Thyroid nodule diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]
Overview
Diagnostic criteria
There is no definite diagnostic criteria for thyroid nodule. Different diagnostic methods can be used to diagnose thyroid nodules, based on their specific properties.
- The primary evaluation method that should be used in the thyroid patients is thyroid ultrasound. Thyroid ultrasound should be performed in all patients with a suspected thyroid nodule or nodular goiter on physical examination or with nodules incidentally noted on other imaging studies. Ultrasound diagnosis of malignant thyroid nodules if done based on marked hypoechogenicity, microcalcification and mixed central/peripheral or central Doppler colour flow pattern has sensitivity of 100 % and a specificity of 76 % were obtained in detecting malignant nodules using this criteria.[1]
- Subsequent evaluation is based upon the TSH level and sonographic features of the nodule(s)
- The malignancy diagnosis of thyroid nodules is based on cytology. Cytology is the primary determinant in thyroid nodule management, include thyroidectomy indication. After a suspicious to thyroid malignancy based on ultrasound features, fine needle aspiration biopsy (FNAB) is the most appropriate method for further evaluation. Overall sensitivity and specificity of the FNAB technique have been reported to be 83% and 92% respectively.[2]
- Thyroid function should be assessed in all patients with thyroid nodules.
- Thyroid scintigraphy is used to determine the functional status of a nodule. Scintigraphy utilizes one of the radioisotopes of iodine (usually 123-I) or technetium-99m pertechnetate. If available, radioiodine scanning is preferred. Studies suggest that with an uptake threshold of 15.2%, sensitivity and specificity of thyroid scinitigraphy are 82.4% and 69.0% respectively.[3]
Ultrasound indicating critera
- Suspected thyroid nodule
- Nodular goiter
- Radiographic abnormality
- Nodule found incidentally on computed tomography (CT) or magnetic resonance imaging (MRI)
- Thyroidal uptake on 18FDG-PET scan
Diagnostic approach
Abbreviations:
TSH: Thyroid stimulating hormone, FNA: Fine needle aspiration, FLUS: Follicular lesion of undetermined significance, AUS: Atypia of undetermined significance.
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References
- ↑ Lingam RK, Qarib MH, Tolley NS (2013). "Evaluating thyroid nodules: predicting and selecting malignant nodules for fine-needle aspiration (FNA) cytology". Insights Imaging. 4 (5): 617–24. doi:10.1007/s13244-013-0256-6. PMC 3781256. PMID 23712566.
- ↑ Maia FF, Zantut-Wittmann DE (2012). "Thyroid nodule management: clinical, ultrasound and cytopathological parameters for predicting malignancy". Clinics (Sao Paulo). 67 (8): 945–54. PMC 3416902. PMID 22948464.
- ↑ Hou H, Hu S, Fan R, Sun W, Zhang X, Tian M (2015). "Prognostic value of (99m)Tc-pertechnetate thyroid scintigraphy in radioiodine therapy in a cohort of Chinese Graves' disease patients: a pilot clinical study". Biomed Res Int. 2015: 974689. doi:10.1155/2015/974689. PMC 4387899. PMID 25879041.