DOI:10.2214/AJR.06.5075
AJR 2006; 187:W448
© American Roentgen Ray Society
Concurrent Routine Breast and Thyroid Sonography for Detection of Thyroid Tumors
Ismail Mihmanli and
Fatih Kantarci
Department of Radiology Istanbul University Cerrahpasa Medical
Faculty Istanbul, Turkey 34300
WEB—This is a Web exclusive article.
We read with interest the article of Park and colleagues
[1] that was published in the
April issue of the AJR. The authors evaluated incidental thyroid
cancer diagnosed by screening sonography in a population who underwent breast
sonography. The differences in incidences of thyroid cancer between those with
and those without breast cancer were investigated. They concluded that routine
concurrent breast and thyroid sonography were helpful for the detection of
thyroid tumors in all women who underwent breast sonography. In our opinion,
this suggestion would lead not only to overuse of sonography but also to
anxiety in women who underwent screening breast examination.
If we assess the authors' results, 13 (1.9%) of 685 patients in the cancer
group and 29 (0.6%) of 4,864 patients in the noncancer group showed thyroid
malignancy. Even if these two groups show statistically significant
difference, this would still remain within the normal population thyroid
cancer incidence range. The prevalence of occult thyroid cancer was found to
be 5% to 35% in autopsy series
[2]. It was shown that the
normal population has 30% to 60% of incidentalomas, depending on many factors,
such as geography. Thyroid malignancy would be diagnosed in 5% to sometimes
18% of these incidentalomas [3,
4]. In addition, radiation
exposure is assumed as a risk factor for thyroid carcinoma. But we did not
know whether Park's cancer group underwent radiotherapy previously.
We think that routine sonography of the thyroid gland in all women who
underwent breast sonography would lead to anxiety for both the patient and the
physician. There should be selection criteria for which patients undergo both
examinations, such as radiation exposure. It would be more optimal to perform
thyroid sonography during the evaluation of supraclavicular lymph node
involvement in patients already diagnosed with breast carcinoma, thus avoiding
the overuse of routine sonography during breast sonography. Furthermore, since
the incidence of thyroid carcinoma that the authors reported is below the
population incidence of thyroid carcinoma
[1], the cost-effectiveness of
performing routine thyroid sonography is questionable as well.
References
- Park JS, Oh KK, Kim EK, Chang HS, Hong SW. Sonographic screening
for thyroid cancer in females undergoing breast sonography.
AJR 2006; 186:1025
-1028[Abstract/Free Full Text]
- Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of
the thyroid: a "normal" finding in Finland—a systematic
autopsy study. Cancer 1985;56
: 531-538[CrossRef][Medline]
- Liebeskind A, Sikora AG, Komisar A, Slavit D, Fried K. Rates of
malignancy in incidentally discovered thyroid nodules evaluated with
sonography and fine-needle aspiration. J Ultrasound
Med 2005; 24:629
-634[Abstract/Free Full Text]
- Iannuccilli JD, Cronan JJ, Monchik JM. Risk for malignancy of
thyroid nodules as assessed by sonographic criteria: the need for biopsy.
J Ultrasound Med 2004;23
: 1455-1464[Abstract/Free Full Text]
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