Re-Evaluation of 162 Malignant Thyroid Nodules that were Interpreted as Benign Based on Ultrasound Findings

• Main Authors: Tomoko Fujimoto, Mitsuyoshi Hirokawa, Ayana Suzuki, Hisashi Ota, Maki Oshita, Takumi Kudo, Mitsuhiro Fukushima, Kaoru Kobayashi, Akira Miyauchi
• Format: Article
• Language: English
• Published: Georg Thieme Verlag KG 2018-10-01
• Series: Ultrasound International Open
• Subjects: thyroid; sonography; risk of malignancy; interobserver variation
• Online Access: http://www.thieme-connect.de/DOI/DOI?10.1055/a-0732-5795
• ISSN: 2509-596X; 2199-7152

Purpose The goal of this study was to estimate the risk of malignant thyroid nodules being interpreted as benign based on ultrasound findings and to clarify the pathological features of these malignant nodules. Materials and Methods We retrospectively re-evaluated ultrasound and pathological findings for 162 malignant thyroid nodules that were initially interpreted as benign based on ultrasound findings at Kuma Hospital between April 2012 and June 2015. Results The incidences of malignancy among “benign” thyroid nodules were 0.5% overall and 6.2% among resected nodules. In addition, 82.7% of thyroid nodules that were originally judged to have low or very low suspicion patterns were subsequently re-categorized as having high or intermediate suspicion patterns. The incidences of irregular margins (63.6%) and low echogenicity (36.4%) were higher than those of punctate microcalcification (17.9%) and the taller-than-wide shape (20.4%). Among microcarcinomas, the incidences were 65.7% for irregular margins and 51.4% for low echogenicity. Rim calcification with small extrusive soft tissue components and extrathyroidal extensions were not observed. After re-evaluation, 40.0% of papillary thyroid carcinomas remained benign based on their variants, such as the encapsulated, follicular, macrofollicular, and oxyphilic cell variants. Conclusion We conclude that more careful observation, especially for lesions with irregular margins and low echogenicity, can help improve the diagnostic accuracy of thyroid ultrasonography. Furthermore, greater care may decrease the incidence of malignancy among thyroid nodules with low or very low suspicion patterns. Some variants of papillary thyroid carcinoma can have benign ultrasound findings.