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Journal of Ultrasound in Medicine, Vol 17, Issue 8 487-496, Copyright © 1998 by American Institute of Ultrasound in Medicine
Thyroid palpation versus high-resolution thyroid ultrasonography in the detection of nodules
P. W. Wiest, M. F. Hartshorne, P. D. Inskip, L. A. Crooks, B. S. Vela, R. J. Telepak, M. R. Williamson, R. Blumhardt, J. M. Bauman and M. Tekkel
Department of Radiology, University of New Mexico School of Medicine, Veterans Affairs Medical Center, Albuquerque, USA.
Detection of thyroid nodules by physical examination and high-resolution
ultrasonography was compared using small groups of blinded, experienced
physician examiners working with a sample of 2441 persons from Estonia,
most of whom were Chernobyl nuclear reactor clean-up workers. A random
subsample of 113 (5%) persons was subjected to triple control examinations
with both physical examination and high-resolution ultrasonography.
Positive high-resolution ultrasonographic findings were considerably more
reproducible among different observers than were positive physical
examination findings. Agreement between methods was poor. Nodules were
found in 169 (6.9%) subjects by physical examination and in 249 (10.2%)
subjects by high-resolution ultrasonography. Physical examination found
only 53 (21%) of the 249 nodules found by high-resolution ultrasonography.
High-resolution ultrasonography did not confirm the existence of 115 (68%)
of the 169 nodules found by physical examination. Only 6.4% of nodules less
than 0.5 cm in diameter, as based on high-resolution ultrasonographic
results, were detected by physical examination. Physical examination
detection improved with increasing nodule size but was still only 48.2% for
nodules larger than 2 cm. Physical examination was relatively effective in
detecting nodules in the isthmus of the thyroid gland but much less so for
nodules in the upper pole of the gland. Clinical evaluation and
epidemiologic studies of nodular thyroid disease stand to benefit from the
greater sensitivity and specificity of ultrasonographic examinations.
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