Differential diagnosis of thyroid nodules/ focal lesions using ultrasound confirmed with histopathology

Objectives: To assess the sensitivity, specificity of ultrasonography for the differential diagnosis of thyroid nodules/focal lesions in cases confirmed with histopathology. Methods: A descriptive retrospective study was conducted at the Radiology department in King Abdullah Medical Complex Hospital and King Fahad General Hospital in Jeddah, Saudi Arabia. During the period between 2020 and 2024. A sample collected from hospitals recorded which included 177 patients within the age group of 18-65 years, who were presented with thyroid disease, and were examined by ultrasonography as well as fine needle aspiration biopsy (for suspected malignant thyroid nodule/lesion). Ultrasonography was performed using both gray scale and color Doppler. Results: Our results demonstrated that the sensitivity of the ultrasonography in the confirmation of a malignant thyroid lesion is 100.0%, and its specificity is 32.4%. Malignant lesions accounted for 21.5%, with papillary carcinoma being the most frequent (19.2%), while the least common type is undifferentiated and medullary carcinoma (0.6%). Commonly, thyroid cancer occurs unilaterally in more than half of cases (seen at the right lobe 55.9%), meaning on one side of the gland, often singularly. Our study showed that 78.5% of thyroid nodules were benign, with follicular adenoma being the most common (33.3%), followed by goitrous nodules (20.3%) and colloid nodules (15.8%). Conclusion: Ultrasonography is very cost-effective, patient-friendly, had a highly sensitive rate. Ultrasound, though routinely used, has limited diagnostic accuracy for thyroid cancer, demonstrating 100% sensitivity but only 32.4% specificity, highlighting its potential for misdiagnosis.