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DOI: 10.1148/radiol.2373050220
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Management of Thyroid Nodules Detected at US: Society of Radiologists in Ultrasound Consensus Conference Statement1

Mary C. Frates, MD, Carol B. Benson, MD, J. William Charboneau, MD, Edmund S. Cibas, MD, Orlo H. Clark, MD, Beverly G. Coleman, MD, John J. Cronan, MD, Peter M. Doubilet, MD, PhD, Douglas B. Evans, MD, John R. Goellner, MD, Ian D. Hay, MD, PhD, Barbara S. Hertzberg, MD, Charles M. Intenzo, MD, R. Brooke Jeffrey, MD, Jill E. Langer, MD, P. Reed Larsen, MD, Susan J. Mandel, MD, William D. Middleton, MD, Carl C. Reading, MD, Steven I. Sherman, MD and Franklin N. Tessler, MD

1 From the Depts of Radiology (M.C.F.) and Pathology (E.S.C.) and Thyroid Unit, Div of Endocrinology, Diabetes and Hypertension, Dept of Medicine (P.R.L.), Brigham and Women's Hosp, Harvard Medical School, 75 Francis St, Boston, MA 02115; Depts of Radiology (J.W.C., C.C.R.) and Pathology (J.R.G.) and Division of Endocrinology (I.D.H.), Mayo Clinic, Rochester, Minn; Dept of Surgery, Univ of California at San Francisco (O.H.C.); Dept of Radiology (B.G.C., J.E.L.) and Div of Endocrinology, Diabetes and Metabolism (S.J.M.), Hosp of the Univ of Pennsylvania, Pa; Dept of Radiology, Rhode Island Hosp, Brown Univ Medical School, Providence (J.J.C.); Depts of Surgery (D.B.E.) and Endocrine Neoplasia and Hormonal Disorders (S.I.S.), Univ of Texas M.D. Anderson Cancer Ctr, Houston; Dept of Radiology, Duke Univ Medical School, Durham, NC (B.S.H.); Dept of Radiology, Thomas Jefferson Univ, Philadelphia, Pa (C.M.I.); Dept of Radiology, Stanford Univ, Palo Alto, Calif (R.B.J.); Mallinckrodt Inst of Radiology, Washington Univ School of Medicine, St Louis, Mo (W.D.M.); and Dept of Radiology, Univ of Alabama, Birmingham (F.N.T.). Received Feb 8, 2005; revision requested Mar 29; revision received Apr 26; accepted May 11. Address correspondence to M.C.F. (e-mail: mfrates{at}partners.org).



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  		Figure 1a. Punctate echogenicities in thyroid nodules. (a) Sagittal US image of nodule (arrowheads) containing multiple fine echogenicities (arrow) with no comet-tail artifact. These are highly suggestive of malignancy. FNA and surgery confirmed papillary carcinoma. (b) Transverse US image of nodule (arrowheads) containing cystic areas with punctate echogenicities and comet-tail artifact (arrow) consistent with colloid crystals in a benign nodule.

 


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  		Figure 1b. Punctate echogenicities in thyroid nodules. (a) Sagittal US image of nodule (arrowheads) containing multiple fine echogenicities (arrow) with no comet-tail artifact. These are highly suggestive of malignancy. FNA and surgery confirmed papillary carcinoma. (b) Transverse US image of nodule (arrowheads) containing cystic areas with punctate echogenicities and comet-tail artifact (arrow) consistent with colloid crystals in a benign nodule.

 


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  		Figure 2a. US images of thyroid nodules of varying parenchymal composition (solid to cystic). (a) Sagittal image of solid nodule (arrowheads), which proved to be papillary carcinoma. (b) Sagittal image of predominantly solid nodule (arrowheads), which proved to be benign at cytologic examination. (c) Transverse image of mixed solid and cystic nodule (calipers), which proved to be benign at cytologic examination. (d) Sagittal image of predominantly cystic nodule (calipers), which proved to be benign at cytologic examination. (e) Sagittal image of cystic nodule (arrowheads). FNA of this presumed benign lesion was not performed because the nodule appears entirely cystic.

