Systematic differences between ultrasound and pathological evaluation of thyroid nodules: a method comparison study

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High‐resolution ultrasound (US) is recommended for all patients with known or suspected thyroid nodules.1 This assesses the risk of malignancy by evaluating nodule size, number and parenchymal characteristics such as echogenicity, calcifications, internal vascularity, margins and the presence of associated cervical lymphadenopathy.1 Furthermore, US‐measured nodule size (US size, USS) plays a critical role in selecting patients for further evaluation with fine needle aspiration (FNA) and surgical decision‐making.
Current American Thyroid Association (ATA) guidelines give strong recommendations for routine FNA in nodules >10 mm if classed as high or intermediate risk on imaging. FNA of lesions >15 mm is recommended for nodules with low risk features on imaging (weak recommendation, based on low‐quality evidence). In solitary nodules between 1 and 4 cm (on US) without extra‐thyroidal extension or evidence of lymph node metastases, patients may undergo either lobectomy or total thyroidectomy depending on patient preference, pre‐operative pathology and need for radioactive iodine treatment. However, it is the histopathological size in malignant nodules that determines the final cancer staging.1
There are limited data comparing USS and pathological size (PS), and these studies have not analysed their systematic differences.3 The primary objective of this study was to uncover the lack of agreement (bias) between USS and PS measurements using a method comparison study. The secondary aim was to assess nodules with USS <10 mm, as size discrepancies may alter management decisions.

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