Follicular thyroid cancer echocardiography or ultrasound

Follicular thyroid cancer Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Key Echocardiography/Ultrasound Findings in Thyroid Cancer

• Large size, microcalcifications, and hypoechogenicity are suspicious feature
• Lymphadenopathy is a suspicious feature
• Microcalcifications is the most specific finding associated with malignancy (~95%)
• Coarse calcifications ​can also be seen in malignant nodules
• Peripheral rim calcification can be seen in malignant nodules
• 25 % of follicular and medullary cancer are isoechoic solid nodule.
• There is 5% chance of a hyperechoic nodule being malignant.
• Invasion of local structures favors anaplastic thyroid carcinoma and thyroid lymphoma.
• A nodule taller than it is wide is suspicious for malignancy.
• Irregular margins are suspicious for malignancy

Lymphnode

• Enlarged regional lymph nodes are suspicious for thyroid malignancy
• Microcalcifications in regional lymph nodes are highly suspicious
• Lymph nodes with cystic change are highly suspicious
• Loss of normal fatty hilum, irregular node appearance
• Increased colour Doppler flow is suspicious
• Low threshold criteria for lymph node biopsy
• Biopsy if suspicious features
• Consider biopsy if >8 mm

Sonographic features favouring a malignant nodule

• Hypoechoic solid
• Presence of microcalcifications: almost always warrants a FNA
• Local invasion of surrounding structures
• Taller than it is wide
• Large size: the cut off is often taken as 10 mm to warrant a FNA
• Suspicious neck lymph nodes suggesting metastatic disease
• Intranodular blood flow