Objective: To compare the diagnostic performance of American College of Radiology-Thyroid Image Reporting and Data Systems (ACR-TIRADS) and the American Thyroid Association (ATA) guidelines on screening for thyroid malignancy. Methodology: A cross-sectional criterion-referenced study involving Filipino patients with thyroid nodules, 18-80 years old, who underwent ultrasound guided fine needle aspiration biopsy at the Thyroid Clinic of The Medical City from July to December 2019. The ACR-TIRADS and the ATA guidelines were compared for 197 nodules. Standard diagnostic parameters were calculated, namely sensitivity, specificity, PPV, NPV, positive and negative likelihood ratios and overall accuracies. Results: The risks of malignancy were 15% and 22% for TIRADS 4 and 5 respectively. For ATA guidelines, it’s 2%, 20%, and 15% for nodules with low, intermediate, and high suspicion respectively. The sensitivity, specificity, PPV, NPV, and accuracy of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TIRADS) in relation to Fine Needle Aspiration Cytology (FNAC) is 100%, 52.2%, 16.5%, 100%, and 56.4% respectively. For the American Thyroid Association (ATA) guidelines it is 88.2%, 57.8%, 16.5%, 98.1%, and 60.4% respectively. Conclusion The ACR TIRADS classifications appears to be more sensitive than the ATA classification. The ATA guidelines prove to be a more specific test. Each tool has its unique advantages and disadvantages. Therefore, clinicians must use these tools with utmost vigilance to avoid over or under diagnosis and to avoid unnecessary thyroid nodule biopsies.
Thyroid Neoplasms ; Thyroid Nodule

No abstract available.
Humans ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule*

No abstract available.
Humans ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule*

Preoperative staging of thyroid cancer is very important for radiologist to help the surgeon manage the patient. Ultrasound plays a key role in diagnostic work-up at most cases. In this review, I discuss preoperative radiological staging of well differentiated thyroid cancer and compare US with CT.
Humans ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

No abstract available.
Humans ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

No abstract available.
Humans ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

PURPOSE: We studied the patterns of FDG uptake of primary papillary thyroid microcarcinoma (PTMCa) lesions and benign thyroid nodules in dual time point (18)F-FDG PET/CT imaging. MATERIALS AND METHODS: Consecutive 134 patients (154 lesions) with PTMCa and 49 patients (61 nodules) with benign thyroid nodules equal to or less than 1.0 cm who underwent dual time point (18)F-FDG PET/CT study before surgery were enrolled. We calculated the maximum standardized uptake value of PTMCa and benign nodules in both time points, and percent change of SUVmax (delta%SUVmax) and lesion to background ratio of SUVmax (delta%L:B ratio) between both time points. The mean time interval between scans was 23.4+/-4.4 minutes (thyroid to thyroid interval: 10.7+/-4.4 minutes). RESULTS: The mean of SUVmax of PTMCa was increased from 4.9+/-4.3 to 5.3+/-4.7 (p<0.001) and delta%SUVmax was 12.3+/-23.6%. But, the mean of SUVmax of benign nodules was no definite change (2.1+/-1.0 to 2.1+/-1.3, p=0.686) and delta%SUVmax was -0.3+/-20.5%. Of the 154 PTMCa, 100 nodules (64.9%) showed an increase in SUVmax over time, while 19 (31.1%) of the 61 benign thyroid nodules showed an increase (p<0.001). The dual time point (18)F-FDG PET/CT found more PTMCa in visual assessment (62.3% vs. 76.6%, p=0.006), even in smaller than 0.5 cm (38.6% vs. 60.0%, p=0.011). CONCLUSION: Dual time time (18)F-FDG PET/CT imaging was more useful than single time point (18)F-FDG PET/CT imaging for distinction between PTMCa and benign nodule, especially when nodule showed equivocal or negative findings in single time point (18)F-FDG PET/CT imaging or was smaller than 0.5 cm.
Carcinoma, Papillary ; Humans ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

PURPOSE: Metastatic thyroid cancers with I-131 uptake have been known to show no increase of FDG uptake whereas those without I-131 uptake tend to demonstrate increased uptake on PET. In this study, we evaluated the degree of FDG uptake in primary thyroid cancers of papillary histology before surgery. MATERIAL AND METHODS: Forty FDG PET studies were performed on the patients who had papillary cancer proven by fine needle aspiration. The degree of FDG uptake was visually categorized as positive or negative (positive if the tumor showed discernible FDG; negative if the tumor didn't) and the peak standard uptake value (peak SUV) of the papillary thyroid cancer (PTC) were compared with the size of PTC. RESULTS: The mean size of 26 PTC with positive FDG uptake was 1.9+/-1.4 cm(0.5~5 cm). In 13 PTC with negative FDG uptake, the mean size of those was 0.5+/-0.2 cm (0.2~0.9 cm). All PTC larger than 1cm (2.5+/-1.4 cm, 1~5 cm) have positive FDG uptake (peak SUV=6.4+/-5.7, 1.7~22.7). Among the micropapillary thyroid cancer (microPTC; PTC smaller than 1cm), 8 microPTC show positive FDG uptake(peak SUV=2.9+/-1.3, 1.7~5.5), while 13 microPTC show negative finding(peak SUV=1.3+/-0.2, 1.1~1.7). The size of microPTC with positive FDG uptake is significantly larger than that of microPTC with negative FDG uptake (0.7+/-0.1 cm vs 0.4+/-0.2 cm, p=0.01). CONCLUSION: All PTCs larger than 1cm show positive FDG uptake in our study. In other words, thyroid lesions larger than 1cm with negative FDG uptake are unlikely to be PTC. So far, only poorly differentiated thyroid cancers are known to show increased FDG uptake. Our results seem to be contradictory to what is known in the literature. Further study is needed to understand better the significance of increased FDG uptake in PTC in relation to expression of NIS and GLUT.
Biopsy, Fine-Needle ; Humans ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule

Calcifications of thyroid nodules are often found in sonography reports and can be detected in both benign and malignant nodules. Although it is well known that micro-calcifications are associated with thyroid malignancy, especially in papillary thyroid carcinomas, the results for macro-calcifications are controversial. Yoon et al. evaluated the role of presence of macro-calcification in thyroid nodules for predicting malignancy by retrospectively analyzing FNAC data and sonographic findings in one institution, and showed that macro-calcification is also significantly associated with thyroid malignancy. Coarse calcifications were more commonly found in malignant nodules than in benign nodules, however, rim calcification was not associated with malignancy. We should carefully evaluate thyroid nodule(s) with calcification regardless of the pattern of calcification, and it would be mandatory to evaluate the clinical significance of rim calcification by prospective analysis.
Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

No abstract available.
Biopsy, Large-Core Needle* ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule