title: Predictive value of sonographic features in preoperative evaluation of malignant thyroid nodules in a multinodular goiter.
abstract: BACKGROUND
  The primary goal of ultrasonography (US) in the evaluation of a thyroid nodule is to determine its malignancy, although the diagnosis of a malignant nodule on the basis of US alone is nearly impossible. The aim of this prospective study was to evaluate the predictive value of sonographic features in the preoperative diagnosis of malignant thyroid nodules, and to determine the important features of sonography.
  
  
  METHODS
  This prospective study included 550 consecutive patients with , thyroid nodules. Nodules were divided into two groups on the basis of pathological diagnosis: group 1 consisted of 1,633 nodules with a benign pathology, and group 2 consisted of 293 nodules with a malignant pathology.
  
  
  RESULTS
  Microcalcifications, blurred nodular margins, and solid and hypoechoic appearance were more common in malignant nodules compared to benign nodules (89.1% versus 5%; 64.5% versus 4.7%; 81.6% versus 30.6% ; and 62.5% versus 43.1%, respectively; p < 0.001). There was a positive correlation between the detection of malignant thyroid nodules and microcalcification (rs = 0.791, p = 0.0001), blurred nodular margin (rs = 0.625, p = 0.0001), solid appearance (rs = 0.376, p = 0.0001), and hypoechoic appearance (rs = 0.141, p = 0.0001). Microcalcifications, blurred nodular margins, and solid and hypoechoic appearance were independent determinants of malignancy upon US examination of thyroid nodules (OR: 159, OR: 37, OR: 9.9, and OR: 2.2, respectively).
  
  
  CONCLUSIONS
  Although we did not identify a single feature indicative of malignancy in the sonographic examination of nodules, microcalcification and blurred margin were the strongest correlates for malignancy.
authors.affiliation: Department of Radiology, Istanbul Medical Faculty, Istanbul University, Capa 34093, Istanbul, Turkey.
authors.forename: Artür
authors.initials: A
authors.lastname: Salmaslioğlu
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Erbil
authors.forename: Cem
authors.initials: C
authors.lastname: Dural
authors.forename: Halim
authors.initials: H
authors.lastname: Işsever
authors.forename: Yersu
authors.initials: Y
authors.lastname: Kapran
authors.forename: Selçuk
authors.initials: S
authors.lastname: Ozarmağan
authors.forename: Serdar
authors.initials: S
authors.lastname: Tezelman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006044:Goiter, Nodular / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy; D014463:Ultrasonography