Carotid Ultrasonography of Thyroid Incidentaloma

( Won Hong Lee ),( Kyung Rae Dong ),( Cha Dol Kim ),( Moo Jin Park ),( Young Hwan Ryu ),( Eun Hoe Goo ) 조선대학교 공학기술연구원 2010 공학기술논문지 Vol.3 No.4

With the widespread use of a high-resolution sonographic equipment for breast ultrasound or carotid ultrasonography, the proportion of asymptomatic cases in which thyroid nodules are incidentally found has been increased. Given the above background, we attempted to assess the incidence of incidental thyroid cancers, which were incidentally detected while examining the thyroid gland, one of the anatomical structures that are adjacently located, during the carotid ultrasonography, and the rate of malignancy on ultrasonography. The current study was conducted in 258 patients who underwent a carotid ultrasonography. Of these, excluding patients who were aware that thyroid nodules were present in these nodules, 273 patients were finally selected for the incidental thyroid tumor. Then, based on the interpretation results, the incidence of nodules, size and the findings were thyroid nodules were classified into probably benign, indeterminate and suspiciously malignant nodule. Based on this classification, the rate of malignancy was evaluated. In our series, 49 of 237 patients (20.7%) had thyroid nodules detected. Mean size was 1.13 cm (range 0.3 cm~5.1 cm). The number of cases in which the size of thyroid nodules was smaller than 1 cm (60.4%). Of thyroid nodules, probably benign nodule of < 5 mm in size was not recorded on the ultrasonography. Besides, probably benign nodules were identified from 51.7% (30/58), indeterminate nodules were identified from 39.7% (23/58) and suspiciously malignant nodules were identified from 8.6% (5/58). These results indicate that the malignancy rate was relatively higher. It can therefore be inferred that even the incidental thyroid rumors should also be managed and then treated in the same manner a thyroid nodules which are found in a clinical setting.

초음파 유도 하 세침 흡입 세포 검사에서 위 음성을 보인 갑상선 결절의 초음파 소견 분석

김지영,정소령,김범수,안국진,한성태 대한영상의학회 2007 대한영상의학회지 Vol.57 No.3

Purpose: To analyze the ultrasonographic (US) findings of thyroid nodules that yielded false negative results after an initial ultrasound-guided fine needle aspiration biopsy (FNAB). Materials and Methods: Between August 2003 and February 2006, 389 patients with 405 thyroid nodules received a repeat US-guided FNAB. We retrospectively reviewed the US findings, cytology results and postsurgical pathological results. The cytology diagnoses were classified as benign, a suspicious malignancy, a follicular neoplasm, a papillary carcinoma, and a non-diagnostic result. The US findings of the thyroid nodules were analyzed with regard to size, internal content, shape, margin, echogenecity, and calcification pattern. Results: Of the 405 thyroid nodules, 17 nodules were false negative. The major US findings of these nodules were a solid internal component in 16 nodules, hypoechogenicity or marked hypoechogenicity in 14 nodules, microcalcifications in 12 nodules, an ovoid to round shape in 9 nodules and a well-defined smooth margin in 9 nodules. Conclusion: An repeat US-guided FNAB should be performed if the thyroid nodules have one of the malignant US features such as hypoechogenecity or marked hypoechogenecity, a microcalcification, a taller than wide shape or a well-defined spiculate margin although the cytology results indicated a benign lesion. In addition, thyroid nodules with findings of a well-defined smooth margin, ovoid to round shape, and solid internal component might also be subject to a repeat US-guided FNAB to exclude a malignancy. 목적: 초음파 유도 하 세침 흡입 세포 검사에서 위 음성을 보였던 결절들의 초음파 소견을 분석하여 위 음성 결절의 특징적 초음파 소견을 알아보고자 한다. 대상과 방법: 2003년 8월부터 2006년 2월까지 초음파 유도 하 세침 흡입 세포검사를 2번 이상 시행한 389명 환자의 405개의 갑상선 결절을 대상으로 초음파 소견, 세포병리 결과, 그리고 조직학적 진단을 후향적으로 조사하였다. 세포병리 결과는 양성, 악성 의심, 여포성 종양, 유두상암, 그리고 부적합으로 분류하였다. 갑상선 결절의 초음파 소견은 크기, 내부 내용, 모양, 경계, 에코, 석회화 유형을 기준으로 분석하였다. 결과: 405개 결절 중 17개의 결절이 위 음성을 보였으며 위 음성 결절들의 주 초음파 소견은 고형 결절 16개, 저에코 또는 현저한 저에코 14개, 미세석회화 12개, 난원형 및 구형 9개, 경계가 분명하면서 부드러운 경우 9개였으며 결절의 모양이 좌우 직경에 비해 전후 직경이 긴 모양이 8개, 경계가 분명하면서 침상인 경우도 6개였다. 결론: 초음파 유도 하 세침 흡입 결과가 양성이라도 갑상선 결절의 초음파 소견이 악성을 시사하는 저에코 또는 현저한 저에코, 미세석회화, 좌우 직경에 비해 전후 직경이 긴 모양, 또는 경계가 분명하면서 침상일 때 중 어느 하나의 소견이라도 있는 경우에는 반드시 재검사를 시행해야 하며 난원형 및 구형 모양을 보이고 경계가 분명하면서 부드러운 고형 결절도 악성 결절을 배제하기 위해 추적검사가 필요하다.

