Background : Nodular thyroid disease is detected in 3-7 % of the adults , Uitrasonography ( 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 maliguant cold solitary solid thyroid nodule and to correlate thee characteristics of benign and maliguant nodules with pathological diagnosis .subjects and methods : twenty six patiens with cold solitary solid examination laboratory and radiological investigations .Gray scale ultrasonography findings that suggested that more tall that it was wide and type III color flow Doppler (CFD) pattern were recorded . if even one of these sonography features was present thee nodule was classified as positive ( malignant ) and if anodule had one 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 afeature benign or malignant was confirmed by histopathologyical examination to excised specimens results : this study included 44 female and 8 males with age range from 23 to 65 years . histopathologyical results showed 18 malignant (34.65 % ) lisions 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 the52 nodule ranged from 3 to 18 mm ( mean size , 10.5 mm) .the sonographic characteristics of malignant lesions were detected in 16 cases out of histopathologyical malignant 18 cases and in 12 cases out of histopathologyical 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) specificity of 64.7% (22/34) and accuracy of 73% (19/26) .regarding to sonographic finding in 18 histopathologyical malignant cases , there were 12 cases with CFD type III (A) , 12 with micro calcification (B) ,10 irregular margin (C) ,8 with marked hypoechgenicity ( D) and 8 more tall then wide ( E) , while in 34 histopathologyical benign cases there were 12 with CED type III , 4 with microcalification 6 with irregular margin , 4with 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% respectively . the accuracy of combination of CFD with gray scale patterns ranged from 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 from benign solitary nodule the senditivity , specificity and accuracy were calculated of 17 histopathological benign cases , 6were 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 from malignant nodule the color doppler alone cannot reliably distinguish benign from malignant thyroid nodule and also when added to gray scale parameters did not increase the accuracy . we recommend 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 .
(Hicham farouk , osama galal , ahmed el-shal , sobhy abou el fotouh , Yasser Mohamed , tawfik el adi and Samir Abdulla . Utility of gray scale ultrasound and color flow Doppler versus histology in cold solitary thyroid nodule . |
