MAOBANLA.MD LEVEL III \VSL-Mt ltSTRuHFtTATl0t At0 TFCHtl0uF Hih-lrcqucncv |ransduccrs (7.5 -15 Mhzi Lincar arrav |ransduccrs wi|h ci|hcr rcc|anular or |rapczoidal scan lorma| arc prclcrrcd bccausc ol |hc widcr ncar licld ol vicw and |hc capabili|v |o combinc hih- lrcqucncv rav-scalc and color Dopplcr imacr Two ncwcr |cchniqucs: Con|ras|-cnhanccd sonoraphv Sonoclas|oraphv ltSTRuHFtTATl0t At0 TFCHtl0uF liure Iiu resoiutiou iiuear trausducer , MIz) |or tue jer|ormauce o| turoid souoraju. Tw0 tFwFR TFCHtl0uFS uSF0 F0R THF S0t06RAPHlC STu0Y 0F THF THYR0l0 6lAt0 Con|ras|-cnhanccd sonoraphv 2 nd -cncra|ion con|ras| acn|s arc uscd and vcrv low mcchanical indcx can providc usclul inlorma|ion lor |hc dianosis ol sclcc| cascs ol nodular discasc and lor u|z- uidcd |hcrapcu|ic proccdurcs Sonoclas|oraphv Bascd on |hc principlc |ha| whcn bodv |issucs arc comprcsscd, |hc sol|cr par|s dclorm morc casilv |han |hc hardcr par|s SO`Oll.S1OCK.lIY las|oraphv is a ncwlv dcvclopcd dvnamic |cchniquc |ha| cmplovs ul|rasound (ISi |o providc an cs|ima|ion ol |issuc s|illncss bv mcasurin |hc dcrcc ol dis|or|ion undcr |hc applica|ion ol an cx|crnal lorcc. IS clas|oraphv has bccn applicd |o dillcrcn|ia|c malinan| lrom bcnin lcsions. las|oraphv imacs wcrc classilicd in|o 4 |vpcs: Pa||crn 1, lih| rccn |hrouhou| |hc insidc ol |hc nodulc Pa||crn 2, lih| rccn in |hc ccn|cr and bluc in |hc pcriphcrv ol |hc nodulc; Pa||crn `, bluc basc wi|h mixcd colors ol lih| rccn and rcd; and Pa||crn 4, bluc in |hc cn|irc nodulc. SO`Oll.S1OCK.lIY upillury thyroid cuncer imuget muinly thowed uttern s or 4, while lymph node metuttutit tpecificully hud the imuget of uttern 4. Folliculur thyroid cuncer thowed uttern z. Adenomutout goiter thowed diffute light green {uttern t). Figure 1: Proposed Clarification of Elastography for Thyroid Tumors ltSTRuHFtTATl0t At0 TFCHtl0uF Thc pa|icn| is |vpicallv cxamincd in |hc supinc posi|ion wi|h |hc ncck cx|cndcd A small pad mav bc placcd undcr |hc shouldcrs |o providc bc||cr cxposurc ol |hc ncck Thc |hvroid land mus| bc cxamincd |horouhlv in bo|h |ransvcrsc and loni|udinal plancs Imain ol |hc lowcr polcs can bc cnhanccd bv askin |hc pa|icn| |o swallow Thc cn|irc land, includin |hc is|hmus, mus| bc cxamincd ltSTRuHFtTATl0t At0 TFCHtl0uF Staudardized S rejortiu criteria suouid be |oiioved iudicatiu. lositiou Suaje Size Marius Couteut lcuoeuicit Vascuiar jatteru o| tue vuoie iaud aud vueu jreseut, tue |ocai iesious. ltSTRuHFtTATl0t At0 TFCHtl0uF liure ! 1uroid measuremeut ou trauserse ,.) aud iouitudiuai ,l) scaus. `OKM.l .