The care of a patient with a thyroid nodule has become increasingly complex. Although early detection and intervention are sought for most human malignant tumors, these mandates have proved less certain for thyroid cancer because many affected patients (even when untreated) do not die of their disease. Thus, physicians increasingly seek noninvasive means by which to identify patients who can avoid unnecessary diagnostic or therapeutic intervention. During the last 2 decades, sonographic imaging of the thyroid has become the most valued tool. The investigation published in this week’s JAMA Internal Medicine by Smith-Bindman and colleagues1 lends further support. The authors performed a large-scale analysis of all thyroid ultrasongraphic examinations performed at a single institution during a 5-year period. Radiologic findings were linked with the California Cancer Registry, allowing masked assessment of sonographic features that convey benign or malignant disease. This investigation confirms the importance of analyzing parenchymal tissue (solid or cystic), measuring nodule size, and identifying sonographic features, such as microcalcifications, irregular margins, and increased vascular flow. These results are important because the large-scale and masked analysis by Smith-Bindman et al validates results from less stringently performed, retrospective analyses. However, the data about suspicious nodule characteristics were derived from a total of only 96 malignant tumors.
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