DIAGNOSTIC ACCURACY OF THYROID ULTRASOUND IN DETECTION OF MALIGNANCY IN THYROID NODULES

Authors

  • Sadia Nawaz
  • M Babar Khan
  • Bushra Parveen
  • M Asif
  • M Rashid
  • M Azeem
  • M Nawaz

DOI:

https://doi.org/10.69656/pjp.v14i3.900

Keywords:

Thyroid, Ultrasound, FNAC, Malignancy, Thyroid nodule, Tumour, Diagnosis

Abstract

Background: Occurrence of thyroid nodules is a common clinical problem in Pakistan being endemic area for hypothyroidism. This study was carried out to evaluate the diagnostic accuracy of thyroid ultrasound in detection of malignancy in thyroid nodules keeping Fine Needle Aspiration Cytology (FNAC) as a gold standard. Methods: A descriptive cross-sectional validation study was conducted at Departments of Radiology and Pathology, Shaikh Khalifa Bin Zayed Al-Nahyan Hospital/ CMH, Muzaffarabad from Dec 2014 to Jun 2015. Patients referred for evaluation of thyroid nodules were included in the study. Ultrasound guided FNAC was performed under direct imaging guidance. The imaging findings and FNAC were compared to access the diagnostic accuracy of ultrasound in predicting malignancy in thyroid nodules. Results: A total of 175 patients were studied with age range between 20–70 years. Mean age of the patients was 44.05±14.8 years. Of these, 35.4% were males and 64.6% were females. On FNAC, 27.4% cases were positive and 72.6% cases were negative while on thyroid ultrasound 26.3% cases were positive and 73.7% cases were negative. True positive were 24.0%, false positive 2.3%, false negative 3.4%, and true negative were 70.3%. Thyroid ultrasound showed sensitivity 87.5%, specificity 96.8%, diagnostic accuracy 94.2%, positive predictive value 91.3% and negative predictive value 95.3%. Conclusion: High resolution ultrasound is a very useful tool in accessing and selecting thyroid nodules for biopsy with a high diagnostic accuracy.

