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KMID : 1202020080010020112
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Journal of Korean Thyroid Association
2008 Volume.1 No. 2 p.112 ~ p.116
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Imaging-Pathology Discordant Thyroid Nodules: Analysis of Causes on Ultrasonography
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Shin Jung-Hee
Han Boo-Kyung
Ko Eun-Young
Kim Suk-Jung
Mun Sung-Hee
Oh Young-Lyun
Kim Jee-Soo
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Abstract
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Background and Objectives: The purpose of this study was to evaluate causes and ultrasonographic features of imaging-pathology discordant thyroid nodules.
Materials and Methods: We prospectively collected cases with imaging-pathology discordant thyroid nodules by comparing the initial ultrasonographic impressions with at least more than two fine-needle aspiration (FNA) or surgical results between March 2006 and March 2007. An experienced radiologist retrospectively evaluated the causes and ultrasonographic findings of these cases.
Results: Of 4747 patients, 122 patients (2.6%) had imaging-pathology discordant nodules. Of 78 patients with at least two or more FNA (n=25) or surgical (n=53) discordant nodules, 29 imaging-pathology discordant benign lesions were associated with non-neoplastic nodules with focal malignant findings (n=12), thyroiditis (n=7), cysts mimicking solid nodules (n=4), post-aspiration cystic nodules (n=4) and pharyngoesophageal diverticulum (n=2). Forty-nine imaging-pathology discordant malignant lesions were associated with papillary carcinomas without definitely suspicious ultrasonographic findings (n=31), other thyroid carcinomas (n=12, including five follicular carcinomas, three follicular variants of papillary carcinoma and four medullary carcinomas), cystic malignancies (n=4) and calcified nodules with a spongiform appearance (n=2). Following a retrospective review, cysts mimicking solid nodules and pharyngoesophageal diverticulum mimicking a calcified nodule could be reclassified into correct ultrasonographic diagnoses.
Conclusion: Failure to understand correctly the ultrasonographic findings of imaging-pathology discordant nodules may lead to unnecessary ultrasonography-guided FNA or a delayed diagnosis of cancer.
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KEYWORD
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Thyroid nodule, Ultrasonography, Diagnosis
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