What is the role of ultrasonography in the evaluation of a solitary thyroid nodule?

Updated: Aug 19, 2020
  • Author: Daniel J Kelley, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Ultrasonography is a safe and effective method of determining the size and the presence of solid or cystic components within a thyroid nodule. High-resolution ultrasonography can be used to determine the presence of nonpalpable nodules as small as 1 mm within the thyroid tissue. The predictive value of several ultrasonic features of thyroid nodules, including calcifications, margins, and vascularity, have been examined by numerous studies.

The addition of elastosonography in combination with high-resolution ultrasonography has significantly improved the diagnostic accuracy of ultrasound. The combination of these newer ultrasound techniques with molecular markers now available for fine-needle aspiration biopsy may prove to be able to distinguish malignant from benign thyroid nodules.

In a review of published studies, use of conventional thyroid ultrasonography did not allow accurate prediction of the histology of solitary thyroid nodules. In current practice, its main indications are the accurate measurement of size of the nodule, assessment for possible lymphadenopathy, and as a guide for fine-needle aspiration biopsy(FNAB). [8, 9, 10, 11]

A study by Yuan et al, however, indicated that the patterns of enhancement differ significantly between benign and malignant solitary thyroid nodules examined with real-time, contrast-enhanced ultrasonography, with most malignant lesions in the report demonstrating an irregular shape, an unclear boundary, and inhomogeneous and incomplete enhancement. The study involved 78 patients, including 41 with benign lesions and 37 with malignant nodules. [12]

A study by Kuo et al indicated that on ultrasonographic examination, calcification and the presence, within a thyroid lesion, of multiple nodule-like solid masses are independent factors that can aid in identifying a lesion as a follicular thyroid carcinoma instead of a follicular adenoma. [13]

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