Korean J Radiol.  2018 Aug;19(4):673-681. 10.3348/kjr.2018.19.4.673.

Ultrasonographic Echogenicity and Histopathologic Correlation of Thyroid Nodules in Core Needle Biopsy Specimens

• Kim JH
• Na DG
• Lee H

• KMID: 2413696
• DOI: http://doi.org/10.3348/kjr.2018.19.4.673

Abstract

OBJECTIVE
To determine the histopathologic features associated with ultrasonographic echogenicity of thyroid nodules.
MATERIALS AND METHODS
This study included 95 nodules of 95 patients (76 women, 19 men; mean age 47.5 ± 12.9 years) with homogeneous echogenicity in which core needle biopsy was performed during a one year period. The nodule echogenicity was categorized into 4 grades (hyperechogenicity, isoechogenicity, mild hypoechogenicity, and marked hypoechogenicity). The biopsy specimens were evaluated by a pathologist regarding the histopathologic features of fibrosis, lymphoid infiltration, microfollicular pattern, uniform follicular pattern, and hypercellularity in nodules. We evaluated the association of each histopathologic feature among 3 categories of nodule echogenicity by multinomial regression analysis.
RESULTS
The nodule echogenicity was isoechoic in 28 (29.5%), mildly hypoechoic in 37 (38.9%), and markedly hypoechoic in 30 (31.6%), and there was no hyperechoic nodule. There was a trend of increasing frequency of fibrosis (> 30%) as nodule echogenicity decreased (isoechogenicity, 10.7%; mild hypoechogenicity, 32.4%; and marked hypoechogenicity, 80%; p < 0.001). The microfollicular pattern, uniform follicular pattern, and hypercellularity were frequently found in mildly hypoechoic nodules than in isoechoic nodules (p ≤ 0.018). The fibrosis (> 30%) and hypercellularity were independently associated with mild or marked hypoechogenicity as compared to isoechogenicity (fibrosis; p ≤ 0.004 and hypercellularity; p ≤ 0.036), and only fibrosis (> 30%) was independently associated with marked hypoechogenicity as compared to mild hypoechogenicity (p = 0.004).
CONCLUSION
The fibrosis (> 30%) and high cellularity are independently associated with mild or marked hypoechogenicity of nodules. The knowledge of the relationship of echogenicity and histopathology of thyroid nodules could improve management of patients with thyroid nodules.

Keyword

Ultrasonography; Echogenicity; Histopathology; Thyroid gland; Thyroid neoplasms; Thyroid nodule; Biopsy; Large-core needle

MeSH Terms

Biopsy
Biopsy, Large-Core Needle*
Clothing
Female
Fibrosis
Humans
Male
Thyroid Gland*
Thyroid Neoplasms
Thyroid Nodule*
Ultrasonography

Figure

• 

  Fig. 1 Ultrasonography and CNB histology features of nodular hyperplasia diagnosed on CNB.Transverse ultrasonography image shows ovoid isoechoic and predominantly solid nodule (A), and needle notch of CNB is positioned within nodule and perinodular normal thyroid tissue (B). CNB histology (C) shows variable sized follicular lesion without any of fibrosis, microfollicular pattern, and high cellularity (haematoxylin-eosin staining, × 40). CNB = core needle biopsy

• 

  Fig. 2 Ultrasonography and CNB histology features of suspicious follicular neoplasm diagnosed on CNB.Transverse ultrasonography image shows ovoid mildly hypoechoic solid nodule (A), and needle notch of CNB is positioned within nodule and perinodular normal thyroid tissue (B). CNB histology (C) shows follicular lesion which shows uniform and microfollicular architectural patterns, high cellularity, and no fibrosis, and fibrous capsule (arrows) is seen between follicular lesion and normal thyroid tissue (haematoxylin-eosin staining, × 40).

• 

  Fig. 3 Ultrasonography and CNB histology features of conventional papillary carcinoma diagnosed on CNB.Transverse ultrasonography image shows round markedly hypoechoic solid nodule with macrocalcifications and spiculated margin (A), and needle notch of CNB is positioned within center of nodule and perinodular normal thyroid tissue (B). CNB histology (C) shows high cellular tumor cells and no histology feature of fibrosis, uniform follicular pattern, and microfollicular pattern (haematoxylin-eosin staining, × 40).

• 

  Fig. 4 Ultrasonography and CNB histology features of fibrotic nodule diagnosed as non-diagnostic on CNB.Transverse ultrasonography image shows round markedly hypoechoic solid nodule (A), and needle notch of CNB is positioned within nodule (B). CNB histology (C) shows only fibrosis and no follicular lesion (haematoxylin-eosin staining, × 40).

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