Moderately suspicious FNA if > 1.5 Follow if > 1 7 pointsTIRADS 5Highly suspiciousFNA if > 1 cm Follow if > 0.5. 2023 Feb 14;14:1137700. doi: 10.3389/fendo.2023.1137700. Epub 2022 Jul 19. These parameters were compared with the McNemar test [20]. Ultrasonography plays pivotal roles in the management of thyroid nodules [23] by identifying those requiring FNA cytology [1, 3] and guiding decisions on long-term follow-up strategies [1, 3]. If we looked at the population of the world we would find that about 20 to 70% of people (1) have a thyroid nodule! Eun NL, Yoo MR, Gweon HM, Park AY, Kim JA, Youk JH, Moon HJ, Chang HS, Son EJ. contributed to this paper as part of their PhD studies in Biotechnologies and Clinical Medicine at the University of Rome, Sapienza. In nodules with echogenic foci, the taller than wide shape (p = 0.026), spiculated margin (p < 0.001), marked . Background WHAT ARE THE IMPLICATIONS OF THIS STUDY? official website and that any information you provide is encrypted Our blog addresses the unique hurdles each person faces. A "taller-than-wide" shape is associated with thyroid malignancy, but taller-than-wide in which plane is most accurate is unclear. Furthermore, the Thyroid Imaging Reporting and Data System, which is applied primarily to exclude a thyroid malignant lesion, until now is not widely accepted to allow the clinicians for a proper therapeutic decision (18). Suggested algorithm for the initial management of thyroid nodules in general practice1 Thyroid nodules are also classified according to their shape, and are broken into categories: taller than wide or wider than tall. Goksuluk D, Korkmaz S, Zararsiz G, Karaagaoglu AE. Ultrasounds are almost always used to evaluate thyroid nodules, and are also often used to examine lymph nodes in the surrounding area. Feel free to download and print this page. a This nodule would fulfill the current definition only (TTW ratio = 1.15); however, applying TIRADS, it would still be submitted to biopsy, being predominantly solid, partially hypoechoic, with lobulated margins. The other 3 nodules had cytological diagnoses of malignancy (TIR5, n = 1) or suspected malignancy (TIR4, n = 2) and were managed with active surveillance following patient preferences. Larger or aggressive cancerous nodules require removal of the whole thyroid and sometimes subsequent radioactive iodine . Usefulness of ultrasonography in the management of nodular thyroid disease. An official website of the United States government. For the present analysis, each nodule was classified as TTW or non-TTW using two definitions: the first based on the currently accepted AP/T diameter ratio threshold for TTW (AP/T >1.0), the second an arbitrarily selected alternative consisting of an AP/T diameter threshold of >1.2; Fig. Kusi Z, Becker DV, Saenger EL, et al. eCollection 2022. Rago T, Scutari M, Loiacono V, Santini F, Tonacchera M, Torregrossa L, Giannini R, Borrelli N, Proietti A, Basolo F, Miccoli P, Piaggi P, Latrofa F, Vitti P. Low elasticity of thyroid nodules on ultrasound elastography is correlated with malignancy, degree of fibrosis and high expression of galectin-3 and fibronectin-1. Thyroid nodules are categorised into five groups based on the sonographic pattern that provides an estimate of the malignancy risk and FNA guidelines (Table 2). The images will show up on a computer screen in real-time and the technician will likely move the probe around at different angles in order to get enough images of all the relevant structures. Moon JH, Hyun MK, Lee JY, Shim JI, Kim TH, Choi HS, Ahn HY, Kim KW, Park DJ, Park YJ, Yi KH. Endokrynol Pol. New York: Elsevier Inc, 2013; p. 11. Figure 1. In conclusion, the current study emphasizes that among the important indicators of thyroid malignancy, taller-than-wide nodules with microcalcifications are most likely to be malignant and surgical treatment should be considered for these patients. Study on diagnosis of thyroid nodules based on convolutional neural network. Re-defining TTW nodules as those with an AP/T ratio 1.2 improves this marker's specificity for malignancy. This study shows that an ultrasound finding of taller-than-wide in a nodule increases the possibility that the nodule is cancerous and should prompt further evaluation with fine needle aspiration biopsy. These considerations suggested that a slightly higher AP/T diameter ratio threshold for TTW nodules might improve the specificity of risk stratification systems in ruling out malignancy and, in particular, in pinpointing nodules for which FNAC can safely be deferred. Conclusions: An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. In: Surgery of the thyroid and parathyroid glands. This might mean that smaller nodules with taller-than-wide shape are more often malignant than larger ones. Again, many studies evaluated the US findings by comparison with the cytological results after FNAB (16-18) but several factors can affect the diagnostic accuracy of FNAB, such as the experience