Thyroid Nodule Location on Ultrasonography as a Predictor of Malignancy |
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| Institution: | 1. Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York;2. Division of Endocrinology, Diabetes & Metabolism, State University of New York, Downstate Medical Center, Brooklyn, New York;3. Ross University School of Medicine, Miramar, Florida;4. Division of Endocrinology, Brookdale University Hospital and Medical Center, Brooklyn, New York.;1. Department of Translational and Precision Medicine, University of Rome Sapienza, Rome, Italy;2. Department of Surgical Sciences, University of Rome Sapienza, Rome, Italy;3. Department of Pathology, Oncology and Radiology, University of Rome Sapienza, Rome, Italy.;1. Associate Professor of Orthopaedics, Alexandria University, Alexandria, Egypt;2. Consultant Orthopaedic Surgeon, Elhadara University Hospital, Elhadara, Lambrouzou, Alexandria, Egypt;3. Associate Professor of Orthopaedics, Mansoura University, Mansoura, Egypt;4. Consultant Orthopaedic Surgeon, Mansoura University Hospital, Mansoura, Egypt;5. Lecturer of Orthopaedics, Mansoura University, Mansoura, Egypt;6. Orthopedic Resident, Elhadara University Hospital, Elhadara, Lambrouzou, Alexandria, Egypt;1. Northwestern University Feinberg School of Medicine, Chicago, Illinois;2. Jaeb Center for Health Research, Tampa, Florida;3. Children''s Mercy Hospital, Kansas City, Missouri;4. University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania;5. Washington University School of Medicine, St. Louis, Missouri.;2. Department of Radiology, MD Anderson Cancer Center, Neuroradiology Department, The University of Texas, Houston, Texas, USA;3. Department of Biostatistics and Bioinformatics, Duke University Hospital, Durham, North Carolina, USA;4. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Health System, Baltimore, Maryland, USA |
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| Abstract: | Objective: The diagnostic capacity of ultrasonography (US) for differentiating between malignant and benign thyroid nodules is crucial in preventing unnecessary invasive procedures. This is the first study to evaluate whether thyroid nodule location on US has predictive value for malignancy.Methods: We retrospectively reviewed data from 219 patients with thyroid nodules who underwent fine-needle aspiration biopsy in 1 year. Patients' demographics as well as nodule's laterality, polarity, morphology, and multinodularity were analyzed. All malignant lesions were confirmed by surgical pathology.Results: The majority of the patients were female (86.2%). Nodules were evenly distributed between the right lobe (46.3%) and left lobe (49.5%). Eight nodules (4.2%) were located in the isthmus. Most nodules (79.3%) were located in the lower pole, while 9.6% were located in the upper pole and 6.9% in the middle pole. Seventy-five patients (39.9%) had multiple nodules. Fourteen nodules were malignant, representing a prevalence of 7.4%. A significantly higher frequency of malignancy was observed in upper pole (22.2%) compared to lower pole (4.7%) and middle pole (15.4%). A multiple logistic regression model confirmed such association after adjusting for age, body mass index, multinodularity, and laterality. The odds of malignancy in the upper pole were 4 times higher than other locations (odds ratio, 4.6; P = .03).Conclusion: Our study is the first showing that thyroid nodules located in the upper pole can be considered as having higher risk for malignancy. It may enhance the predictive value of malignancy if it is included in thyroid nodule ultrasound classification guidelines.Abbreviations: AACE = American Association of Clinical Endocrinologists; ATA = American Thyroid Association; BMI = body mass index; FNA = fine-needle aspiration; TMS = total malignancy score; TTW = taller than wide; US = ultrasonography |
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