Role of preoperative ultrasonography in the management of thyroid nodules

Service de Chirurgie Digestive, Générale et Endocrinienne, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France.
Annales de Chirurgie (Impact Factor: 0.52). 01/2007; 131(10):577-82. DOI: 10.1016/j.anchir.2006.01.008
Source: PubMed


Ultrasonography is the evidence-based diagnostic method for thyroid nodules. The account has to specify the technical used, and has to exactly describe the echogenicity of the thyroid, the feature of the nodules (number, size, echostructure, echogenicity, edges), and the presence or absence of lymph nodes. The malignancy criteria of thyroid nodules are: (1) hypoechoic solid nodule, (2) presence of internal microcalicifications, (3) ill-defined-irregular edges or absence or breaking of the peripheral halo. The nodes' criteria of malignancy are: (1) diameter of 1 cm or more, (2) clear hypoechoic pattern or non-homogeneous pattern, with alternating hypoechoic and hyperechoic areas, (3) cystic appearance (4) presence of internal calcifications (5) rounded shape with increased anteroposterior diameter, (6) long/short diameter ratio higher than 0.7, (7) absence of hilum. When these criteria are present, a histological diagnosis has to be performed. They could change the operative procedure in the patients.

1 Read
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of the study was to explore high-frequency ultrasound (HFUS) for noninvasive microimaging of thyroid in living mice. Thyroid examination was performed by HFUS in 10 normal C57BL/6 mice, eight mice treated by propylthiouracil, and 22 Tg-TRK-T1 transgenic mice. The dimension of the gland and the presence of nodules were evaluated. Nodules were classified as malignant (hypoechogenicity, poorly defined margins, internal microcalcification, irregular shapes, and extra glandular extension) or not, and the findings were compared with histological data. Thyroid images were successfully obtained in all the animals analyzed. Normal thyroid reached a volume of 4.92 microl (range 2.11-4.92 microl). Mice with propylthiouracil-induced goiter showed diffuse thyroid enlargement (median volume 6.67 microl, range 4.09-8.82 microl). In 19 of 22 Tg-TRK-T1 mice (86%), HFUS identified a nodular process (the smallest detected nodule had a diameter of 0.46 mm). Eleven nodules were classified as malignant and eight as benign. Compared with histological analysis, HFUS showed a sensitivity of 100% in the detection of thyroid nodules and a specificity of 60% (two of the nodules identified by HFUS were not confirmed at the histology). The specificity and sensitivity of HFUS in predicting the malignancy of the thyroid nodules were 83 and 91%, respectively. Thus, HFUS is an accurate imaging modality that can potentially replace more invasive techniques, and, therefore, it represents a significant advancement in phenotypic assessment of mouse models of thyroid cancer.
    No preview · Article · Aug 2009 · Endocrinology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction La pathologie thyroïdienne nodulaire est très fréquente dans la population générale, surtout dans les zones en carence en iode, et constitue un véritable problème de santé publique. Mais le vrai problème réside dans l’augmentation continue de l’incidence du cancer dans les goitres et des nodules thyroïdiens. But Étudier l’incidence du cancer dans les goitres thyroïdiens, en insistant sur les différents facteurs clinique, paraclinique et épidémiologique qui expliquent l’augmentation de cette incidence. Méthodes Étude rétrospective ayant inclus 368 patients opérés pour une pathologie thyroïdienne nodulaire. Nous avons étudié l’incidence de malignité ainsi que ses principaux facteurs de risque. Résultats Sur les 368 patients opérés, on a découvert 23 cancers, soit 6,25 % des cas, l’âge moyen des cancéreux est de 48 ans, avec un sex-ratio de 2 en faveur des femmes, tous vivant dans des zones en carence en iode. L’association de plusieurs signes de présomption de malignité clinique et échographique a permis de confirmer le diagnostic chez 19 des 23 cas de cancer. Conclusion Les résultats de notre étude viennent conforter ceux de la littérature, l’incidence du cancer dans les goitres et nodules thyroïdiens est en augmentation continue ces dernières années. Cette augmentation est liée au développement des moyens diagnostiques, notamment l’échographie et la cytoponction à l’aiguille fine (CPAF). Elle donne au chirurgien une autre raison pour opérer un goitre nodulaire.
    No preview · Article · May 2010 · Journal africain du cancer / African Journal of Cancer
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Even though calcifications in thyroid nodules constitute a common finding in imaging and histopathology, and also may occur in both benign and malignant thyroid disease, their clinical importance remains unclear. A way to establish a possible relationship between their presence and the associated pathology may be given through a precise description of their chemical composition. In order to attain this goal, last generation Field Effect Scanning Electron Microscopy (FE-SEM) and classical Fourier Transform Infra Red (FTIR) experiments have been performed on thyroid calcifications. Calcifications corresponding to different pathologies have been considered, including Graves' disease, papillary carcinoma or multinodular goiter. The complete set of experiments shows for the first time a chemical diversity of pathological calcifications but no correlation between the chemical composition of the pathological calcifications and the disease.
    Full-text · Article · Jan 2016