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- Title
Heterogeneous echogenicity of the underlying thyroid parenchyma: how does this affect the analysis of a thyroid nodule?
- Authors
Park, Mina; So Hee Park; Kim, Eun-Kyung; Jung Hyun Yoon; Hee Jung Moon; Hye Sun Lee; Jin Young Kwak; Park, So Hee; Yoon, Jung Hyun; Moon, Hee Jung; Lee, Hye Sun; Kwak, Jin Young
- Abstract
<bold>Background: </bold>Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. Thus, the aim of this study was to evaluate the influence of underlying thyroid echogenicity on diagnosis of thyroid malignancies using US.<bold>Methods: </bold>A total of 1,373 patients who underwent US-guided fine needle aspiration of 1,449 thyroid nodules from June 2009 to August 2009 were included. The diagnostic performance of US assessment for thyroid nodules was calculated and compared according to underlying thyroid echogenicity. The diagnostic performance of US assessments in the diagnosis of thyroid malignancy according to the underlying parenchymal echogenicity was compared using a logistic regression with the GEE (generalized estimating equation) method. Each US feature of malignant and benign thyroid nodules was analyzed according to underlying echogenicity to evaluate which feature affected the final diagnosis.<bold>Results: </bold>Among the 1,449 nodules, 325 (22.4%) were malignant and 1,124 (77.6%) were benign. Thyroid glands with heterogeneous echogenicity showed significantly lower specificity, PPV, and accuracy compared to thyroid glands with homogeneous echogenicity, 76.3% to 83.7%, 48.7% to 60.9%, and 77.6% to 84.4%, respectively (P=0.009, 0.02 and 0.005, respectively). In benign thyroid nodules, microlobulated or irregular margins were more frequently seen in thyroid glands with heterogeneous echogenicity than in those with homogenous echogenicity (P<0.001).<bold>Conclusion: </bold>Heterogeneous echogenicity of the thyroid gland significantly lowers the specificity, PPV, and accuracy of US in the differentiation of thyroid nodules. Therefore, caution is required during evaluation of thyroid nodules detected in thyroid parenchyma showing heterogeneous echogenicity.
- Subjects
UNITED States; THYROID cancer diagnosis; CANCER; NEEDLE biopsy; MEDICAL needs assessment; THYROID cancer patients; ULTRASONIC imaging; THYROID gland tumors; RETROSPECTIVE studies; DIFFERENTIAL diagnosis; THYROID gland
- Publication
BMC Cancer, 2013, Vol 13, Issue 1, p1
- ISSN
1471-2407
- Publication type
journal article
- DOI
10.1186/1471-2407-13-550