Nomogram for selecting thyroid nodules for ultrasound-guided fine-needle aspiration biopsy based on a quantification of risk of malignancy.

Overview

BACKGROUND: Our aim through this study was to develop a statistical tool to quantify risk of malignancy in thyroid nodules based on clinical, biochemical, and ultrasound features, which could be used to select which nodules require ultrasound-guided fine-needle aspiration. METHODS: Clinical records, biochemical profiles, pathology reports, and ultrasound images were reviewed. Multivariate logistic regression was used to rank variables in their ability to predict malignancy. RESULTS: In all, 190 nodules were reviewed. The final diagnoses were papillary carcinoma in 105 patients (66%), other carcinoma in 8 patients (5%), and benign thyroid pathology in 45 patients (29%). After exclusions, 182 nodules remained for analysis on a per nodule basis. The 8 variables with highest predictive value were: age; thyroid-stimulating hormone; and ultrasound size, shape, echo texture, calcification, margin, and vascularity. The nomogram had a concordance index of 75%. CONCLUSION: We produced a nomogram able to accurately predict the need to perform ultrasound-guided fine-needle aspiration on a thyroid nodule based on biochemical, clinical, and ultrasound features.