Prevalence and Distribution of Carcinoma in Patients with Solitary and Multiple Thyroid Nodules on Sonography

Harvard University, Cambridge, Massachusetts, United States
Journal of Clinical Endocrinology & Metabolism (Impact Factor: 6.21). 09/2006; 91(9):3411-7. DOI: 10.1210/jc.2006-0690
Source: PubMed


Controversy remains as to the optimal management of patients with multiple thyroid nodules.
The objective of this study was to determine the prevalence, distribution, and sonographic features of thyroid cancer in patients with solitary and multiple thyroid nodules.
We describe a retrospective observational cohort study that was carried out from 1995 to 2003.
The study was conducted in a tertiary care hospital.
Patients with one or more thyroid nodules larger than 10 mm in diameter who had ultrasound-guided fine needle aspiration (FNA) were included in the study.
The main outcome measures were prevalence and distribution of thyroid cancer and the predictive value of demographic and sonographic features.
A total of 1985 patients underwent FNA of 3483 nodules. The prevalence of thyroid cancer was similar between patients with a solitary nodule (175 of 1181 patients, 14.8%) and patients with multiple nodules (120 of 804, 14.9%) (P = 0.95, chi(2)). A solitary nodule had a higher likelihood of malignancy than a nonsolitary nodule (P < 0.01). In patients with multiple nodules larger than 10 mm, cancer was multifocal in 46%, and 72% of cancers occurred in the largest nodule. Multiple logistic regression analysis of statistically significant features demonstrates that the combination of patient gender (P < 0.02), whether a nodule is solitary vs. one of multiple (P < 0.002), nodule composition (P < 0.01), and presence of calcifications (P < 0.001) can be used to assign risk of cancer to each individual nodule. Risk ranges from a 48% likelihood of malignancy in a solitary solid nodule with punctate calcifications in a man to less than 3% in a noncalcified predominantly cystic nodule in a woman.
In a patient with one or more thyroid nodules larger than 10 mm in diameter, the likelihood of thyroid cancer per patient is independent of the number of nodules, whereas the likelihood per nodule decreases as the number of nodules increases. For exclusion of cancer in a thyroid with multiple nodules larger than 10 mm, up to four nodules should be considered for FNA. Sonographic characteristics can be used to prioritize nodules for FNA based on their individual risk of cancer.