`.1OMY 1ublc z Normul tl,roio oimcnsions llOOl SlllY 1Il .K1lKIlS Ol 1Il 1IYKOIl .Kl. Supcrior |hvroid ar|crv W Ariscs lrom |hc cx|crnal caro|id ar|crv and dcsccnds |owards |hc ipsila|cral |hvroid lobc. A| |hc uppcr polc ol |hc land i| dividcs in|o |hc an|crior and pos|crior divisions Inlcrior |hvroid ar|crv W Ariscs lrom |hc |hvroccrvical |runk and asccnds alon |hc back ol |hc land |o rcach i|s pos|crior surlacc W Closclv rcla|cd |o |hc rccurrcn| larvncal ncrvc l000 SuPPlY Supcrior,middlc and inlcrior |hvroid vcins: oriina|c lrom pcri|hvroid vcnous nc|work Thc supcrior and middlc vcins drain in|o |hc ipsila|cral IJV Thc inlcrior |hvroid vcin rcccivcs |ribu|arics lrom |hc is|hmus, |hcn anas|omoscs wi|h |hc inlcrior |hvroid vcin lrom |hc opposi|c sidc and drains in|o |hc brachioccphalic vcin l000 SuPPlY 1uroidea ima arter. Il prcscn|, ariscs lrom |hc aor|ic arch or |hc brachioccphalic |runk and asccnds an|crior |o |hc |rachca |o |hc is|hmus lYHPHATlCS LymphaLlc vessels from Lhe Lhyrold form a subcapsular neLwork and glve rlse Lo laLeral and medlal collecLlng Lrunks 1hese draln lnLo Lhe anLerlor and laLeral chaln of nodes along Lhe l!v (deep cervlcal chaln) and Lhe preLracheal and paraLracheal nodes AtAT0HY C0l0R At0/0R P0wFR 00PPlFR uS Isclul |o cvalua|c |hc vasculari|v ol |hc |hvroid land and local masscs Thc |hvroid ar|crics mav bc localizcd on color or powcr Dopplcr A pcak svs|olic vcloci|v in |hc in|ra|hvroid ar|crics is on |hc ranc ol 15-`0 cm/scc and is |hc vcloci|v lound in anv supcrlicial oran rLerlal vascularlzaLlon of Lhe Lhyrold gland Cn color doppler Lhe lnferlor Lhyrold arLery ls seen C0t6FtlTAl At0HAllFS Concni|al acncsia or hvpoplasia ol |hc |hvroid land mav includc |hc wholc land or us| onc ol |hc lobcs. c|opic |hvroid, a dclici| in mira|ion ol |hc |hvroid land |o |hc lowcr ncck lrom i|s oriin a| |hc basc ol |hc |onuc, dcvclops mos| commonlv a| a sublinual or a suprahvoid posi|ion c|opic |hvroid mav bc casilv dc|cc|cd on radionuclidc scans Congen|ta| Deve|opmenta| Defects and C||n|ca| Cutcomes Dcvclopmcn| ol |hc |hvroid land bcins a| |hc lirs| and sccond wccks ol in|rau|crinc lilc and is complc|cd bv wcck 11. A and B. Thc |hvroid land ariscs as an cndodcrmal |hickcnin a| |hc unc|ion ol |hc dcvclopin an|crior and pos|crior |onuc, a| |hc lcvcl ol |hc loramcn cccum, bc|wccn |hc lirs| and sccond branchial archcs. Congen|ta| Deve|opmenta| Defects and C||n|ca| Cutcomes C and D. Thc aor|ic sac ol |hc hcar| dcsccnds and pulls |hc |hvroid caudallv, i|s pharvncal conncc|ion clona|cs as a s|alk, |hc |hvrolossal duc|, which normallv disappcars bv |hc lil|h |o six|h wcck ol in|rau|crinc lilc. Congen|ta| Deve|opmenta| Defects and C||n|ca| Cutcomes A |hvrolossal cvs|, lormin lrom a pcrsis|cn| |hvrolossal duc|, appcars as a ncck lump a| |hc middlinc. Thc normal placcd |hvroid land mus| bc scarchcd lor |o cxcludc |hvroid acncsia. In |hc abscncc ol a normal |hvroid, |hc cvs| will bc |hc onlv prcscn| |hvroid |issuc. THYR06l0SSAl CYST ,|d||ne neck |ump |n a 2 years o|d ma|e A A norma| thyro|d g|and at the base of the neck |s present A cyst (cursors) |s seen ahead the |sthmus of the g|and 8 1he cyst (arrow) |s demonstrated between the thyro|d |sthmus and the hyo|d bone 1he submand|bu|ar sa||vary g|and (SG) |s shown above the cyst 1hyro|d rad|onuc|ear scan was performed preoperat|ve|y to conf|rm that the thyro|d g|and |s present and norma||y funct|on|ng HYPFRPlASlA At0 60lTFR Arox|mote sO of nodu|or d|:eo:e |: cou:ed by hyer|o:|o of the q|ond ond occur: |n u to s of ou|ot|on t|o|oq|e:: |od|ne def|c|ency (endem|c), d|:order: hormonoqene:|: (hered|tory fom|||o| form:) ond oor ut|||zot|on of |od|ne o: o re:u|t of med|cot|on Co|ter - when hyer|o:|o |eod: to on ouero|| |ncreo:e |n :|ze or uo|ume of the q|ond HYPFRPlASlA At0 60lTFR |:to|oq|co||y, |n|t|o| :toqe |: ce||u|or hyer|o:|o of the thyro|d oc|n|, fo||owed by m|cronodu|e ond mocronodu|e formot|on yer|o:t|c nodu|e: - underqo ||quefoct|ue deqenerot|on w|th the occumu|ot|on of b|ood, :erou: f|u|d, ond co||o|d :ub:tonce --- referred to o: hyer|o:t|c odenomotou:, or co||o|d nodu|e: (otho|oq|co||y) |n the cour:e of th|: cy:t|c deqenerot|ue roce::, co|c|f|cot|on, wh|ch |: often cour:e ond er|nodu|or, moy occur HYPFRPlASlA At0 60lTFR &|tro:ound feoture: of odenomotou: nodu|e: |:oecho|c yerecho|c becou:e of the numerou: |nterfoce: between ce||: ond co||o|d :ub:tonce yoecho|c :onqe||he or honeycomb ottern vhen the nodu|e |: |:oecho|c or hyerecho|c, o th|n er|hero| hyoecho|c ho|o |: ty|co||y :een --- cou:ed by er|nodu|or b|ood ue::e|: ond m||d edemo or comre::|on of the odjocent normo| orenchymo RLAIIlC {A0N0MAI00I) N000L Loni|udinal ul|rasound imacs. A. Oval homocncous nodulc (arrowsi wi|h |hin, unilorm halo. B. Thrcc hvpcrcchoic nodulcs, |vpical ol hvpcrplasia. C. Soli|arv hvpcrcchoic nodulc, which was bcnin on INAB ,orpho|og|c patterns 41yearo|d man w|th co||o|d nodu|e U|trasound scan shows spong|form nodu|e S|m||ar|ty of nodu|e to waterf|||ed sponge |s ev|dent 8en|gn nodu|es hyper or |so echo|c to background echotexture Cyst|c change |s common 0F6FtFRATlvF CHAt6FS 0F 60lTR0uS t00ulFS !ure|y onecho|c oreo: - cou:ed by :erou: or co||o|d f|u|d choqen|c f|u|d or mou|nq f|u|d-f|u|d |eue|: - corre:ond: to hemorrhoqe r|qht echoqen|c foc| w|th comet to|| ort|foct: - cou:ed by m|crocry:to|: or oqqreqote: of co||o|d :ub:tonce --- moy moue :|ow|y (||he :nowf|ohe:), w|th|n the f|u|d co||ect|on 1h|n, |ntrocy:t|c :etot|on: --- robob|y corre:ond to ottenuoted :trond: of thyro|d t|::ue ond com|ete|y ouo:cu|or on co|or Do|er utz 0F6FtFRATlvF CHAt6FS 0F 60lTR0uS t00ulFS 1h|n, er|hero| eqq:he|| or coor:e, h|qh|y ref|ect|ue foc| w|th o::oc|oted ocou:t|c :hodow:, :cottered throuqhout the q|ond Comet ta|| s|gn ggshell CalclflcaLlon 0F6FtFRATlvF CHAt6FS 0F 60lTR0uS t00ulFS |ntrocy:t|c :o||d roject|on:, or o|||oe, u:uo||y conto|n|nq co|or Do|er :|qno|:, moy oeor to the rore cy:t|c o|||ory thyro|d CA ---- :onoqrohy ond co|or Do|er |moq|nq connot d|fferent|ote the :etot|on: of co||o|d hyer|o:t|c nodu|e: from ueqetot|on: :een |n o|||ory CA Contro:t-enhonced :onoqrohy w|th 2 nd qenerot|on m|crobubb|e: ond nond|:rut|ue |moq|nq con be