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. |
