Assessment of Vascularity Patterns and Sonographic Criteria in Distinguishing Benign from Malignant Thyroid Nodules

Abstract

Author(s): Mostafa Abdollahi, Bita Bijari, Alireza Mirgholami, Ehsan Hassannejad, Ahmad Shoja, Mahyar Mohammadifard

Introduction: Thyroid nodules are a prevalent concern, prompting extensive research into diagnostic criteria for malignancy. While sonographic criteria in TIRADS have been widely studied, the role of nodule vascularity pattern, a less explored factor, remains uncertain. This study aims to investigate various vascularity patterns in different types of thyroid nodules, evaluating their potential utility in determining nodule malignancy. Methods: A prospective study was conducted at Imam Reza (AS) Birjand Hospital from November 2022 to November 2023, involving 92 patients with thyroid nodules presenting for fine-needle aspiration (FNA). Skilled radiologists performed ultrasound exams, documenting nodule characteristics according to Tirads criteria and predefined vascularity patterns. Pathology reports were included for correlation. Data analysis was performed using SPSS-22, with an epidemiologist conducting statistical analyses. Results: Qualitative analysis of 92 thyroid nodules revealed four vascularity index categories: no vascularity (31.6%), peripheral vascularity (49.4%), central vascularity (13.9%), and central/peripheral vascularity (5.1%). The observed distribution was statistically significant (p < 0.001). Simultaneous consideration of central or central/peripheral vascularity as indicators of malignancy and peripheral vascularity or absence of vascularity as indicators of benign nodules yielded a diagnostic sensitivity and specificity of 76.9%. When applying this criterion, the specificity increased to 81%. Moreover, the positive predictive value was 40%, and the negative predictive value was 95.5%. Conclusion: Combining vascularity patterns with established sonographic criteria in thyroid assessments significantly aids in distinguishing between benign and malignant nodules. However, caution should be exercised, as malignant nodules may exhibit any of the four vascularity patterns investigated in this study

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