Thyroid Ultrasound Imaging Has Potential to Reduce Biopsies with Low Risk Cancer Patients

Thyroid ultrasound imaging could soon be used to identify patients who have a low risk of cancer for whom biopsy could be postponed, according to new findings.

The retrospective case-control study of 8,806 patients who underwent 11,618 thyroid ultrasound-imaging examinations from January 2000 through March 2005 included 105 patients diagnosed as having thyroid cancer. Rebecca Smith-Bindman, MD, from the University of California, San Francisco (USA; UCSF), and colleagues conducted the research.

Thyroid nodules were common in patients diagnosed as having cancer (96.9%) and patients not diagnosed as having thyroid cancer (56.4%). Three ultrasound nodule characteristics—microcalcifications (odds ratio [OR] 8.1), size greater than 2 cm (OR, 3.6), and a completely solid composition (OR, 4.0)—were the only findings tied to the risk of thyroid cancer. Compared with performing biopsy for all thyroid nodules larger than 5 mm, implementation of this more stringent approach requiring two abnormal nodule characteristics to order a biopsy would reduce unnecessary biopsies by 90% while sustaining a low risk of cancer, according to the study findings.

“Although thyroid nodules are common, most [98.4%] are benign; highlighting the importance of being prudent in deciding which nodules should be sampled to reduce unnecessary biopsies. Adoption of uniform standards for the interpretation of thyroid sonograms would be a first step toward standardizing the diagnosis and treatment of thyroid cancer and limiting unnecessary diagnostic testing and treatment,” the study authors concluded.

The study’s findings were published online August 26, 2013, in JAMA Internal Medicine.

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