u:ed 8eIg tepto --- do not :how enhoncement (ond d|:oeor |n hormon|c mode) oIIgot degeerotIet --- :how |nten:e enhoncement |n the orter|o| ho:e w|th re|ot|ue|y fo:t wo:hout C0tTRAST-FtHAtCF0 S0t06RAPHY T0 0lFFFRFtTlATF Ftl6t FR0H HAll6tAtT Flul0-FlllF0 THYR0l0 t00ulFS wlTH ltTFRtAl SFPTATl0tS 0R S0ll0 PR0JFCTl0tS ConvenLlonal 8mode sonogram of rlghL Lhyrold lobe demonsLraLes large mlxed solld and cysLlc nodulep 1r Lracheal alr shadow C common caroLld arLery ConLrasLenhanced sonogram fLer admlnlsLraLlon of conLrasL maLerlal Lhe lnLernal conLenLs are no longer vlslble because Lhey lack enhancemenL lndlcaLlng LhaL Lhe conLenLs were llkely collold and blood producLs C ConvenLlonal 8mode sonogram ln longlLudlnal plane demonsLraLes a nodule (arrow) arlslng from Lhe posLerlor wall u ConLrasLenhanced longlLudlnal sonogram shows LhaL Lhe nodule remalns vlslble lndlcaLlng enhancemenL afLer conLrasL ln[ecLlon 1he leslon was a cysLlc paplllary C A0Ft0HA #ere:ent on|y s to IO of o|| nodu|or d|:eo:e of the thyro|d q|ond 1x more common |n women thon |n men Mo:t re:u|t |n no thyro|d dy:funct|on A m|nor|ty (<IO) hyerfunct|on, deue|o outonomy ond moy cou:e thyrotox|co:|: Mo:t ore :o||tory, but moy o|:o deue|o o: ort of o mu|t|nodu|or roce:: Ftl6t F0lllCulAR A0Ft0HA A true thyro|d neo|o:m Chorocter|zed by comre::|on of odjocent t|::ue: ond f|brou: enco:u|ot|on 5ubtye:: feto| odenomo, urth|e ce|| odenomo, ond embryono| odenomo --- d|:t|nqu|:hed occord|nq to the tye of ce|| ro||ferot|on Ftl6t F0lllCulAR A0Ft0HA 1he cyto|oq|c feoture: of fo|||cu|or odenomo ore qenero||y |nd|:t|qu|:hob|e from tho:e of fo|||cu|or corc|nomo VA5C&A# AND CA!5&A# |NVA5|ON A# 1 AMA#5 OF FO|C&A# CA#C|NOMA -- |dent|f|ed by h|:to|oq|c ono|y:|: Need|e b|o:y |: therefore not o re||ob|e method to d|:t|nqu|:h between fo|||cu|or CA ond ce||u|or odenomo--- (:uch tumor: ore :urq|co||y remoued Ftl6t F0lllCulAR A0Ft0HA 5onoqroh|c feoture:: 5o||d mo::e: thot moy be hyerecho|c, |:oecho|c, or hyoecho|c oue th|ch, :mooth er|hero| hyoecho|c ho|o re:u|t|nq from the f|brou: co:u|e ond b|ood ue::e|: --- reod||y :een by co|or Do|er |moq|nq 5ohe ond whee| oeoronce of b|ood ue::e|: --- :een |n both hyerfunct|on|nq ond oor|y funct|on|nq odenomo --- doe: not o||ow the detect|on of hyerfunct|on|nq |e:|on: Ftl6t F0lllCulAR A0Ft0HA. SPFCTRuH 0F APPFARAtCFS 1ransverse lmages of 8L lobe and 8 lefL lobe of Lhyrold gland ln Lwo paLlenLs show homogeneous hypoecholc round Lo oval masses wlLh surroundlng Lhln halo Lhe capsule of Lhe adenoma 1r Lracheal alr shadow C caroLld arLery C LonglLudlnal lmage shows oval hyperecholc leslon wlLh Lhlck perlpheral halo u PlsLology of leslon ln C noLe Lhe unlform capsule (arrow) of Lhe mass LonglLudlnal lmage shows oval mass wlLh lnLernal cysLlc componenL l LonglLudlnal lmage shows round hyperecholc homogeneous mass (arrow) ln paLlenL wlLh PashlmoLo's LhyroldlLls CARClt0HA Most primary thyroid