of physicians in its performance, sampling error, non-diagnostic reports or cytological atypia of undetermined significance (19). International patterns and trends in thyroid cancer incidence 1973-2002. Huang K, Gao N, Zhai Q, Bian D, Wang D, Wang X. Franco C, Niedmann JP, Castro A, et al. Ultrasounds are dynamic, meaning that the technician can see the images while performing the test and can focus on areas of concern. Liu Y, Wu H, Zhou Q, Gou J, Xu J, Liu Y, Chen Q. Conclusion: Among the important indicators of thyroid malignancy, taller-than-wide nodules with microcalcifications are most likely to be malignant. TALLER-THAN-WIDE SHAPED THYROID NODULES IN ANY PLANE HAVE AN INCREASED RISK OF THYROID CANCER and2011;21:1249-53.longitudinalHJ, Kwak JY, EpubultrasonographicATaller-than-wide shape in thyroid nodules in transverse planes and the prediction of malignancy . They can travel through soft tissue and fluids, but they bounce back off of denser structures, such as bone. Aviva S . They can travel through soft tissue and fluids, but they bounce back off of denser structures, such as bone. In particular, the proposed definition increased the malignancy rate of the highest risk class of all classifications. b This nodule would fulfill the arbitrary definition (TTW ratio = 1.35). While the majority of patients will be euthyroid, a suppressed TSH level indicates a hyperfunctioning nodule, which t, if confirmed, has an exceedingly small risk of malignancy.1 Further evaluation of a patient with suppressed TSH levels is best managed by an endocrinologist. The study described below was undertaken to explore this possibility. Thyroid 2012;22(9):91825. A little inspiration can go far. Regarding multinodular lesions, only nodules more than 6 mm were finally evaluated. While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Accessibility Children and teenagers have unique interests and learn differently compared to adults. Reduction in Thyroid Nodule Biopsies and Improved Accuracy with American College of Radiology Thyroid Imaging Reporting and Data System. JAMA 2015;313(9):92635. Overall, 917 thyroid nodules were sonographically evaluated prior to biopsy. Hoang JK, Middleton WD, Farjat AE, Langer JE, Reading CC, Teefey SA, et al. Role of conventional ultrasonography and color flow-doppler sonography in predicting malignancy in cold thyroid nodules. Get great advice and inspiration from others on a similar journey. material, see www.karger.com/doi/10.1159/000504219), the five sonographic systems most widely used to estimate the probability of thyroid nodule malignancy define TTW nodules as those with an anteroposterior (AP) diameter that exceeds the transverse (T) diameter [1, 2, 3, 4, 5], without specifying any minimum magnitude for the excess. Taller-than-wide shape is considered an insensitive but highly specific indicator of malignancy (9, 15-18), especially in sub-centimeter thyroid nodules (15, 16), and it is assigned more points (3 points) in ACR TI-RADS to reflect an association with malignancy . Endocrine. Grani G, Lamartina L, Ascoli V, Bosco D, Biffoni M, Giacomelli L, et al. As the probability of a first diagnosed nodule being malignant is almost 7% (4), it is important for the clinician to be able to accurately distinguish between benign and malignant nodules in order to make the best clinical decision and minimize unnecessary surgical procedures. These points are added together to provide a score that determines the risk of cancer in a nodule. Since an intraobserver variability of up to 18% has been reported for the AP diameter evaluation, we proposed that the TTW shape be defined as an AP/T diameter ratio of 1.2 (i.e., the AP diameter is at least 20% greater than the T diameter). 2023 Aug;81(2):306-315. doi: 10.1007/s12020-023-03358-y. This cookie is used for counting the new visitors to the website by assigning a unique visitor ID. During an ultrasound, a technician or a radiologist will place ultrasound gel over the area being examined. Nodules were considered malignant if they were classified as TIR4 or TIR5 (suspected malignancy or malignancy, similar to Bethesda classes V and VI [14]), and benign if they were classified as TIR2, comparable to Bethesda class II. This website uses cookies to improve your experience while you navigate through the website. The primary goal of a GP is to differentiate between a benign and a malignant nodule. Let us know if you'd like us to cover more on a particular topic. *Giorgio Grani, MD, PhD, Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, IT00161 Rome (Italy), E-Mail. Setting: All study information was collected from a single academic tertiary care hospital. In conclusion, adopting an arbitrary definition of TTW as an AP/T diameter ratio 1.2 would reduce the number of indicated biopsies according to five widely used sonographic risk stratification systems and improve specificity without negatively influencing overall diagnostic performance. The final diagnosis was based on histopathology in 145 nodules in 120 patients, and cytology in the remaining patients. Patients with low, intermediate, or high risk of malignancy are biopsied when a nodule is greater than or equal to 1 cm in size. The site is secure. 