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

Evaluation And Analysis Of Thyroid Nodules Flashcards

(80 cards)

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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
Benign or malignant? Colloid within cystic nodule...
Benign
26
What artifact does colloid within a cystic nodule produce on ultrasound?
- Comet tail | - Cat's eye
27
Benign or malignant? Eggshell calcifications (smooth)...
Benign
28
Benign or malignant? Eggshell calcifications (interrupted)...
Malignant
29
Amorphous calcifications with shadowing... Diagnosis?
Hashimoto's thyroiditis
30
Benign or malignant? Multiple confluent nodules without normal intervening parenchyma.
Benign
31
A patient with a multiple discrete thyroid nodules has ______ risk of malignancy as a patient with a solitary nodule.
The same
32
Multiple discrete nodules need to be evaluated individually. True or false?
True
33
Benign or malignant? Spongiform echotexture
Benign
34
"Spongiform" nodules have an aggregation of multiple microcystic components in more than ___% of the volume of the nodule.
50%
35
What is the best ultrasound test for benign nodules?
Shrinkage of a nodule over time
36
How do you calculate the volume of a nodule?
Pi/6 (width x depth x length)
37
Name the types of thyroid cancer. | 6 types
- Papillary - Follicular - Medullary - Anaplastic - Lymphoma - Metastatic
38
Benign or malignant? Hypoechoic (or heterogeneous)
Malignant
39
Is Anaplastic carcinoma usually hypoechoic or hyperechoic?
Hypoechoic
40
Which four cancers most commonly metastasize to the thyroid?
- Renal cell carcinoma - Breast carcinoma - Lung carcinoma - Melanoma
41
Benign or malignant? Irregular or 'infiltrative' border
Malignant
42
Benign or malignant? Irregular mural component of cyst
Malignant
43
Benign or malignant? Invasion of adjacent tissues...
Malignant
44
Benign or malignant? Cervical lymphadenopathy
Malignant
45
Thyroid ultrasound should always include evaluation of the neck for abnormal lymph nodes. True or false?
True
46
When abnormal lymph nodes are present, biopsy for ______ and _______ should be performed at the same time as the nodule biopsy.
- Cytology | - Thyroglobulin analysis
47
Benign or malignant? Intranodular vascularity...
Malignant
48
Benign or malignant? Microcalcifications...
Malignant
49
What do dense calcifications look like on ultrasound?
Hyperechoic spots with acoustic shadowing
50
What do micro-calcifications look like on ultrasound?
Hyperechoic spots without acoustic shadowing (thought to represent psammoma) (
51
Does distinction between small calcifications and comet tail artifact require a lower or higher frequency probe?
Lower | 10 mHz, rather than 12 - 14 mHz
52
What are 'string of pearls' microcalcifications suggestive of?
Papillary cancer
53
Benign or malignant? Increasing size on or off TSH suppression
Malignant
54
Benign or malignant? Microcalcifications without shadowing
Malignant
55
Benign or malignant? Macrocalcifications...
Malignant
56
How big are macrocalcifications?
More than 1 - 2 mm
57
Are macrocalcifications usually solitary or multiple?
Solitary
58
Benign or malignant? "Taller than wide" (on transverse view)
Malignant
59
_____% of all thyroid cancers are iso/hyperechoic: they are predominantly ______ type.
20 - 30% | Follicular / Hurthle
60
Diagnosing papillary cancer... Sensitivity? Microcalcifications.
45%
61
Diagnosing papillary cancer... Sensitivity? Absence of halo.
66%
62
Diagnosing papillary cancer... Sensitivity? Irregular margins.
64%
63
Diagnosing papillary cancer... Sensitivity? Hypoechoic.
80%
64
Diagnosing papillary cancer... Sensitivity? Increased intranodular flow.
67%
65
Diagnosing papillary cancer... Sensitivity? Microcalcifications + irregular margin.
30%
66
Diagnosing papillary cancer... Sensitivity? Microcalcifications + hypoechoic.
28%
67
Diagnosing papillary cancer... Sensitivity? Solid + hypoechoic.
73%
68
Diagnosing papillary cancer... Sensitivity? FNA.
92%
69
Diagnosing papillary cancer... Specificity? Microcalcifications.
85%
70
Diagnosing papillary cancer... Specificity? Absence of halo.
46%
71
Diagnosing papillary cancer... Specificity? Irregular margins.
77%
72
Diagnosing papillary cancer... Specificity? Hypoechoic.
45%
73
Diagnosing papillary cancer... Specificity? Increased intranodular flow.
81%
74
Diagnosing papillary cancer... Specificity? Microcalcifications + irregular margins.
95%
75
Diagnosing papillary cancer... Specificity? Microcalcifications + hypoechoic.
95%
76
Diagnosing papillary cancer... Specificity? Solid + hypoechoic.
69%
77
Diagnosing papillary cancer... Specificity? FNA.
84%
78
Ultrasound allows an objective method to follow the size of a nodule. True or false?
True
79
Does ultrasound replace FNA biopsy?
No
80
Knowledge of a nodule's characteristics and changes in size component the FNA biopsy data in deciding which nodules need surgery. True or false?
True

ECNU - CCE Examination (13 decks)

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