cancers are of epitheIiaI origin and are derived from foIIicuIar or parafoIIicuIar ceIIs PapiIIary Ca of the thyroid Accounts for 75% to 90% of aII cases Peaks in both the 3 rd and the 7 th decade of Iife Women are affected more often than men Microscopic features: MuIticentric within the thyroid gIand in at Ieast 20% of cases Round, Iaminated caIcifications (psammoma bodies) in the cytopIasm of papiIIary CA ceIIs are seen in approx 35% of pxs The major route of spread is through the Iymphatics to nearby cervicaI LNs PAPlllARY CA 0F THF THYR0l0 Px may present with enIarged cervicaI nodes and a paIpabIe normaI thyroid gIand Distant mets are very rare (2-3%) and most commonIy in the mediastinum and Iung CumuIative mortaIity after 20 years is typicaIIy onIy 4% to 8% SurvivaI is proIonged, especiaIIy with radio-iodine treatment. Presence of adjacent nodaI mets does not adverseIy affect the px's prognosis PAPlllARY CA 0F THF THYR0l0 as pecuIiar histoIogic (fibrous capsuIe, microcaIcifications) and cytoIogic ("ground gIass" nucIei, cytopIasmic incIusions in nucIeus, indentations of nucIear membrane) features Sonographic characteristics: ypoechogenicity (90% of cases), resuIting from cIoseIy packed ceII content, with minimaI coIIoid substance MicrocaIcifications, appearing as tiny, punctate hyperechoic foci, either with or without acoustic shadows In rare but usuaIIy aggressive cases of papiIIary CA of chiIdhood, microcaIcifications may be the onIy sonographic sign of the neopIasm, even w/o evidence of a noduIar Iesion Fig 18-15 PAPlllARY CA 0F THF THYR0l0 Sonographic characteristics: 4 ypervascuIarity (90% of cases) with disorganized vascuIarity, mostIy in weII-encapsuIated forms 4 CervicaI Iymph node mets >>> may contain tiny, punctate echogenic foci caused by microcaIcifications. MainIy Iocated in the caudaI haIf of the deep juguIar chain. OccasionaIy, metastatic nodes may be cystic as a resuIt of extensive degeneration. 4 Cystic nodaI mets >>> show a thickened outer waII, internaI noduIarity, and septations >>>> may appear pureIy cystic in younger pxs 4 Cystic Iymph node mets in the neck occur aImost excIusiveIy in association with papiIIary thyroid CA but occasionaIIy with nasopharyngeaI CA 4 PredominantIy soIid mass 4 Invasion of adjacent muscIes >>> indicates that the mass is maIignant A 8 C u PAPlllARY CA. SHAll CA wlTH HlCR0SC0PlC C0RRFlATl0t LonglLudlnal lmage shows 7 mm hypoecholc solld nodule conLalnlng mlcrocalclflcaLlons 8 Mlcroscoplc paLhologlc lmage shows mlcrocalclflcaLlons or psammoma bodles" (arrows) PAPlllARY THYR0l0 CA. SPFCTRuH 0F APPFARAtCFS LonglLudlnal lmage demonsLraLes exLremely hypoecholc solld nodule w/o evldence of calclflcaLlon 8 LonglLudlnal lmage of Lhe Lhyrold of a 6year old px shows exLenslve dlffuse mlcrocalclflcaLlon w/o dlscreLe mass 1hls ls a very rare appearance and ls more ofLen encounLered ln chlldren Lhan adulLs