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References

1. Moon WJ, Baek JH, Jung SL, Kim DW, Kim EK, Kim JY, et al. Ultrasonography and the Ultrasound-Based Management of Thyroid Nodules: Consensus Statement and Recommendations. Korean J Radiol 2011;12(1):1–14.
2. Kwak JY, Kim EK, Kim HJ, Kim MJ, Son EJ, Moon HJ. How to combine ultrasound and cytological information in decision making about thyroid nodules. Eur Radiol 2009;19(8):1923–31.
3. Taddesse A, Yaqub A. Clinical, sonographic and cytological evaluation of small versus large thyroid nodules. J Pak Med Assoc 2011;61(5):466–9.
4. Baier ND, Hahn PF, Gervais DA, Samir A, Halpern EF, Mueller PR, et al. Fine-Needle Aspiration Biopsy of Thyroid Nodules: Experience in a Cohort of 944 Patients. Am J Roentgenol 2009;193(4):1175–9.
5. Frates MC, Langer JE. Biopsy of Thyroid Nodules: Comparison of three sets of guidelines. Am J Roentgenol 2010;195:W472.
6. Lingam RK, Qarib MH, Tolley NS. Evaluating thyroid nodules: predicting and selecting malignant nodules for fine-needle aspiration (FNA) cytology. Insights into Imaging 2013;4(5):617–24.
7. Ahn SS, Kim EK, Kang DR, Lim SK, Kwak JY, Kim MJ. Biopsy of Thyroid Nodules: Comparison of three sets of guidelines. Am J Roentgenol 2010;194(1):31–7.
8. Yunus M, Ahmed Z. Significance of ultrasound features in predicting malignant solid thyroid nodules: Need for fine-needle aspiration. J Pak Med Assoc 2010;60(10): 848–53.
9. Vinayak S, Sande JA. Avoiding unnecessary Fine-Needle Aspiration Cytology by accuractely predicting the benign nature of thyroid nodules using ultrasound. J Clin Imaging Sci 2012;2(1):23.
10. Frates MC, Benson CB, Doubilet PM, Charboneau JW, Cibas ES, Orlo HC. Likelihood of thyroid cancer based on sonographic assessment of nodule size and composition [abstract]. In Radiological Society of North America Scientific Assembly and Annual Meeting Program. Oak Brook, IL: 2004.p. 395.
11. Hong Y, Liu X, Li Z, Zhang X, Chen M, Luo Z. Real-time ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules. J Ultrasound Med 2009;28(7):861–7.
12. Romitelli F, Di Stasio E, Santoro C, Iozzino M, Orsini A, Cesareo R. A comparative study of fine needle aspiration and fine needle non-aspiration biopsy on suspected thyroid nodules. Endocr Pathol 2009;20(2):108–13.
13. Ejaz R, Salaria SM, Bukhari MH, Ahmed M, Nosheen J, Ejaz U. Histopathological spectrum of surgically treated goiters in Muzaffarabad. Pak J Med Health Sci 2015;9(1)2–4.
14. Tarrar AM, Wahla MS, Ilyas S, Khan OU, Waqas A, Raza A. Solitary thyroid nodule; frequency of malignancy at Combined Military Hospital Rawalpindi. Professional Med J 2010;17(4):598–602.
15. Alam T, Khattak YJ, Beg M, Raouf A, Azeemuddin M, Khan AA. Diagnostic accuracy of ultrasonography in differentiating benign and malignant thyroid nodules using fine needle aspiration cytology as the reference standard. Asian Pac J Cancer Prev 2014;15(22):10039–43.
16. Muhammad D, Khan S, Rahman A. Diagnostic accuracy of gray-scale and colour doppler ultrasonography in diagnosing malignant thyroid nodules. Pak Arm Forces Med J 2016;66(4):574–8.
17. Ram N, Hafeez S, Qamar S, Hussain SZ, Asghar A, Anwar Z, et al. Diagnostic validity of ultrasonography in thyroid nodules. J Pak Med Assoc 2015;65(8):875–8.
18. Shah AH, Marfani S, Ejaz A. To determine the frequency of malignancy in solitary nodule of thyroid in ENT, Head and Neck Surgery Department at Civil Hospital Karachi. Med Forum 2016;27(4):44–7.
19. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. The American Thyroid Association Guidelines Taskforce. Thyroid 2006;16(2):109–42.
20. Akhtar T, Ullah Z, Paracha Pl, Lutfullah G. Impact assessment of salt iodization on the prevalence of goiter in district Swat. Pak J Med Sci 2004;20(4):303–7.
21. Sushel C, Khanzada TW, Zulfikar I, Samad A. Histopathological pattern of diagnoses in patients undergoing thyroid operations. Rawal Med J 2009;34(1):14–6.
22. Zuberi LM, Yawar A, Islam N, Jabbar A. Clinical presentation of thyroid cancer patients in Pakistan-AKUH experience. J Pak Med Asso 2004;54(10):526–7.
23. Cheng P, Chen ED, Zheng HM, He QX, Li Q. Ultrasound score to select subcentimeter-sized thyroid nodules requiring ultrasound-guided fine needle aspiration biopsy in eastern China. Asian Pac J Cancer Prev 2013;14(8):4689–92.
24. Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee T, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 2002;178(3):687–91.
25. Rahimi M, Farshchian N, Rezaee E, Shahebrahimi K, Madani H. To differentiate benign from malignant thyroid nodule comparison of sonography with FNAC findings. Pak J Med Sci 2013;29(1):77–80.
26. Shin S, Park SE, Kim Y, Hyun MK, Kim SW, Kwon JW, et al. Effectiveness of ultrasonographic screening for thyroid cancer: Round-table Conference in the National Evidence-based Healthcare Collaborating Agency (NECA) in conjunction with the Korean Thyroid Association. Asian Pac J Cancer Prev 2014;15(12):5107–10.
27. Koike E, Noguchi S, Yamashita H, Murakam T, Ohshima A, Kawamoto H, et al. Ultrasonographic characteristics of thyroid nodules: prediction of malignancy. Arch Surg 2001;136:334–7.
28. Frates MC, Benson CB, Doubilet PM, Cibas ES, Marqusee E. Can color doppler sonography aid in the prediction of malignancy of thyroid nodules? J Ultrasound Med 2003;22(2):127–31.
29. Mazzaferri EL, Sipos J. Should all patients with subcentimeter thyroid nodules undergo fine-needle aspiration biopsy and preoperative neck ultrasonography to define the extent of tumor invasion? Thyroid 2008;18(6):597–602.
30. Accurso A, Rocco N, Palumbo A, Leone F. Usefulness of ultrasound-guided fine-needle aspiration cytology in the diagnosis of non-palpable small thyroid nodules. Tumori 2005;91(4):355–7.
31. Lee MJ, Kim EK, Kwak JY, Kim MJ. Partially cystic thyroid nodules on ultrasound: probability of malignancy and sonographic differentiation. Thyroid 2009;19(4):341–6.
Pak J Physiol 2018;14(3)

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Published

20-08-2018

How to Cite

1.
Nawaz S, Khan MB, Parveen B, Asif M, Rashid M, Azeem M, et al. DIAGNOSTIC ACCURACY OF THYROID ULTRASOUND IN DETECTION OF MALIGNANCY IN THYROID NODULES. Pak J Phsyiol [Internet]. 2018 Aug. 20 [cited 2024 Nov. 21];14(3):11-3. Available from: https://pjp.pps.org.pk/index.php/PJP/article/view/900

Issue

Vol. 14 No. 3 (2018): Pakistan Journal of Physiology

Section

Original Article

License

Pakistan Journal of Physiology, Pak J Physiol, PJP is FREE for research and academic purposes. It can be freely downloaded and stored, printed, presented, projected, cited and quoted with full reference of, and acknowledgement to the author(s) and the PJP. The contents are published with an international CC-BY-ND-4.0 License.