title: The predictive value of sonographic images of follicular lesions - a comparison with nodules unequivocal in FNA - single centre prospective study.
abstract: BACKGROUND
  To determine the diagnostic efficacy of ultrasonographic malignancy risk features (UMRFs) in follicular lesions (FL) in a population with low risk of malignancy in FL and to compare it with a similar analysis in a group of patients with unequivocal cytology (UC): benign lesion (BL) or malignant neoplasm (MN).
  
  
  METHODS
  Presence of UMRFs (hypoechogenicity, solid echostructure, taller-than-wide shape, pathological vascularization, irregular margins, microcalcifications and macrocalcifications) and their sets were assessed in 322 FL: 202 follicular lesions of undetermined significance (FLUS) and 120 suspicious for follicular neoplasm (SFN) and 300 nodules with UC: 200 BL and 100 MN, subsequently evaluated histopathologically.
  
  
  RESULTS
  Cancers were confirmed in 100% nodules in MN group (89.0% of them were papillary carcinomas - PTC), in 6.4% FLUS nodules (69.2% PTC), and in 10.8% SFN nodules (30.8% PTC). In the UC group all UMRFs occurred more frequently in cancers than in benign lesions. In the FL group only calcifications were found in cancers more frequently - macro and microcalcifications together: 34.6 vs. 11.5% (p = 0.001) and isolated macrocalcifications: 26.0 vs. 6.8% (p = 0.001); the presence of those features increased the basic risk of malignancy in FL more than 2 times. The presence of at least 2 of the following URMFs: hypoechogenicity, solid echostructure, any type of calcifications and suspected shape, additionally improved sensitivity.
  
  
  CONCLUSIONS
  Evaluation of UMRFs in FLs is less effective than in nodules with UC, and its effectiveness decreases parallel to the decrease in percentage of PTCs among malignant neoplasms and to the increase of the percentage of adenomas among benign nodules. The presence of macrocalcifications in such FLs significantly increases the basic risk of malignancy in these nodules.
authors.affiliation: Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Sterlinga Str 5, Łódź, 91-425, Poland. dsk@tyreo.umed.lodz.pl.
authors.forename: Dorota
authors.initials: D
authors.lastname: Słowińska-Klencka
authors.affiliation: Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Sterlinga Str 5, Łódź, 91-425, Poland.
authors.forename: Martyna
authors.initials: M
authors.lastname: Wojtaszek-Nowicka
authors.affiliation: President Stanisław Wojciechowski Higher Vocational State School in Kalisz, Kalisz, Poland.
authors.forename: Stanisław
authors.initials: S
authors.lastname: Sporny
authors.affiliation: Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Sterlinga Str 5, Łódź, 91-425, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Woźniak-Oseła
authors.affiliation: Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Sterlinga Str 5, Łódź, 91-425, Poland.
authors.forename: Bożena
authors.initials: B
authors.lastname: Popowicz
authors.affiliation: Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Sterlinga Str 5, Łódź, 91-425, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Klencki
mesh_terms: D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D006080:Ovarian Follicle / Q000000981:diagnostic imaging*; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014463:Ultrasonography
keywords: Cancer; FLUS; Fine needle aspiration biopsy; Follicular lesions; SFN; Thyroid; Ultrasonography