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ECNU - CCE Examination > Evaluation And Analysis Of Thyroid Nodules > Flashcards

Evaluation And Analysis Of Thyroid Nodules Flashcards

1
Q

What age groups are higher risk for thyroid malignancy?

A

Age less than 20 years or greater than 60 - 80.

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2
Q

Name 6 thyroid cancer risk factors on history and physical (other than age).

A
  • Prior radiation
  • Rapid growth
  • Family history
  • Hoarseness
  • Dysphagia
  • Lymphadenopathy
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3
Q

What features have high clinical suspicion for thyroid cancer?

(8 features)

A
  • Rapid tumor growth
  • Very firm nodule (rock hard)
  • Fixation to adjacent structures
  • Vocal cord paresis
  • Enlarged regional lymph nodes
  • Family history of PTC or MEN 2
  • Distant metastasis
  • History of radiation exposure to the head/neck
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4
Q

What is the positive predictive value of ‘high clinical suspicion’ features for thyroid cancer?

A

70 - 75% (Good)

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5
Q

What is the negative predictive value of ‘high clinical suspicion’ features for thyroid cancer?

A

85% (Unacceptable)

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6
Q

Name three tests for thyroid nodules.

A
  • I-123 scan
  • Thyroid ultrasound
  • FNA biopsy
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7
Q

Palpation is not accurate in up to ____% of patients with solitary palpable nodules.

A

30%

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8
Q

___% of patients have no corresponding nodule on US.

A

16

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9
Q

____% have an additional non-palpable nodule > 1 cm on US

A

15

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10
Q

Ultrasound will find additional non-palpable nodules > 1 cm in ___ in ___ patients.

A

1 in 7 patients

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11
Q

Ultrasound is extremely sensitive.

True or false?

A

True

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12
Q

In what 5 scenarios does the normal neck need to be ultrasound-ed?

A
  • External radiation during childhood
  • History of familial thyroid cancer
  • Previous history of thyroid cancer
  • Hyperparathyroidism
  • Morphology impeding exam
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13
Q

Are discrepancies between ultrasound features of risk of malignancy operator-dependent?

A

Yes

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14
Q

What is a ‘white knight’?

A

Hyperechoic nodule - particularly in Hashimoto’s thyroiditis

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15
Q

What is the primary goal in evaluating thyroid nodules?

A

To determine if the nodule is benign or malignant.

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16
Q

Are most hyperechoic nodules benign or malignant?

A

Benign

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17
Q

What kind of neoplasm is a thick, irregular halo suggestive of?

A
  • Follicular or Hurthle cell carcinoma or adenoma

- Encapsulated papillary cancer follicular variant

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18
Q

What is a halo thought to represent?

A

Thought to represent the compressed perinodular vessels.

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19
Q

If halo is absent - suggestive of an infiltrative malignancy…

Sensitivity?

A

66%

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20
Q

If halo is absent - suggestive of an infiltrative malignancy…

Specificity?

A

54%

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21
Q

Benign or malignant?

Thin-walled cyst without a solid component.

A

Benign

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22
Q

Benign or malignant?

Halo

A

Benign

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23
Q

Benign or malignant?

Smooth margin

A

Benign

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24
Q

Benign or malignant?

Hyperechoic nodule

A

Benign

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25
Q

Benign or malignant?

Colloid within cystic nodule…

A

Benign

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26
Q

What artifact does colloid within a cystic nodule produce on ultrasound?

A
  • Comet tail

- Cat’s eye

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27
Q

Benign or malignant?

Eggshell calcifications (smooth)…

A

Benign

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28
Q

Benign or malignant?

Eggshell calcifications (interrupted)…

A

Malignant

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29
Q

Amorphous calcifications with shadowing…

Diagnosis?

A

Hashimoto’s thyroiditis

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30
Q

Benign or malignant?

Multiple confluent nodules without normal intervening parenchyma.

A

Benign

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31
Q

A patient with a multiple discrete thyroid nodules has ______ risk of malignancy as a patient with a solitary nodule.

A

The same

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32
Q

Multiple discrete nodules need to be evaluated individually.

True or false?

A

True

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33
Q

Benign or malignant?

Spongiform echotexture

A

Benign

34
Q

“Spongiform” nodules have an aggregation of multiple microcystic components in more than ___% of the volume of the nodule.

A

50%

35
Q

What is the best ultrasound test for benign nodules?

A

Shrinkage of a nodule over time

36
Q

How do you calculate the volume of a nodule?

A

Pi/6 (width x depth x length)

37
Q

Name the types of thyroid cancer.

6 types

A
  • Papillary
  • Follicular
  • Medullary
  • Anaplastic
  • Lymphoma
  • Metastatic
38
Q

Benign or malignant?

