Abstract
Purpose
To evaluate the performance of ultrasonography (US) and TI-201/Tc-99m dual (Tl/Tc) scintigraphy in differentiating between benign and malignant thyroid nodules.
Methods
Eighty-six patients diagnosed to have a thyroid tumor on postoperative histopathologic examination between June 2009 and February 2017 were included in this retrospective study. A radiologist reviewed the US and Tl/Tc scintigraphy reports along with all available clinical and histopathologic information. On Tl/Tc scintigraphy, a nodule in which uptake was higher in the delayed phase than in the surrounding parenchyma was defined as a delayed accumulation pattern and a nodule in which uptake was higher in the delayed phase than in the early phase was defined as a persistent pattern. The Tl/Tc scintigraphy images were evaluated in a blinded manner to assess reproducibility. A statistical analysis was performed to identify features associated with malignancy. Interobserver variability was calculated using the κ statistic.
Results
US had higher sensitivity (81.2%), specificity (88.2%), and positive (96.6%) and negative (53.6%) predictive values than Tl/Tc scintigraphy. An ill-defined margin and microcalcification were independent predictors of a malignant thyroid nodule on multivariate logistic regression (P = 0.003 and P = 0.014, respectively). The persistent pattern had high specificity (85.7%) equivalent to that of US but had lower sensitivity (34.7%). The κ values for the delayed accumulation and persistent patterns were 0.66–0.78 and 0.32–0.50, respectively.
Conclusions
An ill-defined margin and microcalcification on US were independent predictors of a malignant thyroid nodule. A persistent pattern seen on Tl/Tc scintigraphy could contribute to the differential diagnosis.
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References
S.I. Sherman Thyroid carcinoma. Lancet 361, 501–511 (2003)
J.R. Burgess Temporal trends for thyroid carcinoma in Australia: An increasing incidence of papillary thyroid carcinoma (1982–1997). Thyroid 12, 141–149 (2002)
H. Lim, S.S. Devesa, J.A. Sosa, D. Check, C.M. Kitahara Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. J. Am. Med. Assoc. 317, 1338–1348 (2017)
A. Koike, T. Naruse, Incidence of thyroid cancer in Japan. Semin. Surg. Oncol. 7, 107–111 (1991)
F. Suehiro, Thyroid cancer detected by mass screening over a period of 16 years at a health carecenter in Japan. Surg. Today 36, 947–953 (2006)
H. Miki, H. Inoue, K. Komaki, T. Uyama, T. Morimoto, Y. Monden, Value of mass screening for thyroid cancer. World J. Surg. 22, 99–102 (1998)
S. Ishigaki, K. Shimamoto, H. Satake, A. Sawaki, S. Itoh, M. Ikeda, T. Ishigaki, T. Imai, Multi-slice CT of thyroid nodules: Comparison with ultrasonography. Radiat. Med. 22, 346–353 (2004)
E.K. Kim, C.S. Park, W.Y. Chung, K.K. Oh, D.I. Kim, J.T. Lee, H.S. Yoo New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. Am. J. Roentgenol. 178, 687–691 (2002)
M. Miyakawa, N. Onoda, M. Etoh, I. Fukuda, K. Takano, T. Okamoto, T. Obara Diagnosis of thyroid follicular carcinoma by the vascular pattern and velocimetric parameters using high-resolution pulsed and power Doppler ultrasonography. Endocr. J. 52, 207–212 (2005)
M.C. Frates, C.B. Benson, P.M. Doubilet, E.S. Cibas, E. Marqusee Can color-Doppler sonography aid in the prediction of malignancy of thyroid nodules? J. Ultrasound Med. 22, 127–131 (2003)
N. Fukunari, M. Nagahama, K. Sugino, T. Mimura, K. Ito, K. Ito Clinical evaluation of color-Doppler imaging for the differential diagnosis of thyroid follicular lesions. World J. Surg. 28, 1261–1265 (2004)
N.M. Elsayed, Y.A. Elkhatib Diagnostic criteria and accuracy of categorizing malignant thyroid nodules by ultrasonography and ultrasound elastography with pathologic correlation. Ultrason. Imaging 38, 148–158 (2016)