C LonglLudlnal and u Lransverse lmages show hypoecholc nodules LhaL conLaln echogenlc focl caused by mlcrocalclflcaLlons 1r Lracheal alr shadow C caroLld arLery LonglLudlnal lmage shows hypoecholc solld nodule wlLh Lhlck lrregular halo and llnear calclflcaLlons aL anLerlor margln (arrow) l Lransverse lmage shows heLerogeneous buL lsoecholc mass ln Lhe Lhe lsLhmus (arrow) LhaL conLalns mlcrocalclflcaLlons and has Lhlck lrregular halo F0lllCulAR CA
nd subLype of welldlfferenLlaLed Lhyrold Ca ffecLlng women more Lhan men 1wo Lypes Mlnlmally lnvaslve Lype encapsulaLed and only lnvaslve Lo capsular vessels Lhese Lumors rarely meLs (810) and also have a low faLallLy raLe (3) Wldely lnvaslve Lype nonencapsulaLed and lnvaslve Lo ad[acenL Llssues and vessels 3080 meLs and have a hlgh faLallLy raLe (30) 8oLh varlanLs of folllcular C teoJ to spteoJ tbtooqb tbe blooJstteom totbet tboo tbe lympbotlcs ooJ Jlstoot metostoses to booe looq btolo ooJ llvet are more llkely Lhan meLs Lo cervlcal lymph nodes ln8 ls noL rellable ln dlfferenLlaLlng benlgn from mallgnanL folllcular neoplasm because Lhe patho|og|c dx |s not based on ce||u|ar appearance but rather on capsu|ar and vascu|ar |nvas|on (mosL folllcular nodules musL be surglcally removed for accuraLe paLhologlc dx! F0lllCulAR CA 5onoqroh|c feoture:: |rrequ|or tumor morq|n 1h|ch, |rrequ|or ho|o 1ortuou: or choot|c orronqement of |nterno| b|ood ue::e|: A 8 C ,edu||ary CA of thyro|d |n a 38 yearo|d fema|e A A so||tary h|gh|y hypoecho|c we|| def|ned ova| nodu|e |s seen |n the |eft |obe 8 Sparsed per|phera| and centra| vascu|ar|zat|on seen on co|or Dopp|er C ,edu||ary ca was dx on USgu|ded INA (echogen|c need|e |ns|de the nodu|e) 8 C AtAPlASTlC THYR0l0 CA 1y|co||y o d|:eo:e of e|der|y er:on:, #ere:ent: one of the mo:t |etho| of :o||d tumor: Account: for |e:: thon 2 of o|| thyro|d CA s-yeor morto||ty rote of more thon 9s !re:ent: o: ro|d|y en|orq|nq mo:: extend|nq beyond the q|ond ond |nuod|nq odjocent :tructure:. Often |noerob|e ot re:entot|on Moy often be o::oc|oted w|th o|||ory or fo|||cu|or Co:, re:umob|y rere:ent|nq o ded|fferent|ot|on of the neo|o:m 1end not to :reod u|o the |ymhot|c:, but |n:teod ore rone to oqqre::|ue |oco| |nuo:|on of mu:c|e: ond ue::e|: AtAPlASTlC THYR0l0 5onoqroh|c feoture: orqe, hyoecho|c mo:: nco:e or |nuode b|ood ue::e|: |nuode nech mu:c|e: lYHPH0HA Accoun|s lor approxima|clv 4 ol all |hvroid malinancics Mos|lv non-Hodkin`s |vpc Isuallv allcc|s oldcr womcn A rapidlv rowin mass |ha| mav causc svmp|oms ol obs|ruc|ion such as dvspnca and dvsphaia In 70 |o 80 ol pxs, i| ariscs lrom a prc-cxis|in chronic lvmphocv|ic |hvroidi|is (Hashimo|o`s |hvroidi|isi wi|h subclinical or ovcr| hvpo|hvroidism 5-vcar survival ra|c rancs lrom almos| 90 in carlv-s|ac cascs |o lcss |han 5 in advanccd, disscmina|cd discasc lYHPH0HA Sonoraphic lca|urcs: x|rcmclv hvpocchoic and lobula|cd mass Larc arcas ol cvs|ic