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    • "The prevalence of nodular thyroid disease, detectable by ultrasound , is estimated at around 50%. However, only about 5% of the nodules reveal malignant cyto histological diagnosis [11]. Therefore , the differential diagnosis of nodules is crucial to allow the early diagnosis of cancers and ensure appropriate treatment. "
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    ABSTRACT: The purpose of this study was to evaluate the sonographic features of thyroid nodules suspicious for malignancy with standard examination in B-mode and Colour Doppler associated with modern techniques such as ultrasound RTE (Real Time Elastosonography) and BFI (B-flow imaging) in correlation with the results of the sonographically guided fine-needle aspiration to establish their role in predicting the risk of malignancy. Between November 2012 and January 2014, 354 consecutive patients (age range, 18-73 years; mean age ± SD, 41.2 ± 9.2 years; 90 male and 264 female) with 493 suspected nodules (maximum diameter >9 mm) were enrolled in this prospective study. Sonographic , elastosonographic and BFI examinations were performed with a commercially available real-time ultrasound system, and all patients also underwent a cytologic evaluation. Patients with suspicious or malignant cytologic features underwent surgery. On histologic examination, 71 of 493 nodules were malignant (62 papillary thyroid carcinoma, 1 Hu¨rthle cell carcinoma, and 8 follicular carcinoma). All sonographic characteristics, which were potential predictors of thyroid malignancy (microcalcifications, hypoechogenicity, absence of a halo, and a predominantly solid composition), were found in different percentages in both histologically verified malignant and benign nodules. For BFI, pattern 3 (≥4 signs and distance >2 mm) was the most predictive factor for malignancy (specificity, 99.6%; sensitivity, 65.2%), whereas pattern 2 (≥4 signs and distance <2 mm) was a positive factor because it was detected only in benign lesions. For the RTE , scores 1-2 were detected in 68 % of benign nodules, while scores 3-4 in 94 % of malignant nodules. Our results indicate that Elastosonography and BFI can overcome the limits of the traditional B-mode and color Doppler sonographic features in the diagnosis of thyroid nodules. This techniques provides maximum specificity levels both in the case of benign nodules and in the case of malignant nodules.
    Full-text · Article · May 2014 · International Journal of Surgery (London, England)
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    • "Patients with multiple thyroid nodules have the same risk of malignancy as those with a solitary nodule13,14). However, some studies found that thyroid multiple nodules are not common and not related to malignancy15,16). The present study also showed that in thyroid nodules found by ultrasonography in 28 infants with thyroid nodules, the number of single nodules (78.6%) was significantly larger than the number of multiple nodules (21.4%). "
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    ABSTRACT: This study aimed to assess the characteristics of thyroid nodules among infants diagnosed with congenital hypothyroidism. A retrospective study of 660 infants (374 males, 286 females) diagnosed with congenital hypothyroidism was carried out at the Pediatric Endocrine Clinic in Soonchunhyang University Hospital, Korea, between May 2003 and February 2013. The average age at diagnosis was 1.16±1.68 months. Of the 28 patients (4.2%) with thyroid nodules, 17 (2.6%) had cystic thyroid nodules and 11 (1.6%) had solid thyroid nodules. There were no significant differences in gender or age between congenital hypothyroidism patients who hadthyroid nodules and those who did not. All nodules were asymptomatic. The average age at diagnosis of congenital hypothyroidism with nodules was 1.42±1.39 months. All detected nodules measured less than 1 cm in diameter. Twenty-two of the 28 infants (78.6%) had only one nodule, while multiple nodules were found in 6 infants (21.4%). Of the 28 infants diagnosed with nodules, 16 underwent thyroid ultrasonography during follow-up and 8 of them (50%) showed no signs of nodules at thyroid ultrasonography. The prevalence of thyroid nodules in infants with congenital hypothyroidism was 4.2%. Most thyroid nodules were small in size and benign, disappearing during follow-up observation. We therefore conclude that thyroid nodules in infants with congenital hypothyroidism can simply be observed and do not require direct treatment.
    Full-text · Article · Feb 2014 · Korean Journal of Pediatrics
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    • "The prevalence of malignancy in SN has been estimated at 5% [63]. As indicated in the recent guidelines for the management of thyroid nodules patients with multiple thyroid nodules have the same risk of malignancy as those with solitary nodules [64–67]. Individual studies, however, provide cancer prevalence in patients with MNG that are lower (4.1%) "
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    ABSTRACT: Background. In the last decades, thyroid cancer incidence has continuously and sharply increased all over the world. This review analyzes the possible reasons of this increase. Summary. Many experts believe that the increased incidence of thyroid cancer is apparent, because of the increased detection of small cancers in the preclinical stage. However, a true increase is also possible, as suggested by the observation that large tumors have also increased and gender differences and birth cohort effects are present. Moreover, thyroid cancer mortality, in spite of earlier diagnosis and better treatment, has not decreased but is rather increasing. Therefore, some environmental carcinogens in the industrialized lifestyle may have specifically affected the thyroid. Among potential carcinogens, the increased exposure to medical radiations is the most likely risk factor. Other factors specific for the thyroid like increased iodine intake and increased prevalence of chronic autoimmune thyroiditis cannot be excluded, while other factors like the increasing prevalence of obesity are not specific for the thyroid. Conclusions. The increased incidence of thyroid cancer is most likely due to a combination of an apparent increase due to more sensitive diagnostic procedures and of a true increase, a possible consequence of increased population exposure to radiation and to other still unrecognized carcinogens.
    Full-text · Article · May 2013 · Journal of Cancer Epidemiology
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