Differentiation of Benign and Malignant Thyroid Nodule on the Basis of Vascular Pattern by Using Color Doppler Ultrasonography

Main Article Content

Rabail Asif
Tayyaba Iqbal
Dr Atia Masood Ahmed Chaudhary
Hafiza Maria Fawad
Noor Fatima
Mehak Fatima
Esha Aftab
Mahnoor Zulfiqar

Abstract

Background: Thyroid nodules are frequently encountered in clinical practice, and although most are benign, accurate risk stratification is essential to identify lesions requiring cytological evaluation while avoiding unnecessary invasive procedures. Gray-scale ultrasonography remains the first-line imaging modality, while Color Doppler ultrasonography may provide adjunctive information regarding nodular vascularity. Objective: To evaluate Doppler vascularity patterns in thyroid nodules and determine their association with demographic characteristics, nodule dimensions, and gray-scale sonographic features. Methods: This cross-sectional analytical study included 69 patients aged 18–70 years with clinically or sonographically detected thyroid nodules at Government Teaching Hospital, Shahdara, Lahore. High-resolution ultrasonography with Color Doppler assessment was used to evaluate nodule number, thyroid part involvement, shape, margin, echogenicity, calcification, dimensions, and vascularity. Data were analyzed using IBM SPSS version 25. Categorical associations were assessed using chi-square tests, and age and nodule dimensions were compared across vascularity groups using one-way ANOVA with Tukey post hoc analysis. Results: Females constituted 67 patients (97.1%), and the mean age was 41.67 ± 13.62 years. Minimally present vascularity was the most common Doppler pattern (39.1%), followed by absent (33.3%) and increased vascularity (27.5%). Vascularity was not significantly associated with nodule number, thyroid part involvement, margin, echogenicity, calcification, or shape. Age differed significantly across vascularity groups (p = 0.031), with increased vascularity observed in older patients. Conclusion: Color Doppler vascularity showed limited association with most sonographic features, although increased vascularity was more common in older patients. Doppler assessment may complement gray-scale ultrasound, but vascularity alone cannot reliably differentiate benign and malignant nodules without cytological correlation.

Article Details

Section

Articles

How to Cite

1.
Rabail Asif, Tayyaba Iqbal, Dr Atia Masood Ahmed Chaudhary, Hafiza Maria Fawad, Noor Fatima, Mehak Fatima, et al. Differentiation of Benign and Malignant Thyroid Nodule on the Basis of Vascular Pattern by Using Color Doppler Ultrasonography. JHWCR [Internet]. 2026 Jun. 13 [cited 2026 Jun. 13];4(11):1-10. Available from: https://www.jhwcr.com/index.php/jhwcr/article/view/1791

References

1. Benvenga S, Tuccari G, Ieni A, Vita R. Thyroid gland: anatomy and physiology. In: Encyclopedia of Endocrine Diseases. 2nd ed. Amsterdam: Elsevier; 2018. p. 382-90.

2. Welker MJ, Orlov D. Thyroid nodules. Am Fam Physician. 2003;67(3):559-66.

3. Zamora EA, Khare S, Cassaro S. Thyroid nodule. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.

4. Maddaloni E, Briganti SI, Crescenzi A, Beretta Anguissola G, Perrella E, Taffon C, et al. Usefulness of color Doppler ultrasonography in the risk stratification of thyroid nodules. Eur Thyroid J. 2021;10(4):339-44.

5. Daniels K, Gummadi S, Zhu Z, Wang S, Patel J, Swendseid B, et al. Ultrasonic features of thyroid nodule. 2019.

6. Lee YH, Kim DW, In HS, Park JS, Kim SH, Eom JW, et al. Differentiation between benign and malignant solid thyroid nodules using an US classification system. Korean J Radiol. 2011;12(5):559-67.

7. Xie C, Cox P, Taylor N, LaPorte S. Ultrasonography of thyroid nodules: a pictorial review. Insights Imaging. 2016;7(1):77-86.

8. Varverakis E, Neonakis E, Tzardi M, Chrysos E. Role of color Doppler ultrasonography in preoperative management of cold thyroid nodules. Hormones (Athens). 2007;6(1):44-51.

9. Fathy MM, Megali HI, El-Hafeez WA. Vascular pattern and spectral parameters of Doppler ultrasound in differentiation between malignant and benign thyroid nodules. J Curr Med Res Pract. 2021;6(1):82-6. doi:10.4103/JCMRP.JCMRP_41_20.

10. Sanehane S, Gharib H. Thyroid nodule update on diagnosis and management. Clin Diabetes Endocrinol. 2016;2:17.

11. Kant R, Davis A, Verma V. Thyroid nodules: advances in evaluation and management. Am Fam Physician. 2020;102(5):298-304.

12. Zeng Z, Zhou C, Shi B, Wu X, Liu J. Systematic review and meta-analysis: diagnostic value of different ultrasound for benign and malignant thyroid nodules. Gland Surg. 2022;11(6):1067-77.

13. Alamdaran SA, Farshidianfar M, Masoumi A, Rashed MM, Jaberi M. Diagnostic value of colour Doppler ultrasound in differentiating malignant and benign nodules in thyroiditis background. J Med Radiat Sci. 2024;71(2):233-9.

14. Li W, Gao L, Du Y, Wang Y, Yang X, Wang H, et al. Ultrasound microflow patterns help in distinguishing malignant from benign thyroid nodules. 2024.

15. Hegedüs L. The thyroid nodule. N Engl J Med. 2004;351(17):1764-71.

16. Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al. Benign and malignant thyroid nodules: US differentiation—multicenter retrospective study. Radiology. 2008;247(3):762-70.

17. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab. 2002;87(5):1941-6.

18. Bomeli SR, LeBeau SO, Ferris RL. Evaluation of a thyroid nodule. Otolaryngol Clin North Am. 2010;43(2):229-38.

19. Chammas MC, Gerhard R, Oliveira IRS, Widman A, Barros N, Durazzo M, et al. Thyroid nodules: evaluation with power Doppler and duplex Doppler ultrasound. Otolaryngol Head Neck Surg. 2005;132(6):874-82.

20. Khadra H, Bakeer M, Hauch A, Hu T, Kandil E. Is vascular flow a predictor of malignant thyroid nodules? A meta-analysis. Gland Surg. 2016;5(6):576-82.

21. Tamsel S, Demirpolat G, Erdogan M, Nart D, Karadeniz M, Uluer H, et al. Power Doppler US patterns of vascularity and spectral Doppler US parameters in predicting malignancy in thyroid nodules. Clin Radiol. 2007;62(3):245-51.

22. Darvish L, Khezri M, Teshnizi SH, Roozbeh N, Dehkordi JG, Amraee A. Color Doppler ultrasonography diagnostic value in detection of malignant nodules in cysts with pathologically proven thyroid malignancy: a systematic review and meta-analysis. Clin Transl Oncol. 2019;21(12):1712-29.

23. Sultan LR, Xiong H, Zafar HM, Schultz SM, Langer JE, Sehgal CM. Vascularity assessment of thyroid nodules by quantitative color Doppler ultrasound. Ultrasound Med Biol. 2015;41(5):1287-93.