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      The Association of Colour Flow Doppler Sonography and Conventional Ultrasonography Improves the Diagnosis of Thyroid Carcinoma

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          Objective: In the present study, we compared the results of conventional ultrasonography (US) and colour flow Doppler sonography (CFDS) with those of US guided fine needle aspiration biopsy (FNAB) and of pathologic staging of resected thyroid nodules, to assess the relative importance of US and CFDS in discriminating malignant thyroid nodules. Subjects and Study Design: We retrospectively reviewed records of 230 patients submitted to US-guided FNAB before surgery for solitary, not hot thyroid nodules. Before US guided FNAB, they were examined with conventional US and CFDS. Conventional US evaluated nodule size, echogenicity, presence of halo sign and microcalcifications. CFDS evaluated the vascular pattern classified as types I, II and III. Twenty-seven patients with inadequate cytology were excluded from this study (11.7%). Results: Two hundred and three patients underwent surgery. At histology a thyroid carcinoma was found in 36 patients (17.7%) and a benign nodule was observed in 167 patients (82.3%). We did not find any difference in cancer prevalence between nodules with a primary tumour size ≤1 cm and those >1 cm (17.6 vs. 17.7%; p = 0.99). A solid echo texture was not statistically significant to suggest malignancy (p = 0.32). Microcalcifications were seen in 83.3% (30/36) of malignant nodules and in33.5% (56/167) ofbenign nodules. These results were statistically significant (p < 0.0001). The type III flow as determined by CFDS was a statistically significant criterion to suggest malignant disease (p < 0.005). The most predictive findings of malignancy on conventional US was the combination of microcalcifications plus the absence of halo sign (sensitivity 75%, specificity 71.9%, p < 0.0001). The combination of an absence of halo sign on conventional US and a type III pattern on CFDS presented the higher sensitivity (83.3%) for malignancy with a specificity of 43.7%. Microcalcifications on US in combination with a type III CFDS pattern showed a lesser sensitivity (80.6%) with an improved specificity (75.4%). In our opinion, the better balanced combination of US and CFDS features was the absence of halo sign plus microcalcifications and a type III CDFS pattern (sensitivity 72.2%, specificity 77.2%). Conclusions: The combination of conventional US and CFDS provides benefits in increasing the screening sensitivity and accuracy in distinguishing malignant thyroid nodules.

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          Most cited references 15

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          Gross and microscopic findings in clinically normal thyroid glands.

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            Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings

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              Occult papillary carcinoma of the thyroid. A study of 408 autopsy cases.

              On examination of the thyroid glands in 408 consecutive autopsy cases, 64 occult papillary carcinomas (OPC) were found in 46 cases (11.3%) whose age ranged from 16 to 82 years. Their incidence was 26 of 247 (10.5%) in male and 20/161 (12.4%) in female cases. No definite correlation was found between the incidence of carcinoma and sex or age. All 64 carcinomas were less than 7.7 mm in diameter. They exhibited nuclear characteristics of papillary carcinoma although their growth patterns were "follicular" in the tumors less than 1 mm, and "papillary" in 70% of the tumors more than 3 mm in diameter. The carcinomas were classified into three types according to the presence or absence of capsular formation and fibrosis: encapsulated tumors (ET), nonencapsulated sclerosing tumors (NEST), and nonsclerosing tumors (NST). The NEST (28 tumors) and NST (26 tumors) were found in persons of all ages, whereas ET (ten tumors) were found only in those of older than 53 years. The mean tumor diameters of the three types, 4.57 mm for ET, 2.10 mm for NEST, and 0.85 mm for NST, were significantly different. These findings suggested that papillary carcinomas arose as minute carcinomas showing follicular pattern at any age as NST and then changed to NEST and ET, and papillary pattern became prominent if the tumors continued to grow. Very minute carcinomas were detected in serial sections of two of 27 fibrosclerotic nodules. Occult papillary carcinomas were found at significantly high incidence in cases with adenomatous goiter.

                Author and article information

                Horm Res Paediatr
                Hormone Research in Paediatrics
                S. Karger AG
                October 2006
                20 October 2006
                : 66
                : 5
                : 249-256
                aService of Endocrinology, Regina Elena Cancer Institute, and bRadiology, San Gallicano Institute, Rome, Italy
                96013 Horm Res 2006;66:249–256
                © 2006 S. Karger AG, Basel

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                Figures: 1, Tables: 3, References: 34, Pages: 8
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