건강한 사람들에게서 초음파로 발견한 갑상선 결절과 갑상선기능 검사 사이의 관계

정혜진,문용식,김무영,이수형,박기현,김현준,황인영,손윤정,김태호 대한가정의학회 2019 Korean Journal of Family Practice Vol.9 No.1

Background: The detection of thyroid nodules through ultrasonography (US) has improved with the development of imaging technologies and thyroid cancer screening in Korea. We evaluated the relationship between the presence of thyroid nodules on US and thyroid function test (TFT) results in healthy individuals. Methods: We performed a retrospective review of data from 449 adults (313 men and 136 women) who underwent tests to evaluate serum thyrotropin (TSH) and free thyroxine levels, thyroid US, and if needed, fine needle aspiration cytology (FNAC). Results: Of the 449 subjects, 144 subjects (32.1%) had thyroid nodules. Among the 144 with thyroid nodules, 24 (16.7%) were advised to undergo FNAC, and all of them showed normal serum TSH levels. Logistic regression analysis showed that the presence of thyroid nodules was not related to abnormalities noted on TFTs after adjusting for age, sex, smoking status, and presence of risky drinking behavior and hypertension (P=0.647). Conclusion: The presence of thyroid nodules on US in healthy adults was not associated with abnormal TFT results. Serum TSH check-ups during the evaluation of thyroid nodules discovered through US in asymptomatic individuals living in areas with a low prevalence of autonomous functioning thyroid nodules might not be necessary from the perspective of cost-effectiveness and subject convenience.

Quantitative Analysis of Thyroid Blood Flow and Static Imaging in the Differential Diagnosis of Thyroid Nodules

Song, Li-Ping,Zhang, Wen-Hong,Xiang, Yang,Zhao, Na Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.11

Objective:To evaluate the performance of combined quantitative analysis of thyroid blood flow and static imaging data in the differential diagnosis of thyroid nodules. Method: Thyroid blood flow and static imaging were performed in 165 patients with thyroid nodules. Patients were divided into a benign thyroid nodule group (BTN, n=135) and a malignant thyroid nodule group (MTN, n=30) based on the results of post-surgical pathologic examination. Carotid artery thyroid transit times (CTTT), perfusion ratio of thyroid nodule blood/thyroid blood (TNB/TB), and perfusion ratio of thyroid nodule blood/carotid artery blood (TNB/CAB) were measured using thyroid blood flow imaging. The ratios between thyroid nodule and ipsilateral submandibular gland (TN/SG) and thyroid nodule and normal thyroid tissue (TN/T) were measured from thyroid static imaging. The differences between the BTN and MTN groups were compared. Results: 1) CTTT was markedly lower in the MTN group than the BTN group, the difference being statistically significant. 2) TNB/TB and TNB/CAB were both significantly higher in MTN than BTN groups. 3) TN/T was significantly lower in MTN group than BTN group. 4) TN/SG was lower in MTN group than BTN group, but the difference was not statistically significant. 5) Using the combination of CTTT and TN/T, the sensitivity, specificity and accuracy were 93.1%, 95.3% and 94.9% respectively for the diagnosis of MTN. Using the combination of CTTT, TNB/TB and TN/T, the sensitivity, specificity and accuracy changed to 89.7%, 100%, and 98.1% respectively. 6) Correlation analysis demonstrated a significant correlation between TN/T and TNB/TB (r=-0.384, P=0.036) and TNB/CAB (r=-0.466, P=0.009) in the MTN group. Conclusion: The combination of quantitative markers from thyroid blood flow and thyroid static imaging had high specificity and accuracy in differential diagnosis of benign and malignant thyroid nodules, thus providing an important imaging diagnostic approach.

Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules: is it Necessary to Use Local Anesthesia for the Application of One Needle Puncture?