1 They are palpable in 4-7% of the population and have been detected using ultrasonography in up to 67% of adults. Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. Niedziela M, Breborowicz D, Trejster E, Korman E. Hot nodules in children and adolescents in western Poland from 1996 to 2000: Clinical analysis of 31 patients. If a nodule is present within the thyroid gland, it will generally be visible on ultrasound imaging, and its appearance will be evaluated in order to gain clinical information about the nodule itself. Considering the final histology or follow-up, the presence of microcalcifications or taller-than-wide shape was strongly related with malignancy (43.5% in malignant vs. 25.2% in benign), whilst the combination of solid, isoechoic/hyperechoic, wider-than-tall, and smooth margins without calcifications was prevalent in benign cases (37.2% in . Also see your doctor if you have signs and symptoms that may mean your thyroid gland isn't making enough thyroid hormone (hypothyroidism), which include: Feeling cold. This site needs JavaScript to work properly. The sensitivities and specificities according to different cutoff values of the AP/T ratio to define TTW shape are plotted in online supplementary Figure 2. PMC J Clin Endocrinol Metab. Clinical examination should involve inspection and palpation of the thyroid gland and examination of the cervical lymph nodes. Thyroid. Zhang S, Zhao J, Xin XJ, Wang HL, Wei X, Zhao LH. Shin JH, Baek JH, Chung J, Ha EJ . Hyperplastic Ramundo V, Lamartina L, Falcone R, Ciotti L, Lomonaco C, Biffoni M, et al. Ultrasonography scoring systems can rule out malignancy in cytologically indeterminate thyroid nodules. High-resolution ultrasonography (US) is a powerful tool for detecting thyroid lesions and identify nodules even with a size of a few millimeters (4,5). Video content with easy-to-digest information. All analyses were performed using SPSS version 23.0 (IBM, Armonk, NY, USA). Predictive Value of Malignancy of Thyroid Nodule Ultrasound Classification Systems: A Prospective Study. Does the ACR TI-RADS scoring allow us to safely avoid unnecessary thyroid biopsy? Classification of a nodule as TTW alone predicted a reference diagnosis of malignancy with 26.2% sensitivity (95% CI 13.942.0) and 83.8% specificity (95% CI 80.386.8) when the current definition of TTW was used. None of the benign nodules with taller-than-wide shape had microcalcifications, increasing the specificity to 100%. Thyroid cancer does not behave more aggressively during pregnancy, and age-matched, non-pregnant women have a similarly excellent prognosis.10 These patients should be referred to a thyroid surgeon for discussion regarding delaying surgery or timing surgery to minimise fetal and patient risks. Italian consensus for the classification and reporting of thyroid cytology. 1). Continuous variables were compared using the Mann-Whitney U-test, while discrete variables were compared using the chi-square or Fisher's exact test, as appropriate. The current and proposed definitions have a sensitivity of 26.2 and 11.9% (p = 0.03) and a specificity of 83.8 and 95.5% (p < 0.001). Int J Clin Pract. Practice, Formerly Australian Family Physician (AFP). Hong MJ, Lee YH, Kim JH, Na DG, You SH, Shin JE, Kim SK, Yang KS; Korean Society of Thyroid Radiology. Ultrasound can help evaluate a thyroid nodule and determine the need for biopsy. We included patients with a nodular goiter who underwent routine preoperative US followed by total thyroidectomy between January 2012 and December 2017. Received 2020 Mar 14; Accepted 2020 Apr 8. Criterion 1 showed high sensitivity (68%) and negative predictive value (87.7%), whereas criteria 2 and 3 showed high specificity (83.5% and 94.5%, respectively). Nam SJ, Kwak JY, Moon HJ, Yoon JH, Kim EK, Koo JS. Before MEN2 is associated with medullary thyroid cancer and FNMTC, which effects two or more first degree relatives and can occur in isolation or as part of a syndrome such as familial adenomatous polyposis, Cowdens syndrome, Gardners syndrome and Carneys complex type 1. Medullary Full details on the procedures used for sonographic assessment, risk stratification, and FNAC examination of the nodules have been published elsewhere [11, 17, 18]. Thyroid nodules are lumps that can develop on the thyroid gland. Because each thyroid nodule, regardless of the size, has a small risk of turning into thyroid cancer. The Diagnosis and Management of Thyroid Nodules: A Review. Thirty-nine nodules were histologically confirmed as anaplastic thyroid cancer (n = 1); follicular thyroid cancer (n = 1); follicular-variant papillary thyroid cancer (n = 6); medullary thyroid cancer (n = 2); papillary thyroid cancer (n = 26); and metastases from other solid tumors (n = 3). Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. Persichetti A, Di Stasio E, Guglielmi R, Bizzarri G, Taccogna S, Misischi I, et al. Liu J, Zheng D, Liq Q, Tang X, Luo Z, Yuan Z, Gao L, Zhao J. Necessary cookies are absolutely essential for the website to function properly. An official website of the United States government. Thyroid fine-needle aspiration biopsy: an evaluation of its utility in a community setting. Taller-than-wide shape compared to the other US features demonstrated the highest specificity, at 98%, for distinguishing malignant from benign thyroid nodules (Table III), reaching 100% when combined with the presence of microcalcifications (data not shown). Additionally, we found a strong negative correlation between size and taller-than-wide shape of a thyroid nodule (r=-0.41, p<0.001). Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. Lymphoma HHS Vulnerability Disclosure, Help We hypothesized that the mechanism of the "taller-than-wide sign" is no or minimal compressibility of a malignant thyroid mass by the ultrasound probe, whereas compressibility is seen more frequently in benign than malignant masses. For each sonographic risk stratification system, the indication for FNAC under each of the test conditions (i.e., current vs. proposed definition of TTW) was defined as a test positivity. The positive likelihood ratio of the arbitrary definition was 2.64 (95% CI 1.066.60), the negative likelihood ratio was 0.92 (0.821.03), and the diagnostic odds ratio was 2.87 (95% CI 1.037.98). FOIA Additionally, Capelli et al. For those assigned to high-risk classes, FNAC is generally recommended if the maximum diameter is 1 cm [1, 2, 3, 4, 5]. Received 2019 Sep 12; Accepted 2019 Oct 17. Keywords: comparative study , CT , sonography , thyroid cancer , thyroid nodule According to the presence of these features, thyroid nodules will be categorized into: very low, low, intermediate, and high risk of malignancy. Accessibility K.D.P: study concept and design, data analysis and interpretation, statistical analysis and article writing; H.J.K: study concept design, data analysis and interpretation and critical revision of the article; C.C.E., I.A.I., K.S.M., N.I.K. Management guidelines for both thyroid nodules and thyroid cancer have been published and updated by a number of societies internationally. To apply these systems, an essential prerequisite is the adoption of a uniform language and definition of suspicious features [6]. The risk of cancer increased with the size of nodule. Federal government websites often end in .gov or .mil. Many endocrinologists are now experienced in interpreting and performing thyroid ultrasonography and FNA and can offer expertise in interpreting indeterminate cytology. The quantitative evaluation, however, would avoid confusion about the TTW and taller-than-long shape (the latter is defined as an AP diameter longer than the longitudinal one) that some earlier studies considered a single entity (online suppl. Research studies and new treatments available. Objectives. A taller-than-wide (TTW) shape is a suspicious feature of thyroid nodules commonly defined as an anteroposterior/transverse diameter (AP/T) ratio >1. The anteroposterior nodule diameter might be suitable for assessing thyroid malignancy in microcarcinomas, with a critical value >0.7 cm (12). Thyroid nodules are common lesions and are being diagnosed with increasing frequency (1,2). Inclusion in an NLM database does not imply endorsement of, or agreement with, This classification system assigns points based on the presence of nodule characteristics. Thyroid cancer had a 2.9 times higher rate in women (female: male proportion 16.3 : 5.7) . Thyroid nodules have diverse presentations. Introduction: A taller-than-wide (TTW) shape is a suspicious feature of thyroid nodules commonly defined as an anteroposterior/transverse diameter (AP/T) ratio >1. Cytology was reported according to the Italian Consensus for Thyroid Cytopathology criteria [12, 13]. The positive likelihood ratio was 1.61 (95% CI 0.932.78), the negative likelihood ratio was 0.88 (95% CI 0.7331.06), and the diagnostic odds ratio was 1.83 (95% CI 0.883.78). The .gov means its official. In literature context in male sex and age lower than 20 and over 60 years are detailed to be related within a higher thyroid malignancy risk . Grani G, Lamartina L, Ascoli V, Bosco D, Nardi F, D'Ambrosio F, et al. Finally, the visual assessment of TTW shape is commonly used in clinical practice: this study is not able to compare the performance of a quantitative evaluation to a qualitative one. A strength of our study is that there were final pathological results for all nodules after thyroidectomy and there was no selection bias since all patients who had undergone operations were included, without exception, and this explains how the potential malignancy rate was higher in comparison with the non-operated on nodules.

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