Brief description of key findings. From Dudea SM. Radiology and Medical Imaging, volume I, Editura Medicala, 2015. http://naxos.biomedicale.univ-paris5.fr/diue/wp-content/uploads/2013/06/diuem12-2016nodule_dr_gilles_russ.pdf

1. Thyroid cancer
Ultrasound findings

2. most common thyroid cancer types
papillary – young, most common type
follicular
anaplastic – old
medullary – MEN2

3. US is the first-line imaging modality
to look at the thyroid

4. suspicious US findings in thyroid nodules
intensely hypoechoic nodule, more so than muscle
irregular contours: angulated, lobulated, spiculated
don’t mistake irregular for ill-defined or flou
microCa++
small echogenic particles w/o acoustic shadowing
high specificity for malignancy
always look for microCa++ with thyroid nodule
taller than wide
stiff nodule at elastography
malignant cervical lympadenopathy
US of lymph nodes mandatory if thyroid nodule detected

5. presence of just 1 suspicious findings
 high suspicion of malignancy – TIRADS 4B

6. other findings
thick irregular hypoechoic halo
anarchic vascularization
*papillary, follicular, medullary thyroid cancer types
 all share similar US aspect

7. Anaplastic thyroid cancer
old population
very poor prognosis
risk factors: radiation, goitre

8. Anaplastic thyroid cancer
large mass
locally invasive
heterogeneous – Ca++, necrosis, hemorrhage
irregular
malignant lymph nodes

9. US can not distinguish between adenoma
and low-grade malignant nodules

10. US can not tell between adenoma and low-grade malignant nodules
lab work helps
if hyperthyroidism, low risk of malignancy
nuclear scan helps
if “hot”, low risk of malignancy
 combined findings may allow to forego FNAB

11. Remember
presence of just 1 of the 6 suspicious findings is sufficient
to call nodule highly suspicious of malignancy
always look for microCa++ within thyroid nodule
always assess cervical lymph nodes with thyroid nodule