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- Title
Thyroid Nodule Shape and Prediction of Malignancy.
- Authors
Erik K. Alexander; Ellen Marqusee; Joseph Orcutt; Carol B. Benson; Mary C. Frates; Peter M. Doubilet; Edmund S. Cibas; Alireza Atri
- Abstract
Background: Thyroid nodules are common; the vast majority benign. Preoperative determination of malignancyremains imprecise, despite fine-needle aspiration (FNA). Numerous risk factors have been proposed for predictingmalignancy, though few have been found useful. Oxygen delivery is a crucial component for tumor cellgrowth. It has been hypothesized that malignant tumors may configure their shape to maximize access to localnutrient delivery. Mathematically, surface area to volume is maximized by a spherical shape. We sought todetermine if spherical shape is a predictor of malignancy. Methods:Seven hundred forty-seven consecutive patientsunderwent ultrasound evaluation and FNA of 993 solid thyroid nodules (< 25% cystic) between 1995and 2000 and were retrospectively analyzed. Nodules were classified as benign or malignant based on FNAand/or surgical pathology. Spherical shape was estimated by calculating a ratio of the longest to shortest dimensions,and rate of malignancy correlated. Results: Spherical shape was independently correlated with riskof malignancy (p < 0.001). Thyroid cancer was detected in 11% of all nodules, but ranged from 18% in sphericalnodules to 5% in those least spherical. Nodules found to have suspicious or intermediate cytology showedsimilar variation in malignant risk. A long to short axis ratio greater than 2.5 was 100% predictive of a benignprocess, although present in only 4% of our cohort. A prospective validation was performed and confirmedconsistent results (p < 0.01). Conclusion: Spherical shape is associated with an increased rate of malignancy insolid thyroid nodules. Determination of shape may assist in clinical risk assessment of thyroid cancer.
- Publication
Thyroid, 2004, Vol 14, Issue 11, p953
- ISSN
1050-7256
- Publication type
Article