 


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  		Figure 2b. US images of thyroid nodules of varying parenchymal composition (solid to cystic). (a) Sagittal image of solid nodule (arrowheads), which proved to be papillary carcinoma. (b) Sagittal image of predominantly solid nodule (arrowheads), which proved to be benign at cytologic examination. (c) Transverse image of mixed solid and cystic nodule (calipers), which proved to be benign at cytologic examination. (d) Sagittal image of predominantly cystic nodule (calipers), which proved to be benign at cytologic examination. (e) Sagittal image of cystic nodule (arrowheads). FNA of this presumed benign lesion was not performed because the nodule appears entirely cystic.

 


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  		Figure 2c. US images of thyroid nodules of varying parenchymal composition (solid to cystic). (a) Sagittal image of solid nodule (arrowheads), which proved to be papillary carcinoma. (b) Sagittal image of predominantly solid nodule (arrowheads), which proved to be benign at cytologic examination. (c) Transverse image of mixed solid and cystic nodule (calipers), which proved to be benign at cytologic examination. (d) Sagittal image of predominantly cystic nodule (calipers), which proved to be benign at cytologic examination. (e) Sagittal image of cystic nodule (arrowheads). FNA of this presumed benign lesion was not performed because the nodule appears entirely cystic.

 


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  		Figure 2d. US images of thyroid nodules of varying parenchymal composition (solid to cystic). (a) Sagittal image of solid nodule (arrowheads), which proved to be papillary carcinoma. (b) Sagittal image of predominantly solid nodule (arrowheads), which proved to be benign at cytologic examination. (c) Transverse image of mixed solid and cystic nodule (calipers), which proved to be benign at cytologic examination. (d) Sagittal image of predominantly cystic nodule (calipers), which proved to be benign at cytologic examination. (e) Sagittal image of cystic nodule (arrowheads). FNA of this presumed benign lesion was not performed because the nodule appears entirely cystic.

 


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  		Figure 2e. US images of thyroid nodules of varying parenchymal composition (solid to cystic). (a) Sagittal image of solid nodule (arrowheads), which proved to be papillary carcinoma. (b) Sagittal image of predominantly solid nodule (arrowheads), which proved to be benign at cytologic examination. (c) Transverse image of mixed solid and cystic nodule (calipers), which proved to be benign at cytologic examination. (d) Sagittal image of predominantly cystic nodule (calipers), which proved to be benign at cytologic examination. (e) Sagittal image of cystic nodule (arrowheads). FNA of this presumed benign lesion was not performed because the nodule appears entirely cystic.

 


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  		Figure 3a. Role of color Doppler US. (a) Transverse gray-scale image of predominantly solid thyroid nodule (calipers). (b) Addition of color Doppler mode shows marked internal vascularity, indicating increased likelihood that nodule is malignant. This was a papillary carcinoma.

 


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  		Figure 3b. Role of color Doppler US. (a) Transverse gray-scale image of predominantly solid thyroid nodule (calipers). (b) Addition of color Doppler mode shows marked internal vascularity, indicating increased likelihood that nodule is malignant. This was a papillary carcinoma.

 


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  		Figure 4a. Transverse US images of mostly cystic thyroid nodule with a mural component containing flow. (a) Gray-scale image shows predominantly cystic nodule (calipers) with small solid-appearing mural component (arrowheads). (b) Addition of color Doppler mode demonstrates flow within mural component (arrowheads), confirming that it is tissue and not debris. US-guided FNA can be directed into this area. The lesion was benign at cytologic examination.

 


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  		Figure 4b. Transverse US images of mostly cystic thyroid nodule with a mural component containing flow. (a) Gray-scale image shows predominantly cystic nodule (calipers) with small solid-appearing mural component (arrowheads). (b) Addition of color Doppler mode demonstrates flow within mural component (arrowheads), confirming that it is tissue and not debris. US-guided FNA can be directed into this area. The lesion was benign at cytologic examination.

 


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  		Figure 5a. Abnormal cervical lymph nodes. (a) Sagittal US image of enlarged node (calipers) with central punctate echogenicities, consistent with microcalcifications, shows mass effect on internal jugular vein (V). Node was proved to be metastatic papillary carcinoma. (b) Sagittal US image of enlarged node (calipers) with cystic component. Node was proved to be metastatic papillary carcinoma.

 


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  		Figure 5b. Abnormal cervical lymph nodes. (a) Sagittal US image of enlarged node (calipers) with central punctate echogenicities, consistent with microcalcifications, shows mass effect on internal jugular vein (V). Node was proved to be metastatic papillary carcinoma. (b) Sagittal US image of enlarged node (calipers) with cystic component. Node was proved to be metastatic papillary carcinoma.

 




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