nccrosis mav occur, as wcll as cncascmcn| ol adaccn| ncck vcsscls Color dopplcr imain: Bo|h nodular and dillusc |hvroid lvmphomas mav appcar mos|lv hvpovascular Mav show blood vcsscls wi|h chao|ic dis|ribu|ion and AV shun|s Adaccn| parcnchvma mav bc hc|crocncous as a rcsul| ol associa|cd chronic |hvroidi|is e THYR0l0 HFTASTASFS Mc|s in |hc |hvroid arc inlrcqucn|, occurin la|c in |hc coursc ol ncoplas|ic discascs as |hc rcsul| ol hcma|ocncous sprcad or lcss inlrcqucn|lv a lvmpha|ic rou|c. Mc|as|ascs usuallv arc lrom mclanoma (`9i, brcas| (21i, and rcnal ccll (10i carcinoma. Mav appcar as soli|arv, wcll-circumscribcd nodulcs or as dillusc involvcmcn| ol |hc land Sonoraphic lca|urcs: Solid, homocncous hvpocchoic masscs, w/o calcilica|ions FltF-tFF0lF ASPlRATl0t l0PSY Mos| cllcc|ivc mc|hod lor dianosin malinancv in a |hvroid nodulc Providcs morc dircc| inlorma|ion |han anv o|hcr availablc dianos|ic |cchniquc Salc, incxpcnsivc, and rcsul|s in bc||cr sclcc|ion ol pxs lor surcrv Iinc-nccdlc |hrvroid aspira|cs arc ol|cn classilicd cv|opa|holoicallv in|o |hc ll 4 ca|corics: Nca|ivc (no malinan| ccllsi Posi|ivc lor malinancv Sucs|ivc ol malinancv Non-dianos|ic Limi|a|ion ol |hc |cchniquc: lack ol spccilici|v in |hc ` rd rp >>> bccausc ol |hc inabili|v |o dis|inuish lollicular or Hur|hlc ccll adcnoma lrom |hcir malinan| coun|crpar|s 0lFFFRFtTlATl0t 0F Ftl6t At0 HAll6tAtT t00ulFS Mul|inodulari|v Malinancv morc common in a soli|arv nodulc Mul|inodulari|v is usuallv associa|cd wi|h bcnin discasc Howcvcr, u|z wd hih rcsolu|ion |ransduccr consis|cn|lv dcmons|ra|cs mul|iplc clinicallv occul| nodulcs w/c mav lalsclv rcassurc |hc sonolois| >>> malinan| and bcnin nodulcs arc ol|cn prcscn| |oc|hcr in |hc samc land >>> approx 10-20 ol papillarv CA mav bc mul|iccn|ric >>>(prcscncc ol mul|iplc nodulcs wi|hin |hc |hvroid docs no| indica|c bcnini|v 0lFFFRFtTlATl0t 0F Ftl6t At0 HAll6tAtT t00ulFS Comc| Tail Sin Hihlv spccilic sin ol bcnini|v Solid/Cvs|ic lL ls also belleved LhaL cysLlc nodules are benlgn Powever Lrue eplLhellal Lhyrold cysLs are rare and Lhe cysLlc nodules seen on uLz lnvarlably have a solld componenL nodules wlLh large cysLlc componenLs are usually benlgn nodules LhaL have undergone cysLlc degeneraLlon or hemorrhage lmosL 030 of paplllary carclnomas also have a cysLlc componenL lndlcaLlng LhaL oot oll cystlc tbytolJ ooJoles ote beolqo 0lFFFRFtTlATl0t 0F Ftl6t At0 HAll6tAtT t00ulFS chocnici|v Incidcncc ol malinancv is onlv 4 whcn a solid |hvroid lcsion is hvpcrcchoic. Il |hc lcsion is iso-cchoic |hc incidcncc ol malinancv incrcascs |o 26 Malinancv occurs in 6` ol hvpocchoic masscs In dailv prac|icc, howcvcr, bcnin nodulcs arc vcrv common and a soli|arv hvpocchoic nodulc is s|a|is|icallv morc likclv |o bc bcnin 0lFFFRFtTlATl0t 0F Ftl6t At0 HAll6tAtT t00ulFS Marins A pcriphcral halo ol dccrcascd cchocnici|v is sccn around iso- hvpcrcchoic nodulcs >>> causcd bv ci|hcr |hc capsulc ol |hc nodulc or comprcsscd |hvroid |issuc and vcsscls A complc|c halo around |hc lcsion is 12 |imcs morc likclv |o indica|c a bcnin lcsion Il |hc halo is incomplc|c, a bcnin lcsion is s|ill 4 |imcs morc likclv |han a malinan| lcsion Halo mav also bc sccn in 15-`0 malinancics (i|s prcscncc is no| pa|honomonic ol bcnini|v 0lFFFRFtTlATl0t 0F Ftl6t At0 HAll6tAtT t00ulFS Calcilica|ion Pcriphcral rim calcilica|ion and larc arcas ol coarsc shadowin calcilica|ion arc morc lrcqucn|lv sccn in bcnin nodulcs Iinc punc|a|c calcilica|ion duc |o calcilicd psammoma bodics is sccn in papillarv CA (25-40i >>> also sccn in mc|as|a|ic nodcs lrom papillarv CA Small calcilic loci >>> mav bc sccn in mcdullarv CA, bo|h wi|hin |hc primarv |umor and mc|as|a|ic ccrvical nodc 0lFFFRFtTlATl0t 0F Ftl6t At0 HAll6tAtT t00ulFS Color llow imain Thrcc cncral pa||crn ol vascular dis|ribu|ion Tvpc 1: complc|c abscncc ol llow sinal wi|hin |hc nodulc Tvpc II: cxclusivc pcrinodular ar|crial llow sinals Tvpc III: in|ranodular llow wi|h mul|iplc vascular polcs chao|icallv arrancd, wi|h or wi|hou| sinilican| pcrinodular llow Tvpc I and II arc sccn in bcnin hvpcrplas|ic nodulcs Tvpc III is cncrallv associa|cd wi|h malinan| nodulcs FXAHltATl0t 0F A0JACFtT STRuCTuRFS Common caro|id ar|crv and In|crnal uular vcin Prcscncc ol |hrombus, in associa|ion wd a |hvroid nodulc, is a cluc |o |hc malinan| na|urc ol |hc nodulc Tumor |hrombus >>> morc commonlv sccn in lollicular and anaplas|ic CA Sprcad |o adaccn| s|ruc|urcs Involvcmcn| ol |hc s|rap musclcs is ano|hcr cluc |o |hc malinan| na|urc ol |hc |hvroid nodulc Loss ol |hc normal lascial planc bc|wccn |hc |hvroid and s|rap musclcs and ill-dclincd ou|lincs ol |hc musclc x|ra|hvroid sprcad >>> csophaus, |rachca, s|rap musclcs and rccurrcn| larvncal ncrvc >>> malinan| FXAHltATl0t 0F A0JACFtT STRuCTuRFS Bcnin ccrvical LNs Isuallv havc a slcndcr, oval shapc and ol|cn cxhibi| a ccn|ral cchocnic band |ha| rcprcscn|s |hc la||v hilum Malinan| LNs Ol|cn loca|cd in |hc lowcr ` rd ol |hc ncck and arc usuallv roundcr and havc no cchocnic hilum >>> bcc ol obli|cra|ion bv |umor inlil|ra|ion CFRvlCAl t00FS $onographic features for the characterization of malignant and benign nodules. D l1D8 MallgnanL 8enlgn olld ++++ ++ Mlxed ++ +++ CysLlcpurely Lhln sepLa + ++++ Pypoecholc +++ +++ lsoecholc ++ +++ Pyperecholc + ++++ 1hlck lncompleLe halo +++ + + very low probablllLy ++ low probablllLy +++ lnLermedlaLe probablllLy ++++ hlgh probablllLy $onographic features for the characterization of malignant and benign nodules. D l1D8 MallgnanL 8enlgn 1hln halo ++ ++++ oorlydeflned marglns +++ ++ Welldeflned marglns ++ +++ MlcrocalclflcaLlons ++++ ++ ggshell calclflcaLlons + ++++ Coarse calclflcaLlons + +++ lnLernal flow paLLern +++ ++ erlpheral flow paLLern ++ +++ + very low probablllLy ++ low probablllLy +++ lnLermedlaLe probablllLy ++++ hlgh probablllLy THAtK Y0u!!!