Hypoechoic (or heterogeneous)

A

Malignant

39
Q

Is Anaplastic carcinoma usually hypoechoic or hyperechoic?

A

Hypoechoic

40
Q

Which four cancers most commonly metastasize to the thyroid?

A
  • Renal cell carcinoma
  • Breast carcinoma
  • Lung carcinoma
  • Melanoma
41
Q

Benign or malignant?

Irregular or ‘infiltrative’ border

A

Malignant

42
Q

Benign or malignant?

Irregular mural component of cyst

A

Malignant

43
Q

Benign or malignant?

Invasion of adjacent tissues…

A

Malignant

44
Q

Benign or malignant?

Cervical lymphadenopathy

A

Malignant

45
Q

Thyroid ultrasound should always include evaluation of the neck for abnormal lymph nodes.

True or false?

A

True

46
Q

When abnormal lymph nodes are present, biopsy for ______ and _______ should be performed at the same time as the nodule biopsy.

A
  • Cytology

- Thyroglobulin analysis

47
Q

Benign or malignant?

Intranodular vascularity…

A

Malignant

48
Q

Benign or malignant?

Microcalcifications…

A

Malignant

49
Q

What do dense calcifications look like on ultrasound?

A

Hyperechoic spots with acoustic shadowing

50
Q

What do micro-calcifications look like on ultrasound?

A

Hyperechoic spots without acoustic shadowing (thought to represent psammoma) (

51
Q

Does distinction between small calcifications and comet tail artifact require a lower or higher frequency probe?

A

Lower

10 mHz, rather than 12 - 14 mHz

52
Q

What are ‘string of pearls’ microcalcifications suggestive of?

A

Papillary cancer

53
Q

Benign or malignant?

Increasing size on or off TSH suppression

A

Malignant

54
Q

Benign or malignant?

Microcalcifications without shadowing

A

Malignant

55
Q

Benign or malignant?

Macrocalcifications…

A

Malignant

56
Q

How big are macrocalcifications?

A

More than 1 - 2 mm

57
Q

Are macrocalcifications usually solitary or multiple?

A

Solitary

58
Q

Benign or malignant?

“Taller than wide” (on transverse view)

A

Malignant

59
Q

_____% of all thyroid cancers are iso/hyperechoic: they are predominantly ______ type.

A

20 - 30%

Follicular / Hurthle

60
Q

Diagnosing papillary cancer…

Sensitivity?

Microcalcifications.

A

45%

61
Q

Diagnosing papillary cancer…

Sensitivity?

Absence of halo.

A

66%

62
Q

Diagnosing papillary cancer…

Sensitivity?

Irregular margins.

A

64%

63
Q

Diagnosing papillary cancer…

Sensitivity?

Hypoechoic.

A

80%

64
Q

Diagnosing papillary cancer…

Sensitivity?

Increased intranodular flow.

A

67%

65
Q

Diagnosing papillary cancer…

Sensitivity?

Microcalcifications + irregular margin.

A

30%

66
Q

Diagnosing papillary cancer…

Sensitivity?

Microcalcifications + hypoechoic.

A

28%

67
Q

Diagnosing papillary cancer…

Sensitivity?

Solid + hypoechoic.

A

73%

68
Q

Diagnosing papillary cancer…

Sensitivity?

FNA.

A

92%

69
Q

Diagnosing papillary cancer…

Specificity?

Microcalcifications.

A

85%

70
Q

Diagnosing papillary cancer…

Specificity?

Absence of halo.

A

46%

71
Q

Diagnosing papillary cancer…

Specificity?

Irregular margins.

A

77%

72
Q

Diagnosing papillary cancer…

Specificity?

Hypoechoic.

A

45%

73
Q

Diagnosing papillary cancer…

Specificity?

Increased intranodular flow.

A

81%

74
Q

Diagnosing papillary cancer…

Specificity?

Microcalcifications + irregular margins.

A

95%

75
Q

Diagnosing papillary cancer…

Specificity?

Microcalcifications + hypoechoic.

A

95%

76
Q

Diagnosing papillary cancer…

Specificity?

Solid + hypoechoic.

A

69%

77
Q

Diagnosing papillary cancer…

Specificity?

FNA.

A

84%

78
Q

Ultrasound allows an objective method to follow the size of a nodule.

True or false?

A

True

79
Q

Does ultrasound replace FNA biopsy?

A

No

80
Q

Knowledge of a nodule’s characteristics and changes in size component the FNA biopsy data in deciding which nodules need surgery.

True or false?

A

True

ECNU - CCE Examination (13 decks)

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