3D Ultrasound and Thyroid Cancer Diagnosis: A Prospective Study
Ghobad Azizi MD, Kirk Faust MD, Lorna Ogden MD, Laura Been MD, Michelle L. Mayo, PA-C, Kele Piper, Carl Malchoff MD
B-mode, or 2-dimensional ultrasound (2D-US), stratifies the malignancy risk of thyroid nodules, but lacks sensitivity. We tested the hypothesis that 3-dimensional ultrasound (3D-US) is superior to 2D-US in predicting malignancy in thyroid nodules.
We prospectively evaluated 344 thyroid nodules using both 2D and 3D ultrasound followed by fine needle aspiration biopsy.
Thyroid nodules were divided into four groups based on the 3D ultrasound appearance of the margins. Bivariate and multivariate analyses were used. A total of 59 patients with 63 thyroid nodules underwent surgery, surgical pathology confirmed 44 thyroid cancers in 40 patients. For 2D-US, irregular margins and microcalcifications were found more frequently in malignant thyroid nodules. Irregular margins on 2D-US had a sensitivity and specificity of 61.4% and 79.3% respectively. Irregular margins on 3D-US had a sensitivity and specificity of 86.4% and 83.3% respectively. Sensitivity, specificity, positive and negative predictive values were higher for irregular margins on 3D-US, than microcalcifications and irregular margins on 2D-US.
We conclude that the evaluation of thyroid nodule margins by 3D-US distinguishes benign from malignant thyroid nodules with greater sensitivity and specificity than other ultrasound criteria including the evaluation of margins by 2D-US.
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