CONTEXT: Predictive models of thyroid nodule cancer risk are presently based upon nodule composition, echogenicity, margins, and the presence of microcalcifications. Nodule shape has shown promise to be an additive factor helping determine the need for nodule biopsy. OBJECTIVE: We sought to determine if calculation of a nodule's spherical shape independently associates with cancer risk. METHODS: This prospective cohort study, conducted at a single large academic healthcare system in the United States, included patients with 1 or 2 clinically relevant thyroid nodules (predominantly solid and over 1 cm) presenting for diagnostic evaluation. Thyroid ultrasound, cytological evaluation with fine-needle biopsy, and/or histopathological examination on occasion of thyroid surgery were performed. We calculated the nodule's long to short ratio (spherical shape), and its association with tissue proven benign or malignant endpoints. RESULTS: The long to short nodule ratio was significantly lower in malignant compared to benign nodules indicating greater risk of malignancy in more spherical nodules (1.63 ± 0.38 for malignant nodules vs 1.74 ± 0.47 for benign, P < 0.0001). The risk of malignancy continually increased as the long to short ratio approached a purely spherical ratio of 1.0 (ratio > 2.00, 14.6% cancer; ratio 1.51-2.00, 19.7%; ratio 1.00-1.50, 25.5%, P < 0.0001). In multiple regression analysis, younger age, male sex, and nodule's spherical shape were each independently associated with cancer risk. CONCLUSION: The more a thyroid nodule is spherically shaped, as indicated by a long to short ratio approaching 1.0, the greater its risk of malignancy. This was independent of age, sex, and nodule size. Incorporating a nodule's sphericity in the risk stratification systems may improve individualized clinical decision making.
CONTEXT: Predictive models of thyroid nodule cancer risk are presently based upon nodule composition, echogenicity, margins, and the presence of microcalcifications. Nodule shape has shown promise to be an additive factor helping determine the need for nodule biopsy. OBJECTIVE: We sought to determine if calculation of a nodule's spherical shape independently associates with cancer risk. METHODS: This prospective cohort study, conducted at a single large academic healthcare system in the United States, included patients with 1 or 2 clinically relevant thyroid nodules (predominantly solid and over 1 cm) presenting for diagnostic evaluation. Thyroid ultrasound, cytological evaluation with fine-needle biopsy, and/or histopathological examination on occasion of thyroid surgery were performed. We calculated the nodule's long to short ratio (spherical shape), and its association with tissue proven benign or malignant endpoints. RESULTS: The long to short nodule ratio was significantly lower in malignant compared to benign nodules indicating greater risk of malignancy in more spherical nodules (1.63 ± 0.38 for malignant nodules vs 1.74 ± 0.47 for benign, P < 0.0001). The risk of malignancy continually increased as the long to short ratio approached a purely spherical ratio of 1.0 (ratio > 2.00, 14.6% cancer; ratio 1.51-2.00, 19.7%; ratio 1.00-1.50, 25.5%, P < 0.0001). In multiple regression analysis, younger age, male sex, and nodule's spherical shape were each independently associated with cancer risk. CONCLUSION: The more a thyroid nodule is spherically shaped, as indicated by a long to short ratio approaching 1.0, the greater its risk of malignancy. This was independent of age, sex, and nodule size. Incorporating a nodule's sphericity in the risk stratification systems may improve individualized clinical decision making.
Authors: Pablo Valderrabano; Melissa J McGettigan; Cesar A Lam; Laila Khazai; Zachary J Thompson; Christine H Chung; Barbara A Centeno; Bryan McIver Journal: Thyroid Date: 2018-07-17 Impact factor: 6.568
Authors: Norra Kwong; Marco Medici; Trevor E Angell; Xiaoyun Liu; Ellen Marqusee; Edmund S Cibas; Jeffrey F Krane; Justine A Barletta; Matthew I Kim; P Reed Larsen; Erik K Alexander Journal: J Clin Endocrinol Metab Date: 2015-10-14 Impact factor: 5.958
Authors: Jin Young Kwak; Kyung Hwa Han; Jung Hyun Yoon; Hee Jung Moon; Eun Ju Son; So Hee Park; Hyun Kyung Jung; Ji Soo Choi; Bo Mi Kim; Eun-Kyung Kim Journal: Radiology Date: 2011-07-19 Impact factor: 11.105
Authors: F Pacini; T Vorontsova; E P Demidchik; E Molinaro; L Agate; C Romei; E Shavrova; E D Cherstvoy; Y Ivashkevitch; E Kuchinskaya; M Schlumberger; G Ronga; M Filesi; A Pinchera Journal: J Clin Endocrinol Metab Date: 1997-11 Impact factor: 5.958
Authors: Xiaoyun Liu; Marco Medici; Norra Kwong; Trevor E Angell; Ellen Marqusee; Matthew I Kim; P Reed Larsen; Nancy L Cho; Matthew A Nehs; Daniel T Ruan; Atul Gawande; Francis Moore; Justine Barletta; Jeffrey F Krane; Edmund S Cibas; Tao Yang; Erik K Alexander Journal: Thyroid Date: 2015-12-16 Impact factor: 6.568