Sonographic Imaging of Thyroid Nodules and Cervical Lymph Nodes
Section snippets
Ultrasound imaging of thyroid nodules
When examined by ultrasound, rather than by palpation, thyroid nodules are commonly detected with a prevalence of 40% to 50% in the general population [1]. However, only 5% to 10% of thyroid nodules are malignant, even if found incidentally [2], [3]. While fine-needle aspiration (FNA) is the cornerstone of the evaluation of thyroid nodules, ultrasound contributes significantly both to identify and to evaluate thyroid nodules. Multiple reports have examined the sonographic features of thyroid
Lymph nodes
In addition to providing excellent imaging for thyroid nodules, high-frequency (10 to 14 MHz) ultrasound transducers allow for high-resolution imaging of small anatomic structures such as cervical lymph nodes. Of the approximately 800 lymph nodes in the human body, about 300 are located in the neck, varying in size from 3 to 30 mm [22]. Most neck lymph nodes are located superficially and are accessible to ultrasound imaging. Because of the frequent metastatic involvement of these lymph nodes by
Summary
Ultrasound is an important tool for the evaluation of the thyroid nodules and cervical lymph nodes. Certain sonographic features of thyroid nodules can be helpful in identifying those nodules most at risk for malignancy including hypoechogenicity, increased vascularity, microcalcifications, irregular margins, and the absence of a halo. These features alone do not have the sensitivity or specificity to diagnose thyroid cancer and FNA remains the procedure of choice to diagnose thyroid cancer.
Acknowledgments
We are grateful to Mr. Sherard Graham for his expert assistance in manuscript preparation.
References (54)
- et al.
Thyroid calcifications: sonographic patterns and incidence of cancer
Clin Imaging
(2004) - et al.
Sonography of neck lymph nodes. Part I: normal lymph nodes
Clin Radiol
(2003) - et al.
Sonography of neck lymph nodes. Part II: abnormal lymph nodes
Clin Radiol
(2003) - et al.
Challenges in neck ultrasonography: lymphadenopathy and parathyroid glands
Endocr Pract
(2004) Management of a solitary thyroid nodule
N Engl J Med
(1993)- et al.
Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features
J Clin Endocrinol Metab
(2002) - et al.
Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings
Clin Endocrinol (Oxf)
(2004) - et al.
Sonographic diagnosis of thyroid nodules: correlation with the results of sonographically guided fine-needle aspiration biopsy
J Clin Ultrasound
(2007) - et al.
Is the anteroposterior and transverse diameter ratio of nonpalpable thyroid nodules a sonographic criteria for recommending fine-needle aspiration cytology?
Clin Endocrinol (Oxf)
(2005) - et al.
Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules
J Clin Endocrinol Metab
(1999)
Power Doppler improves the diagnostic accuracy of color Doppler ultrasonography in cold thyroid nodules: follow-up results
Horm Res
Ultrasonic evaluation of benign and malignant nodules in echographically multinodular thyroids
J Clin Ultrasound
Thyroid nodules: re-evaluation with ultrasound
J Clin Ultrasound
Role of conventional ultrasonography and color flow-Doppler sonography in predicting malignancy in ‘cold’ thyroid nodules
Eur J Endocrinol
New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid
AJR Am J Roentgenol
Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography
J Clin Endocrinol Metab
Sonographic features of benign thyroid nodules: interobserver reliability and overlap with malignancy
J Ultrasound Med
Evaluating the degree of conformity of papillary carcinoma and follicular carcinoma to the reported ultrasonographic findings of malignant thyroid tumor
Korean J Radiol
Natural history of benign solid and cystic thyroid nodules
Ann Intern Med
Sonography of thyroid nodules: a “classic pattern” diagnostic approach
Ultrasound Q
Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules
J Clin Endocrinol Metab
Ill-defined edge on ultrasonographic examination can be a marker of aggressive characteristic of papillary thyroid microcarcinoma
World J Surg
Common and uncommon sonographic features of papillary thyroid carcinoma
J Ultrasound Med
Preoperative ultrasonographic examination for lymph node metastasis: usefulness when designing lymph node dissection for papillary microcarcinoma of the thyroid
World J Surg
Imaging-based nodal classification for evaluation of neck metastatic adenopathy
AJR Am J Roentgenol
Ultrasound of thyroid, parathyroid glands and lymph nodes
Eur Radiol
Very high frequency (13 MHz) ultrasonographic examination of the normal neck: detection of normal lymph nodes and thyroid nodules
J Ultrasound Med
Cited by (91)
Diagnosis and Evaluation of Thyroid Nodules-the Clinician's Perspective
2020, Radiologic Clinics of North AmericaCitation Excerpt :Thyroid ultrasound should be used to determine the size and number of nodules and provide a description of any abnormal lymphadenopathy in the neck. The size and sonographic features of the nodules (eg, composition, echogenicity, shape, margins, and echogenic foci) are taken into consideration while deciding the need for fine needle aspiration (FNA) as described later in this article.16,17 Thyroid ultrasound is not indicated in patients with medical thyroid disease if the gland is normal in size without evidence of a palpable nodule on physical examination.
Pearls and Pitfalls in Pediatric Thyroid Imaging
2020, Seminars in Ultrasound, CT and MRIPediatric Thyroid Cancer
2017, Advances in PediatricsCitation Excerpt :Prior to surgery, it is critical to evaluate for the presence and location of neck lymph node disease by ultrasound and FNA, if this was not done at the time of the initial thyroid nodule evaluation. Ultrasound findings suggestive of cervical lymph node metastasis include increased size of the lymph node, rounded shape, loss of central hilum, cystic appearance, peripheral vascularity on Doppler, and microcalcifications [33]. If any of these characteristics are present, FNA of the lymph node(s) should be obtained to confirm the presence of cervical metastasis, because this influences the extent of surgery.
The additive diagnostic role of diffusion-weighted magnetic resonance and chemical shift imaging (CSI) in differentiation between malignant and benign cervical lymph nodes
2023, Egyptian Journal of Radiology and Nuclear MedicineVirtual Tumor Board: Papillary thyroid carcinoma with nodal disease
2023, CA Cancer Journal for Clinicians