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US Features of Thyroid Malignancy: Pearls and Pitfalls¹

¹ From the Departments of Medical Imaging (J.K.H., W.K.L., M.L.), Pathology (D.J.), and Surgery (S.F.), St Vincent’s Hospital Melbourne, University of Melbourne, 41 Victoria Parade, Fitzroy 3065, Victoria, Australia. Recipient of a Certificate of Merit award for an education exhibit at the 2005 RSNA Annual Meeting. Received March 22, 2006; revision requested July 7 and received August 7; accepted August 14. All authors have no financial relationships to disclose. Address correspondence to J.K.H. (e-mail: jennykh{at}gmail.com).

Thyroid nodules are common and occur in up to 50% of the adult population; however, less than 7% of thyroid nodules are malignant. High-resolution ultrasonography (US) is commonly used to evaluate the thyroid gland, but US is frequently misperceived as unhelpful for identifying features that distinguish benign from malignant nodules. Microcalcifications are one of the most specific US findings of a thyroid malignancy. Other useful US features include a marked hypoechogenicity, irregular margins, and the absence of a hypoechoic halo around the nodule. Lymphadenopathy and local invasion of adjacent structures are highly specific features of thyroid malignancy but are less commonly seen. The number, size, and interval growth of nodules are nonspecific characteristics. Suspicious US features may be useful for selecting patients for fine-needle aspiration biopsy when incidental nodules are discovered and when multiple nodules are present. Common interpretative pitfalls that may lead to failure to recognize a malignancy include mistaking cystic or calcified nodal metastases for nodules in a multinodular thyroid, mistaking diffusely infiltrative thyroid carcinomas and multifocal carcinomas for benign disease, and failing to recognize microcalcifications in papillary thyroid cancer.

© RSNA, 2007

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