Diagnostic performance of margin features in thyroid nodules in prediction of malignancy

Abstract

OBJECTIVE. The purpose of this study was to evaluate thyroid nodule margins for specifc morphologic features and determine the diagnostic performance of these features in differentiating papillary carcinoma from benign thyroid nodules. MATERIALS AND METHODS. Nodules measuring 1-3 cm in largest diameter that had been evaluated with high-resolution ultrasound (12-18 MHz) and ultrasound-guided biopsy with defnitive pathologic diagnosis were analyzed. Three blinded board-certifed readers evaluated high-resolution images of each nodule for jagged edges, lobulated borders, and curved borders along their margins. Reader interpretations were correlated with the pathologic diagnosis to determine the diagnostic performance of each feature. A board-certifed pathologist analyzed 10 randomly selected nodules with jagged edges by slide review to evaluate for structural correlation with the imaging fnding. RESULTS. The diagnostic performance of jagged edges in papillary carcinoma of the thyroid was 67.4% sensitive and 78.3% specifc (odds ratio, 7.44; p < 0.001) for malignancy. Jagged edges correlated with infltrative variant expansion at slide review. Lobulated borders had sensitivity of 76.1% and specifcity of 60.9% for papillary carcinoma (odds ratio, 4.95; p = 0.001) for malignancy. Curved borders were not a signifcant predictor of papillary carcinoma. CONCLUSION. Jagged edges and lobulated borders of thyroid nodule margins are statistically signifcant predictors of papillary carcinoma of the thyroid. Jagged edges correlate with infltrative-type expansion and may be useful predictors of more aggressive papillary carcinomas.