Risk of Thyroid Cancer Based on Thyroid Ultrasound Imaging Characteristics: Results of a Population-Based Study

Details

• Alternative Title:
  JAMA Intern Med
• Personal Author:
  Smith-Bindman, Rebecca ; Lebda, Paulette ; Feldstein, Vickie A. ; Sellami, Dorra ; Goldstein, Ruth B. ; Brasic, Natasha ; Jin, Chengshi ; Kornak, John
• Description:
  Importance ; There is wide variation in the management of thyroid nodules identified on ultrasound imaging. ; Objective ; To quantify the risk of thyroid cancer associated with thyroid nodules based on their ultrasound characteristics. ; Methods ; Retrospective case-control study of patients who underwent thyroid ultrasound between January 1st, 2000 and March 30th, 2005. Thyroid cancers were identified through linkage with the California Cancer Registry. ; Results ; 8 806 patients underwent 11 618 thyroid ultrasound examinations during the study period including 105 subsequently diagnosed with thyroid cancer. Thyroid nodules were common in patients diagnosed with cancer (97%) and patients not diagnosed with thyroid cancer (56%). Three ultrasound nodule characteristics–micro-calcifications (odds ratio OR 8.1 95% CI 3.8, 17.3), size greater than 2 cm (OR 3.6 95% CI 1.7, 7.6) and an entirely solid composition (OR 4.0 95% CI 1.7, 9.2 - were the only findings associated with the risk of thyroid cancer. If a single characteristic is used as an indication for biopsy, most patients with thyroid cancer would be detected (sensitivity .88 95% CI .80, .94) with a high false positive rate (.44 95% CI .43, .45) and a low likelihood ratio positive (2.0 95% CI 1.8, 2.2), and 56 biopsies will be performed per cancer diagnosed. If two characteristics were required for biopsy, the sensitivity and false positive rates would be lower (sensitivity 0.52 95% CI 0.42, 0.62; false positive rate 0.07 95% CI 0.07, 0.08), the likelihood ratio positive would be higher (7.1 95% CI 6.2, 8.2), and only 16 biopsies will be performed per cancer diagnosed. In comparison to performing biopsy of all thyroid nodules greater than 5 mm, adoption of this more stringent rule requiring two abnormal nodule characteristics to prompt biopsy would reduce unnecessary biopsies by 90%, while maintaining a low risk of cancer, 5 per 1000 patients, for whom biopsy is deferred. ; Conclusion ; Thyroid ultrasound could be used to identify patients who have a low risk of cancer for whom biopsy could be deferred. Based on these results, these findings should be validated in a large prospective cohort.
• Subjects:
  • Article
  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Registries
  More +
• Source:
  JAMA Intern Med. 173(19):1788-1796.
• Pubmed ID:
  23978950
• Pubmed Central ID:
  PMC3936789
• Document Type:
  Journal Article
• Funding:
  HHSN261201000034C/PHS HHS/United States ; HHSN261201000035C/PHS HHS/United States ; HHSN261201000140C/PHS HHS/United States ; K24 CA125036/CA/NCI NIH HHS/United States ; R21 CA132987/CA/NCI NIH HHS/United States ; R21CA131698/CA/NCI NIH HHS/United States ; U58DP003862-01/DP/NCCDPHP CDC HHS/United States
• Volume:
  173
• Issue:
  19
• Download URL:
  https://stacks.cdc.gov/view/cdc/29862/cdc_29862_DS1.pdf
• File Type:
  [PDF - 448.94 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:714ee327674f5f23205403cdad5d9608e6dd1f929c1f31b72c414de21b224b2a