Can Clinical Presentation and Ultrasonography Predict the Risk of Malignancy in Thyroid Nodules?

Thyroid nodules are frequent occurrences. This study aims to evaluate the risk of malignancy based on the 2015 American Thyroid Association Management: Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer.
In this cross-sectional study, ultrasonography and clinical manifestations were compared with pathology findings to predict the risk of malignancy in thyroid nodules. Assessment of the ultrasound findings was based on the criteria recommended by The 2015 American Thyroid Association Management Guidelines for Thyroid Nodules. For the evaluation of the association between clinical and ultrasound findings with histopathology results, we used the chi-square and Fisher’s exact tests. The relative risk and prediction of malignancy was assessed by multiple logistic regression analysis. Data analysis was performed by the SPSS19. The significance level was set at P<0.05.
From 130 patients with thyroid nodules, 110 (84.6%) were female. The mean age of participants was 46.1±11.5 years. Histopathology findings showed malignancy in 17.7% of the nodules, all of were papillary thyroid carcinoma. Multivariate logistic regression showed some of the ultrasonography parameters, absence of halo (P<0.001, OR=28), taller than wide shape (P=0.001, OR=18.3), nodule size more than 4 cm (P=0.04, OR=12.1), irregular margin (P=0.001, OR=10.06), solid or mixed composition (P=0.002, OR=8.1), hypoechoic (P=0.001, OR=4.5), lymph node positive  (P=0.002, OR=4.3), positive calcification (P=0.03, OR=2.08), positive internal vascularity (P<0.001, OR=1.05), and intermediate/high level of suspicion (P=0.001, OR=12) could predict malignancy in patients with thyroid nodules.
Based on increasing rate of thyroid cancer, in this study, the new and accurate ultrasound technique is recommended as alternative diagnostic method due non-invasive nature and lower cost used.