title: Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study.
abstract: OBJECTIVE
  To retrospectively evaluate the diagnostic accuracy of ultrasonographic (US) criteria for the depiction of benign and malignant thyroid nodules by using tissue diagnosis as the reference standard.
  
  
  METHODS
  This study had institutional review board approval, and informed consent was waived. From January 2003 through June 2003, 8024 consecutive patients had undergone thyroid US at nine affiliated hospitals. A total of 831 patients (716 women, 115 men; mean age, 49.5 years +/- 13.8 [standard deviation]) with 849 nodules (360 malignant, 489 benign) that were diagnosed at surgery or biopsy were included in this study. Three radiologists retrospectively evaluated the following characteristics on US images: nodule size, presence of spongiform appearance, shape, margin, echotexture, echogenicity, and presence of microcalcification, macrocalcification, or rim calcification. A chi(2) test and multiple regression analysis were performed. Sensitivity, specificity, and positive and negative predictive values were obtained.
  
  
  RESULTS
  Statistically significant (P < .05) findings of malignancy were a taller-than-wide shape (sensitivity, 40.0%; specificity, 91.4%), a spiculated margin (sensitivity, 48.3%; specificity, 91.8%), marked hypoechogenicity (sensitivity, 41.4%; specificity, 92.2%), microcalcification (sensitivity, 44.2%; specificity, 90.8%), and macrocalcification (sensitivity, 9.7%; specificity, 96.1%). The US findings for benign nodules were isoechogenicity (sensitivity, 56.6%; specificity, 88.1%; P < .001) and a spongiform appearance (sensitivity, 10.4%; specificity, 99.7%; P < .001). The presence of at least one malignant US finding had a sensitivity of 83.3%, a specificity of 74.0%, and a diagnostic accuracy of 78.0%. For thyroid nodules with a diameter of 1 cm or less, the sensitivity of microcalcifications was lower than that in larger nodules (36.6% vs 51.4%, P < .05).
  
  
  CONCLUSIONS
  Shape, margin, echogenicity, and presence of calcification are helpful criteria for the discrimination of malignant from benign nodules; the diagnostic accuracy of US criteria is dependent on tumor size.
authors.affiliation: Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. mdmoonwj@naver.com
authors.forename: Won-Jin
authors.initials: WJ
authors.lastname: Moon
authors.forename: So Lyung
authors.initials: SL
authors.lastname: Jung
authors.forename: Jeong Hyun
authors.initials: JH
authors.lastname: Lee
authors.forename: Dong Gyu
authors.initials: DG
authors.lastname: Na
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Baek
authors.forename: Young Hen
authors.initials: YH
authors.lastname: Lee
authors.forename: Jinna
authors.initials: J
authors.lastname: Kim
authors.forename: Hyun Sook
authors.initials: HS
authors.lastname: Kim
authors.forename: Jun Soo
authors.initials: JS
authors.lastname: Byun
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Lee
mesh_terms: D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016606:Thyroid Nodule / Q000000981:diagnostic imaging*; D014463:Ultrasonography