김동욱,김기남,노명호 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.5

Objective: This study was designed to evaluate the difference in the degree of patient pain for an ultrasound-guided fine-needle aspiration biopsy (USFNAB) of a thyroid nodule with one needle puncture with and without local anesthesia. Materials and Methods: A total of 50 patients participated in the study. We examined prospective patients who would undergo US-FNABs of two thyroid nodules (larger than 10 mm maximum diameter), which were located in separate thyroid lobes. For one of these thyroid nodules, US-FNAB was performed following the administration of local anesthesia; for the other nodule, no anesthesia was administered. The application of anesthesia was alternatively administered between patients (either prior to the first US-FNAB procedure or prior to the second procedure). For all patients, the degree of pain during and after each US-guided FNAB was evaluated according to a 4-category verbal rating scale (VRS), an 11-point numeric rating scale (NRS) and a 100-mm visual analogue scale (VAS). Results: The mean maximum diameters of thyroid nodules examined by US-FNAB with the use of local anesthesia and with no local anesthesia were 13.6 mm and 13.0 mm, respectively. There was no significant difference in nodule size (p > 0.05) between two groups. For the VRS, there were 27 patients with a higher pain score when local anesthesia was used and four patients with a higher pain score when no local anesthesia was administered. Nineteen patients had equivalent pain score for both treatments. This finding was statistically significant (p < 0.001). For the NRS, there were 33 patients with a higher pain score when local anesthesia was used and 10 patients with a higher pain score when no local anesthesia was administered. Seven patients had an equivalent pain score for each treatment. This finding was statistically significant (p < 0.001). For the VAS, there were 35 patients with a higher pain score when local anesthesia was used and 11 patients with a higher pain score where no local anesthesia was administered. Four patients had an equivalent pain score for both treatments. This finding was also statistically significant (p = 0.001). Conclusion: In our study, patient pain scales were significantly lower when no local anesthesia was used prior to US-FNABs of thyroid nodules as compared to when local anesthesia was administered. Therefore, we believe that when one needle puncture is used, US-FNAB should be performed without administering local anesthesia. Objective: This study was designed to evaluate the difference in the degree of patient pain for an ultrasound-guided fine-needle aspiration biopsy (USFNAB) of a thyroid nodule with one needle puncture with and without local anesthesia. Materials and Methods: A total of 50 patients participated in the study. We examined prospective patients who would undergo US-FNABs of two thyroid nodules (larger than 10 mm maximum diameter), which were located in separate thyroid lobes. For one of these thyroid nodules, US-FNAB was performed following the administration of local anesthesia; for the other nodule, no anesthesia was administered. The application of anesthesia was alternatively administered between patients (either prior to the first US-FNAB procedure or prior to the second procedure). For all patients, the degree of pain during and after each US-guided FNAB was evaluated according to a 4-category verbal rating scale (VRS), an 11-point numeric rating scale (NRS) and a 100-mm visual analogue scale (VAS). Results: The mean maximum diameters of thyroid nodules examined by US-FNAB with the use of local anesthesia and with no local anesthesia were 13.6 mm and 13.0 mm, respectively. There was no significant difference in nodule size (p > 0.05) between two groups. For the VRS, there were 27 patients with a higher pain score when local anesthesia was used and four patients with a higher pain score when no local anesthesia was administered. Nineteen patients had equivalent pain score for both treatments. This finding was statistically significant (p < 0.001). For the NRS, there were 33 patients with a higher pain score when local anesthesia was used and 10 patients with a higher pain score when no local anesthesia was administered. Seven patients had an equivalent pain score for each treatment. This finding was statistically significant (p < 0.001). For the VAS, there were 35 patients with a higher pain score when local anesthesia was used and 11 patients with a higher pain score where no local anesthesia was administered. Four patients had an equivalent pain score for both treatments. This finding was also statistically significant (p = 0.001). Conclusion: In our study, patient pain scales were significantly lower when no local anesthesia was used prior to US-FNABs of thyroid nodules as compared to when local anesthesia was administered. Therefore, we believe that when one needle puncture is used, US-FNAB should be performed without administering local anesthesia.

