Nomogram for predicting malignancy in thyroid nodules using clinical, biochemical, ultrasonographic, and cytologic features

Surgery. 2010 Dec;148(6):1120-7; discussion 1127-8. doi: 10.1016/j.surg.2010.09.030.


Background: Thyroid nodules often discovered incidentally and present a management problem particularly when investigations suggest atypical or suspicious cells. Prediction of the risk of malignancy within such a thyroid nodule is based on clinical, biochemical, ultrasonographic, and cytologic features. Our aim was to create a nomogram to predict accurately the chance of malignancy within a thyroid nodule.

Methods: All patients with thyroid nodules who underwent ultrasonographic-guided fine needle aspiration and operative resection at our institution during 2007-2008 were identified. Clinical records, biochemical profiles, pathology reports, ultrasonographic images, and cytology slides were reviewed. A multivariate logistic regression was used to quantify the value of the variables in estimating the risk of malignancy.

Results: The records of 158 patients with 190 nodules were reviewed. Eighteen nodules were excluded. The 8 variables with the greatest predictive value selected for the nomogram were biochemical (thyroid-stimulating hormone), ultrasonography (shape, echo texture, and vascularity), and cytology (nuclear grooves, pseudoinclusions, cellularity, and presence of colloid). The nomogram had an excellent predictive accuracy with a concordance index of 91%.

Conclusion: We produced a nomogram that can quantify accurately the risk of malignancy in a thyroid nodule based on biochemical, ultrasonographic, and cytologic features.

MeSH terms

  • Calibration
  • Diagnosis, Differential
  • Humans
  • Multivariate Analysis
  • Nomograms*
  • Oxyphil Cells / pathology
  • Predictive Value of Tests
  • Regression Analysis
  • Reproducibility of Results
  • Thyroid Neoplasms / diagnostic imaging
  • Thyroid Neoplasms / epidemiology*
  • Thyroid Neoplasms / pathology
  • Ultrasonography