The utility of thyroid ultrasonography in the management of thyroid nodules.
BACKGROUND
Ultrasonography for thyroid nodules is one of the most common imaging tests performed in the general population. Details from ultrasound reports guide biopsies and surgery. This study quantifies the completeness of these reports based on Thyroid Imaging and Reporting System (TI-RADS) criteria and considers their utility in predicting malignant disease.


METHODS
We retrospectively reviewed ultrasound reports for 329 thyroidectomy patients and extracted data elements using the TI-RADS criteria: nodule size, echogenicity, margins, vascularity, solid/cystic composition and the presence or absence of microcalcifications and the halo sign. We assessed the reports to determine whether individual or multiple criteria were associated with malignancy.


RESULTS
More than 97% of reports document nodule size; however, more than 90% of the reports noted only 3 or fewer of the 6 remaining TI-RADS criteria. The presence of microcalcifications was the most sensitive marker of malignancy (> 90%), whereas the documentation of irregular margins was the most specific indicator of malignancy (88%). Overall it was clear that microcalcifications, hypoechogenicity, irregular margins and solid nodules were significantly more likely to be found in malignant neoplasms; their absence predicted benign disease. Because so few reports consistently documented all criteria, the overall ability of thyroid ultrasonography to discriminate between lowerand higher-risk nodules is limited.


CONCLUSIONS
Although the accuracy of thyroid ultrasonography is good, few ultrasound reports contain the necessary information, as defined by TI-RADS, to predict malignancy and guide management. When reported, microcalcifications and/or irregular margins are the best predictors of malignancy.
From the Department of Surgery, University of Alberta, Edmonton, Alta. (Gamme, Williams, McMullen); the Department of Radiology, University of Alberta, Edmonton, Alta. (Wiebe); the Department of Oncology, University of Alberta, Edmonton, Alta. (Ghosh, McMullen); and the Department of Radiology, Queen's University, Kingston, Ont. (Litt).
Gary
G
Gamme
From the Department of Surgery, University of Alberta, Edmonton, Alta. (Gamme, Williams, McMullen); the Department of Radiology, University of Alberta, Edmonton, Alta. (Wiebe); the Department of Oncology, University of Alberta, Edmonton, Alta. (Ghosh, McMullen); and the Department of Radiology, Queen's University, Kingston, Ont. (Litt).
Tyler
T
Parrington
From the Department of Surgery, University of Alberta, Edmonton, Alta. (Gamme, Williams, McMullen); the Department of Radiology, University of Alberta, Edmonton, Alta. (Wiebe); the Department of Oncology, University of Alberta, Edmonton, Alta. (Ghosh, McMullen); and the Department of Radiology, Queen's University, Kingston, Ont. (Litt).
Edward
E
Wiebe
From the Department of Surgery, University of Alberta, Edmonton, Alta. (Gamme, Williams, McMullen); the Department of Radiology, University of Alberta, Edmonton, Alta. (Wiebe); the Department of Oncology, University of Alberta, Edmonton, Alta. (Ghosh, McMullen); and the Department of Radiology, Queen's University, Kingston, Ont. (Litt).
Sunita
S
Ghosh
From the Department of Surgery, University of Alberta, Edmonton, Alta. (Gamme, Williams, McMullen); the Department of Radiology, University of Alberta, Edmonton, Alta. (Wiebe); the Department of Oncology, University of Alberta, Edmonton, Alta. (Ghosh, McMullen); and the Department of Radiology, Queen's University, Kingston, Ont. (Litt).
Brendan
B
Litt
From the Department of Surgery, University of Alberta, Edmonton, Alta. (Gamme, Williams, McMullen); the Department of Radiology, University of Alberta, Edmonton, Alta. (Wiebe); the Department of Oncology, University of Alberta, Edmonton, Alta. (Ghosh, McMullen); and the Department of Radiology, Queen's University, Kingston, Ont. (Litt).
David C
DC
Williams
From the Department of Surgery, University of Alberta, Edmonton, Alta. (Gamme, Williams, McMullen); the Department of Radiology, University of Alberta, Edmonton, Alta. (Wiebe); the Department of Oncology, University of Alberta, Edmonton, Alta. (Ghosh, McMullen); and the Department of Radiology, Queen's University, Kingston, Ont. (Litt).
Todd P W
TP
McMullen
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000601:surgery; D013965:Thyroidectomy; D014463:Ultrasonography / Q000592:standards*