Association of Ultrasonographic Characteristics with the Malignancy in Cold Nodules of Thyroid.

Abstract

Objective: To determine association of ultrasonographic findings with malignancy in patients
with cold nodule of thyroid.
Methods: This was a observational study, conducted in Department of ENT, Jinnah
Postgraduate Medical Center, Karachi. The study duration was six months, ie. from 15th April to
15th October, 2015. Patients with diagnosis of palpable nodule in thyroid gland on physical
examination were enrolled. Detailed histories and physical examination was recorded. All
patients underwent 99mTc-pertechnetate scintigraphy and patients with cold nodule were eligible
for study after fulfilling inclusion/exclusion criteria. Thyroid ultrasonography was performed and
findings such as size, shape, calcifications and echogenicity of nodule were recorded. FNA
biopsy was performed under ultrasound guidance. Final diagnosis of malignancy was based on
histopathologic examination. Data was analysed by SPSS and association was established
between ultrasonographic characteristics and frequency of malignancy in cold nodules of thyroid
gland.
Results: Out of total 188 patients of cold nodule, 17 were positive for malignancy. On analysis of
association of various factors with malignancy, 04 patients of age less than 40 years while 13 of
age 40 and above had malignancy (P=0.235). Ten males and 7 females had malignancy (P=
0.514). Seven patients with tumor size <2cm, while 10 patients with tumor size >2cm had
malignancy (P=000). Fourteen patients with abnormal shape (irregular margins, infiltrative,
microlobulated) while 03 patients without abnormal shape had malignancy (p=.036). Seven
patients with calcification (microcalcifications) while 10 patients without calcification had
malignancy (P=0.209). Seven patients with hypoechogenicity while 10 patients without
hypoechogenicity had malignancy (P=0.533).
Conclusions: Majority of patients with malignancy are male of above 40 years of age. Tumor
size above 2 cm and abnormal shape on ultrasound of thyroid gland are strongly associated with
increased chances of malignancy in cold nodules of thyroid