C Anuradha1, M T Manipadam2, H S Asha3, N Dukhabandhu3, D Abraham4, M J Paul4. 1. Radiology, Christian Medical College, Vellore, India. 2. Pathology, Christian Medical College, Vellore, India. 3. Endocrinology, Christian Medical College, Vellore, India. 4. Endocrine Surgery, Christian Medical College, Vellore, India.
Abstract
AIM: To describe two new ultrasound signs for thyroid nodules - "nodule in nodule" and "hypoechoic internal septae" and assess their usefulness in differentiating follicular variant of papillary thyroid carcinoma (FVPTC) from benign thyroid nodules (BTN). METHODOLOGY: Ultrasound findings of 210 patients with histopathologically proven FVPTC (68 nodules, M:F=13:47 with mean age of 39.5±11.9 years) and BTN (165 nodules, (M:F=41:109 with mean age of 44±11.3 years) were retrospectively reviewed from PACS by a single radiologist blinded to the final diagnosis. Logistic regression analysis was performed to identify the best predictors of FVPTC and their diagnostic performance was assessed. RESULTS: The "nodule in nodule" sign was seen in 80.9% of FVPTC and only 12.1% of BTN. The "hypoechoic internal septae" sign was seen in 44.1% of FVPTC and 17% of BTN. Younger patients, heterogeneous echotexture, nodule in nodule sign, thick incomplete non-uniform halo and presence of significant nodes were the best predictors of FVPTC (p<0.05). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and relative risk for FVPTC given as odds ratio (95% CI) for heterogeneous echotexture and nodule in nodule sign which were the best 2 predictors of FVPTC were 91.2%, 81.8%, 67.3%, 95.7%, 84.5%, 46.5 (18.5-117.4) and 80.9%, 87.7%, 74.3%, 91.2%, 86.2%, 32.5 (15.04-70.2), respectively. There was improvement in the specificity (91.5%) and accuracy (86.6%) when a combined criterion of heterogeneous echotexture and nodule in nodule sign was applied to predict FVPTC. CONCLUSION: The "nodule in nodule" sign is common in FVPTC and when combined with heterogeneous echotexture can differentiate FVPTC and BTN with high specificity.
AIM: To describe two new ultrasound signs for thyroid nodules - "nodule in nodule" and "hypoechoic internal septae" and assess their usefulness in differentiating follicular variant of papillary thyroid carcinoma (FVPTC) from benign thyroid nodules (BTN). METHODOLOGY: Ultrasound findings of 210 patients with histopathologically proven FVPTC (68 nodules, M:F=13:47 with mean age of 39.5±11.9 years) and BTN (165 nodules, (M:F=41:109 with mean age of 44±11.3 years) were retrospectively reviewed from PACS by a single radiologist blinded to the final diagnosis. Logistic regression analysis was performed to identify the best predictors of FVPTC and their diagnostic performance was assessed. RESULTS: The "nodule in nodule" sign was seen in 80.9% of FVPTC and only 12.1% of BTN. The "hypoechoic internal septae" sign was seen in 44.1% of FVPTC and 17% of BTN. Younger patients, heterogeneous echotexture, nodule in nodule sign, thick incomplete non-uniform halo and presence of significant nodes were the best predictors of FVPTC (p<0.05). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and relative risk for FVPTC given as odds ratio (95% CI) for heterogeneous echotexture and nodule in nodule sign which were the best 2 predictors of FVPTC were 91.2%, 81.8%, 67.3%, 95.7%, 84.5%, 46.5 (18.5-117.4) and 80.9%, 87.7%, 74.3%, 91.2%, 86.2%, 32.5 (15.04-70.2), respectively. There was improvement in the specificity (91.5%) and accuracy (86.6%) when a combined criterion of heterogeneous echotexture and nodule in nodule sign was applied to predict FVPTC. CONCLUSION: The "nodule in nodule" sign is common in FVPTC and when combined with heterogeneous echotexture can differentiate FVPTC and BTN with high specificity.
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