Thyroid ultrasound is commonly performed to evaluate thyroid nodules, which have a high prevalence but low malignancy rate. While thyroid cancer incidence is increasing worldwide, this is likely due to better detection methods and environmental factors rather than an actual rise in cases. Ultrasound can characterize nodules based on features like size, shape, margins, and vascularity. However, excessive detection of small nodules without suspicious features may lead to unnecessary biopsies. Standardized reporting and adequate examiner training are needed to maximize the benefits and minimize the harms of thyroid ultrasound screening.

1. Sant Eugenio - Rome, 25th
May 2013
THYROID ULTRASOUND:THYROID ULTRASOUND:
BLESSING OR CURSE?BLESSING OR CURSE?
Massimiliano Andrioli
Endocrinology, IRCCS, Istituto Auxologico Italiano, Milan

2. PREAMBLE

3. PREAMBLE

4. PREAMBLE

5. PREAMBLE

6. PREAMBLE

7. PREAMBLE
• radiologists
• endocrinologists
• surgeons
• otorhinolaryngologist
• ginecologists
• angiologists
THYROID US PERFORMED BY:

8. PREAMBLE

9. EPIDEMIOLOGY
• thyroid nodules very common
• palpation prevalence (5 %)
• US prevalence (67 %)

10. EPIDEMIOLOGY

11. • malignancy prevalence (5 %)
• thyroid carcinoma incidence 1-2/100.000/year
• increasing over the world
EPIDEMIOLOGY

12. Davies, JAMA 2006
• environmental influence
• better detection
EPIDEMIOLOGY

15. ?

16. • size
• internal content
• shape
• margins
• echogenicity
• calcifications
• extracapsular relationship
• vascularity
• elasticity
ULTRASOUND FEATURES

18. REQUIREMENTS FOR US TRAINING
AACE Endocrine Certification in Neck US
• theory program (US principles, neck anatomy,
thyroid/parathyroid/lymph node pathology, FNA)
• 100-125 studies/year (70% diagnostic, 30% FNA)
• submit images/reports
AACE/AME/ETA THYROID NODULE GUIDELINES

19. Italian Society of Ultrasound
• Theory (20 h)
• Tutorial practice (105 h) in a certified US
school: hospital/university/research
institute
• 200 h (600 US) in private/hospital practice
AACE/AME/ETA THYROID NODULE GUIDELINES

20. The panel suggest
• at least 600 US/year
• at least 30 cases thyroid tumor, recurrence,
limph node metastasis/year
• at least 70% thyroid tumors suspected at first
US
• at least 150 FNA/year, THY1 <10%
AACE/AME/ETA THYROID NODULE GUIDELINES

21. CONCLUSIONS
• thyroid nodules: high prevalence;
• thyroid cancers: increasing incidence;
• better detection;
• excessive detection;
• standardized report;
• dedicated examiners.

22. Thanks for your attention …