Thyroid Cancer: Are New Ultrasound Guidelines Reliable?
Tuesday, May 22, 2018

New Ultrasound Guidelines Identify Children Who Should be Biopsied for Thyroid Cancer

Thyroid ultrasound
 
MAYWOOD, IL –  A Loyola Medicine study has found that new ultrasound guidelines can reliably identify pediatric patients who should be biopsied for thyroid cancer. The study by radiologist Jennifer Lim-Dunham, MD, and colleagues was presented May 18 during the Society for Pediatric Radiology's annual meeting in Nashville.
 
Thyroid cancer is a common cause of cancer in teenagers, and the incidence is increasing for reasons that are unclear. Adolescents have a 10-fold greater incidence than younger children, and the disease is five times more common in girls than boys.
 
The thyroid is a butterfly-shaped gland at the base of the neck that secretes hormones needed for regulation of growth, development and metabolism. Cancer may occur within lumps in the thyroid called nodules.  
 
Thyroid nodules typically are found during routine physical exams or on imaging tests such as CT scans done for other reasons. A definitive diagnosis requires a percutaneous fine-needle aspiration biopsy – a minimally invasive procedure in which a physician uses a very small needle to withdraw cells from the nodule. The cells are sent to a pathologist, who makes the diagnosis.
 
Since most nodules are benign, not all of them require biopsy. Ultrasound exams are used to identify those nodules that look suspicious enough to require biopsy. In 2017, the American College of Radiology (ACR) released a system for grading nodules on a 1 to 5 scale, with 1 being benign and 5 being highly suspicious of cancer. The grades are based on ultrasound features, such as how white or black the nodule appears (echogenicity), whether the edges of the nodule are jagged or smooth and whether there are white dots inside the nodule (echogenic foci).
 
In the Loyola study, two radiologists used the ACR system to retrospectively grade 74 thyroid nodules from 62 pediatric patients. The ACR grading system proved to be accurate and reproducible. For every one unit increase in the 1-to-5 ACR scale, nodules were 2.63 times more likely to have a malignant diagnosis confirmed by biopsy or surgery.
 
The findings should reassure physicians and parents that the ACR system can be reliably used to differentiate between thyroid nodules in children that require biopsy and those that do not, Dr. Lim-Dunham said. An earlier study led by Dr. Lim-Dunham found that a different set of thyroid nodule ultrasound guidelines from the American Thyroid Association also are reliable in children.
 
The new study is titled "Malignancy Risk Stratification of Pediatric Thyroid Nodules Using ACR Thyroid Imaging, Reporting and Data System (ACR TI-RADS)."
 
In addition to Dr. Lim-Dunham, other co-authors are Iclal Erdem Toslak, MD, Michael Reiter, MD, and Brendan Martin, PhD.
 

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.