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New Sonographic Criteria for Recommending Fine-Needle Aspiration Biopsy of Nonpalpable Solid Nodules of the Thyroid

Eun-Kyung Kim1, Cheong Soo Park2, Woung Youn Chung2, Ki Keun Oh1, Dong Ik Kim1, Jong Tae Lee1 and Hyung Sik Yoo1

1 Department of Diagnostic Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, #134, Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.
2 Department of General Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea.



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  		Fig. 1. —39-year-old woman with papillary carcinoma. Sonogram of right thyroid gland shows 12-mm mass with internal calcifications that is markedly hypoechoic. Calcifications appear as bright punctate echoes but are not large enough to create acoustic shadowing. Microlobulation (arrows) can also be seen.

 


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  		Fig. 2. —36-year-old woman with papillary carcinoma. Sonogram of right lobe of thyroid gland reveals 4-mm, well-defined hypoechoic nodule (calipers). Two tiny hyperechoic foci suggesting microcalcifications within nodule are only sign of malignancy.

 


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  		Fig. 3. —39-year-old woman with papillary carcinoma. Sonogram shows 10-mm nodule on medial aspect of right thyroid gland. Nodule has irregular margin, especially in portion abutting trachea (arrow). Tracheal wall invasion was confirmed at surgery.

 


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  		Fig. 4. —51-year-old woman with papillary carcinoma. Sonogram shows nodule (arrows) with more hypoechoic echogenicity than that of strap muscle (arrowhead).

 


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  		Fig. 5. —53-year-old woman with papillary carcinoma. Sonogram shows nodule (arrow) in posterior aspect of right thyroid gland. Its shape is more tall than wide, which is only sign of malignancy.

 


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  		Fig. 6. —42-year-old woman with papillary carcinoma. Sonogram shows 6-mm, well-defined, oval, isoechoic nodule (arrow) in right lobe of thyroid gland, classified in negative category. However, pathologic diagnosis at fine-needle aspiration biopsy and surgery was papillary carcinoma.

 


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  		Fig. 7. —Diagram of algorithm for evaluation of incidental thyroid lesions.

 

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