A. Tamizu, Y. Okumura, S. Sato, Y. Takeda, K. Maki, T. Hiraki, S. Akaki, M. Kuroda, S. Kanazawa, Y. Hiraki The usefulness of serum thyroglobulin levels and T1-201 scintigraphy in differentiating between benign and malignant thyroid follicular lesions. Ann. Nucl. Med. 16, 95–101 (2002)
K. Maki, Y. Okumura, S. Sato, A. Yoneda, T. Kurose, T. Iguchi, S. Akaki, Y. Takeda, S. Kanazawa, Y. Hiraki Quantitative evaluation by TI-201 scintigraphy in the diagnosis of thyroid follicular nodules. Ann. Nucl. Med. 17, 91–98 (2003)
Y. Yamamoto, Y. Okumura, S. Sato, K. Maki, T. Mukai, H. Mifune, S. Akaki, Y. Takeda, S. Kanazawa, Y. Hiraki Differentiation of thyroid nodules using Tl-201 scintigraphy quantitative analysis and fine-needle aspiration biopsy. Acta Med. Okayama 58, 75–83 (2004)
E. Papini, R. Guglielmi, A. Bianchini, A. Crescenzi, S. Taccogna, F. Nardi, C. Panunzi, R. Rinaldi, V. Toscano, C.M. Pacella Risk of malignancy in nonpalpable thyroid nodules: Predictive value of ultrasound and color-Doppler features. J. Clin. Endocrinol. Metab. 87, 1941–1946 (2002)
T. Rago, P. Vitti Role of thyroid ultrasound in the diagnostic evaluation of thyroid nodules. Best Pract. Res. Clin. Endocrinol. Metab. 22, 913–928 (2008)
S. Bastin, M.J. Bolland, M.S. Croxson Role of ultrasound in the assessment of nodular thyroid disease. J. Med. Imaging Radiat. Oncol. 53, 177–187 (2009)
M. Appetecchia, F.M. Solivetti The association of colour flow Doppler sonography and conventional ultrasonography improves the diagnosis of thyroid carcinoma. Horm. Res. 66, 249–256 (2006)
H.J. Moon, J.Y. Kwak, M.J. Kim, E.J. Son, E.K. Kim, Can vascularity at power Doppler US help predict thyroid malignancy?. Radiology 255, 260–269 (2010).
P. Campanella, F. Ianni, C.A. Rota, S.M. Corsello, A. Pontecorvi, Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: A systematic review and meta-analysis. Eur. J. Endocrinol. 170, R203–R211 (2014).
B.R. Haugen, E.K. Alexander, K.C. Bible, G. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G.W. Randolph, A.M. Sawka, M. Schlumberger, K.G. Schuff, S.I. Sherman, J.A. Sosa, D.L. Steward, R.M. Tuttle, L. Wartofsky, American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 26, 1–33 (2015).
L.R. Ylagan, T. Farkas, L.P. Dehner, Fine-needle aspiration of the thyroid: A cytohistologic correlation and study of discrepant cases. Thyroid 14, 35–41 (2004).
G.M. Sclabes, G.A. Staekel, S.E. Shapiro, B.D. Fornage, S.I. Sherman, R. Vassillopoulou-Sellin, J.E. Lee, D.B. Evans, Fine-needle aspiration of the thyroid and correlation with histopathology in a contemporary series of 240 patients. Am. J. Surg. 186, 702–710 (2003).
T. Kishida, Mechanisms of thallium-201 accumulation in the thyroid gland-clinical usefulness of the dynamic study in thallium-201 chloride scintigraphy for the differential diagnosis of thyroid nodules. Kaku Igaku 24, 991–1004 (1987).
H. Ochi, H. Sawa, T. Fukuda, Y. Inoue, H. Nakajima, Y. Masuda, T. Okamura, Y. Onoyama, S. Sugano, H. Ohkita, Y. Tei, K. Kamino, Y. Kobayashi ThaIlium-20l-chloride thyroid scintigraphy to evaluate benign and/or malignant nodules: Usefulness of the delayed scan. Cancer 50, 236–240 (1982)
H. Sawa, H. Ochi, T. Okamura, M. Hata, T. Kobashi, H. Ikeda, T. Fukuda, J. Oda, InoueY, Y. Onoyama Thallium-201 thyroid scintigraphy of thyroid nodules—washout pattern of Tl-201 in thyroid nodules. Kaku Igaku 27, 757–764 (1990)
E. Henze, J. Roth, H. Boerer, W.E. Adam Diagnostic value of early and delayed 201Tl thyroid scintigraphy in the evaluation of cold nodules for malignancy. Eur. J. Nucl. Med. 11, 413–416 (1986)
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Research involving human participants and/or animals: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Watanabe, K., Igarashi, T., Ashida, H. et al. Diagnostic value of ultrasonography and TI-201/Tc-99m dual scintigraphy in differentiating between benign and malignant thyroid nodules. Endocrine 63, 301–309 (2019). https://doi.org/10.1007/s12020-018-1768-0
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DOI: https://doi.org/10.1007/s12020-018-1768-0