Prevalence of thyroid nodules and their associated clinical parameters: a large-scale, multicenter-based health checkup study

( Jae Hoon Moon ),( Min Kyung Hyun ),( Ja Youn Lee ),( Jung Im Shim ),( Tae Hyuk Kim ),( Hoon Sung Choi ),( Hwa Young Ahn ),( Kyung Won Kim ),( Do Joon Park ),( Young Joo Park ),( Ka Hee Yi ) 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.4

Background/Aims: We evaluated the prevalence and characteristics of thyroid nodules detected by thyroid ultrasound (US) at health checkups and the associated clinical parameters. Methods: A total of 72,319 subjects who underwent thyroid US at three health checkup centers in Korea from January 2004 to December 2010 were included in this study. The correlations between the presence of thyroid nodules and other clinical parameters were analyzed. Results: The prevalence of thyroid nodules and cysts was 34.2% (n = 24,757). Thyroid nodules were more prevalent in women and older age groups. Among the subjects with thyroid nodules with size information (n = 24,686), 18,833 (76.3%) had nodules measuring ≤ 1.0 cm. Women and older age groups showed higher proportion of larger nodules. Percentage of women, age, body mass index (BMI), waist circumference, body fat composition, blood pressure, and the level of fasting glucose, total cholesterol, and low density lipoprotein cholesterol were higher in the subjects with thyroid nodules compared to those without nodules. The prevalence of metabolic syndrome and overt/subclinical thyrotoxic state was higher in the subjects with thyroid nodules. In the multivariable logistic regression analysis, women, age, BMI, metabolic syndrome, and thyrotoxicosis were independently associated with the presence of thyroid nodules. Conclusions: The high prevalence of thyroid nodules in people who underwent thyroid US at a health checkup suggests that increased detection of thyroid nodules resulted in an increased prevalence in the general population. However, metabolic disturbances may also have contributed to the increase in thyroid nodule prevalence in Korea.

갑상선 결절의 임상양상과 미세침흡인검사의 의의

원진호,한희정,채수홍,김현진,송민호,김영건 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

We evaluated clinical manifestation of nodular thyroid disease and fine-needle aspiration cytology results to establish an appropriate diagnostic approach to thyroid nodule. We examined 594 patients who visited Chungnam National University Hospital with one or more thyroid nodules between Jan. 1996 and Dec. 1998. Fine-needle aspiration cytology was carried out after clinical evaluation including medical history, physical examination(hardness,size, multinodularity,fixation) and laboratory test(scan, thyroid function test). Among the 594 cases, 53 cases(8.9%) were diagnosed as cancer and 457 cases(77%) were diagnosed as benign nodule. None of these factors - age, sex. soft and firm nodule, multinodularity, thyroid scan, thyroid sonography, and thyroid function test - were significant to predict cancer in our study. The prevalence of cancer was significantly higher in hard nodule(28. 5%,39/137) than firm(3.8%,12/316) or soft nodule(0%,0/72). There was size difference between malignant(24.2±62.8ml) and benign nodules(12.6±26.1ml),but the size difference wasn't shown to an indicator to say whether malignant or benign. The prevalence of cancer in relation to fixation was significantly higher in fixation(50%,19/38) and partial fixation nodule(33%,4/12) than movable nodules(5.8%,28/476). Rapid growing, vocal cord palsy,and lymphadenopathy among the medical history had higher relative risk to cancer (relative risk= 14, 4.8, 10.2. respectively). We also examined 67 cases which were diagnosed by histology after operation and, through comparison between the results of histology and cytology., evaluated the effectiveness of fine-needle aspiration cytology. Sensitivity, specificity, false negative rate, and false positive rate of fine-needle aspiration cytology were 92-100%, 47-63%, 0-20%, 0-50%,respectively. Our data suggests that thyroid nodules of the patients which are characterized firm, fixed, rapid growing, lymphadenopathy, and vocal cord palsy require more careful evaluation for thyroid cancer. We also recommand thyroid aspiration cytology in first step evaluation to rule out thyroid cancer.

갑상선 결절의 진단에 있어서 TI-201 주사의 의의

윤정한,김동의,범희승 최신의학사 1993 最新醫學 Vol.36 No.4

새로운 권고안(2021 Korean Thyroid Imaging Reporting and Data System)을 이용한 갑상선 결절의 평가

정소령 대한내과학회 2022 대한내과학회지 Vol.97 No.5

The rate of detection of thyroid nodules and carcinomas has increased with the widespread use of ultrasonography (US), which is the primary imaging modality for the detection and risk stratification of thyroid nodules. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.

2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations

Ha Eun Ju,Chung Sae Rom,Na Dong Gyu,Ahn Hye Shin,Chung Jin,Lee Ji Ye,Park Jeong Seon,Yoo Roh-Eul,Baek Jung Hwan,Baek Sun Mi,조성휘,Choi Yoon Jung,Hahn Soo Yeon,Jung So Lyung,Kim Ji-hoon,Kim Seul Kee,Kim 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.12

Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1–2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.