Sands et al developed te McGill Thyroid Nodule Score (MTNS) to evaluate a thyroid nodule. This can help to decide if the nodule is benign or malignant. The authors are from Jewish General Hospital and McGill University in Montreal.
Patient selection: thyroid nodule:
Parameters:
(1) gender
(2) age
(3) palpable nodule
(4) serum TSH levels
(5) consistency
(6) exposure to ionizing radiation
(7) family history of thyroid cancer
(8) ethnicity
(9) echogenicity
(10) increased vascularity
(11) shape
(12) calcification
(13) enlarging (time from not stated)
(14) lymphadenopathy
(15) size in cm
(16) PET scan
(17) Hurthle cell lesion
(18) favor neoplasm
(19) atypia (not reactive)
(20) suspicious for malignancy
(21) HBME-1
(22) BRAF mutation
|
Parameter |
Finding |
Points |
|---|---|---|
|
gender |
female |
0 |
|
|
male |
1 |
|
age |
<= 45 years of age |
0 |
|
|
> 45 years of age |
1 |
|
palpable nodule |
absent |
0 |
|
|
present |
1 |
|
serum TSH concentration |
<= 1.4 mIU/L |
0 |
|
|
> 1.4 mIU/L |
1 |
|
consistency stone or bone hard |
absent |
0 |
|
|
present |
2 |
|
exposure to ionizing radiation |
absent |
0 |
|
|
present |
3 |
|
family history of thyroid cancer |
absent |
0 |
|
|
present |
3 |
|
ethnicity |
Filipino, Hawaian, Icelander |
3 |
|
|
other |
0 |
|
echogenicity |
not hypoechoic |
0 |
|
|
hypoechoic |
1 |
|
increased vascularity |
absent |
0 |
|
|
present |
1 |
|
shape taller than wider |
absent |
0 |
|
|
present |
1 |
|
calcification |
none |
0 |
|
|
coarse |
1 |
|
|
microcalcifications |
2 |
|
enlarging |
less than 10% |
0 |
|
|
10 to 30% in at least 2 axes |
1 |
|
|
> 30% in at least 2 axes |
2 |
|
lymphadenopathy |
absent |
0 |
|
|
present |
2 |
|
size |
< 2 cm |
0 |
|
|
2 to 2.0 cm |
2 |
|
|
3 to 3.9 cm |
3 |
|
|
>= 4 cm |
4 |
|
PET scan focally positive |
absent |
0 |
|
|
present |
4 |
|
Hurthle cell lesion |
absent |
0 |
|
|
present |
2 |
|
favor neoplasm |
absent |
0 |
|
|
present |
3 |
|
atypia, not reactive |
none |
0 |
|
|
mild |
3 |
|
|
moderate |
4 |
|
|
severe or significant |
5 |
|
suspicious for malignancy |
absent |
0 |
|
|
present |
7 |
|
HBME-1 |
negative |
0 |
|
|
positive |
7 |
|
BRAF mutation |
absent |
0 |
|
|
present |
7 |
where:
• The diagnoses of favor neoplasm, severe atypia and suspicious for malignancy seem to overlap.
subscore for clinical presentation and labs =
= SUM(points for first 8 items)
subscore for ultrasound and PET scan =
= SUM(points for second 8 items)
subscore for cytology =
= SUM(points for last 6 items)
total MTNS =
= SUM(points for all 22 items)
Interpretation:
• minimum score: 0
• maximum score: 63
• The higher the score the greater the risk for malignancy.
|
Score |
Percent Malignancy |
|---|---|
|
0 |
0% |
|
1 to 3 |
27% |
|
4 to 7 |
32% |
|
8 |
39% |
|
9 to 11 |
63% |
|
12 or 13 |
88% |
|
14 to 18 |
93% |
|
>= 19 |
100% |
Limitations:
• The cutoff for serum TSH may need to be adjusted for local methods.
Specialty: Endocrinology, Clinical Laboratory
