title: A simple ultrasound score for the identification of candidates to fine needle aspiration of thyroid nodules.
abstract: BACKGROUND
  Cytological examination of fine needle aspirates (FNA) is the standard procedure for discriminating potentially malignant thyroid nodules to be referred to surgery. In a fraction of cases, ultrasound (US) examination could provide information theoretically sufficient to avoid FNA, when typical US features suggesting malignancies are lacking.
  
  
  OBJECTIVE
  The aim of this study was to construct a simple US score predicting malignant nodules so as to reduce the number of unnecessary FNA.
  
  
  METHODS
  In a series of 1632 consecutive patients undergoing US-guided FNA (1812 nodules), echostructure, echogenicity, margins, halo, microcalcification, and vascularization were assessed.
  
  
  RESULTS
  At multivariate analysis, the following parameters showed a strong predictive value for positive cytology (Thy 4 and Thy 5, suspicious and diagnostic for malignancy, respectively, according to the Thyroid British Association): solid echostructure, irregular margins and hypoechogenicity [adjusted odd ratio (OR) 5.13 (1.58-16.66), 3.03 (1.70-5.39), 2.05 (1.17-3.57), respectively]. A 10-point Thyroid Risk Ultrasound Score (TRUS) was constructed on the basis of the adjusted OR. A TRUS≥6 identified malignant nodules with sensitivity and specificity of 73% and 65%, respectively. Among the patients with follicular lesions (Thy 3) and final diagnosis of carcinoma, about 65% had a TRUS≥6.0.
  
  
  CONCLUSIONS
  The sensitivity of TRUS, although higher than that of other scores, could still be insufficient for the identification of patients who could avoid FNA in routine clinical practice, whereas its predictive value for Thy 3 lesions deserves further investigations.
authors: Endocrinology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: L
authors: L
authors: Petrone
authors: E
authors: E
authors: Mannucci
authors: M L
authors: ML
authors: De Feo
authors: G
authors: G
authors: Parenti
authors: C
authors: C
authors: Biagini
authors: R
authors: R
authors: Panconesi
authors: V
authors: V
authors: Vezzosi
authors: S
authors: S
authors: Bianchi
authors: V
authors: V
authors: Boddi
authors: L
authors: L
authors: Di Medio
authors: C
authors: C
authors: Pupilli
authors: G
authors: G
authors: Forti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003581:Cytodiagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology*; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult