Publications of Faculty of Medicine:Utility of Gray Scale Ultrasound and Color Flow Doppler Versus Histology in Cold Solitary Thyroid Nodule: Abstract

Utility of Gray Scale Ultrasound and Color Flow Doppler Versus Histology in Cold Solitary Thyroid Nodule
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Background: Nodular thyroid disease is detected in 3-7% of the adults. Ultrasonography (US) is the most common way to image the thyroid gland and its pathology. Objectives: The objective of study was to assess the utility of color flow criteria alone or in combination with Gray scale sonography criteria for differentiation between benign and malignant cold solitary solid thyroid nodule and to correlate the characteristics of benign and malignant nodules with pathological diagnosis Subjects and Methods: Twenty six patientr with cold solitary solid thyroid nodule were selected from 93 patients with thyroid swelling after full history taking, complete clinical examination, laboratory and radiological investigations. Gray scale ultrasonography findings that suggested malignancy included micro-calcification, an irregular or microlobulated margin, marked hypo-echogenicity, a shape that more tall than it was wide and type III color flow Doppler(CFD)pattern were recorded. If even one of these sonography features was present the nodule was classified as positive (malignant) and if a nodule had none of the features described, it was classified as negative (benign). Hemi-thyroidectomy was done for all the cases with solitary nodule. The final diagnosis of a feature as benign or malignant was confirmed by histopathological examination to excised specimens. Results: This study included 44 females and 8 males with age range from 23 to " 65 years. Histopathological results showed 18 malignant (34.65%) lesions and 34 benign (65.4%).All malignant lesions were papillary carcinoma (100%) (34.2% from total ).The benign lesions were 14 simple nodules (41.2%) (26.9% from total) and 20 follicular adenoma (58.8%) (38.5% from total).Sonographic results: The size of the 52 nodules ranged from 3 to 18 mm (mean size, 10.5 mm).The sonograph:c characteristics of malignant lesions were detected in 16 cases out of histopathologically malignant 18 cases and in 12 cases out of hinopathologically benign 34 cases. The correlation of sonographic categorization with histological findings showed: In these 52 nodules, our sonographic classification method resulted in a sensitivity of 88.9% (16/18), spcificity of 64.7% (22/34), and accuracy of 73% (19/26).Regarding to sonographic finding in 18 histopathologically malignant cases, there were 12 cases with CFD type III (A), 12 with micro calcification (B), 10 with irregular margin (C), 8 with marked hypoechogenicity (D) and 8 more tall then wide (E). while in 34 histopaMologically benign cases there were 12 with CFD type III, 4 with microcalcification, 6 with irregular margin, 4 with hypoechogenicity and 4 more tall than wide. The accuracy of A, B, C, D, & E were 65.38%, 80.8%, 73.1%, 73.1% & 73.1% respecively. The accuracy of combination of CFD with gray scale patterns ranged front 69.2% to 80.8% with the mean of 74.3% .The results showed that there was no single sonographic item with accuracy of 100% can differentiate malignant front benign solitary nodule. The sensitivity, specificity and accuracy were calculated:Of 17 histopathologically benign cases, 6 were classified as positive. The accuracy of color Flow Doppler (CFD) alone was 65.4% while in combination with gray scale parameters the mean accuracy was 74.3%.Conclusions: No single US criterion is reliable in differentiating benign front malignant nodule. The color Doppler alone cannot reliably cistinguish benign from malignant thyroid nodule and also when added to gray scale parameters did not increase the accuracy. We reconunend more studies on larger scale to assess utility of this technique before any final conclusion can be drawn as regard to its accuracy in diagnosis of thyroid carcinoma.