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The prognosis for noncancerous (benign) thyroid nodules is great. eCollection 2022. FACTORS AFFECTING MALIGNANCY IN THYROID NODULES WITH NON-DIAGNOSTIC FINE NEEDLE ASPIRATION BIOPSY RESULT. 0000009119 00000 n
Fu Y, Sun Y, Pei Q, Han X, Qin W, Mei F, Tan S, Cui L. Medicina (Kaunas). <<
Thyroid nodule. At Another Johns Hopkins Member Hospital: The Johns Hopkins Thyroid and Parathyroid Center, Webinar: Thyroid Disease, an Often Surprising Diagnosis, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Radiofrequency Ablation for Thyroid Nodules. Epub 2016 Sep 30. 42 0 obj
In rare cases, they're cancerous. 0000046515 00000 n
Elselvier; 2018. https://www.clinicalkey.com. 2022 Oct 20;12:1013410. doi: 10.3389/fonc.2022.1013410. /Type /Font
I have a thyroid nodule being watched last year it was cystic and this year it is now solid. /Metadata 39 0 R
The logic here is that since the thyroid hormone is partly made of iodine, supplementing will help increase thyroid hormone levels. These are frequently seen in nodules containing papillary thyroid cancer. 94 0 obj
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Mayo Clinic Staff. But your doctor will also want to know if your thyroid is functioning properly. Unable to load your collection due to an error, Unable to load your delegates due to an error. Accessed Oct. 31, 2019. Thyroid nodules are very common and benign in most cases. 500 500 500 500 278 500 500 278 278 500 278 722 500 500 500 500 333 444 278
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If concern arises about the possibility of cancer, the doctor may simply recommend monitoring the nodule over time to see if it grows. Epub 2022 Sep 23. In assessing a lump or nodule in your neck, one of your doctor's main goals is to rule out the possibility of cancer. Unable to process the form. If you see or feel a thyroid nodule yourself usually in the middle of your lower neck, just above your breastbone call your primary care doctor for an appointment to evaluate the lump. /OpenAction [ 41 0 R /Fit ]
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Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection. My husband has been diagnosed with thyroid nodules which are solid and have micro calcifications. If a thyroid nodule isn't cancerous, treatment options include: Watchful waiting. 2015;34(4):304-11. Conclusions: By making a few targeted diet and lifestyle changes, including focusing on your gut health and optimizing your iodine levels, you can likely reduce the size of your thyroid nodules (and your worry). endobj
No sonographic features are 100% sensitive or specific (although lymphadenopathy with microcalcifications is 100% specific). Learn about potential causes of thyroid nodules, from benign tissue overgrowth to. 2007;27(3):847-60. Mayo Clinic. /Filter /FlateDecode
2022 Nov 13;58(11):1639. doi: 10.3390/medicina58111639. 0000018261 00000 n
Others are mixed. Often, your doctor may discover thyroid nodules during a routine medical exam. 0000002826 00000 n
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Cavallo A, Johnson DN, White MG, Siddiqui S, Antic T, Mathew M, Grogan RH, Angelos P, Kaplan EL, Cipriani NA. Nodules are often biopsied to make sure no cancer is present. Liu Y, Li X, Yan C, Liu L, Liao Y, Zeng H, Huang W, Li Q, Tao N, Zhou J. Eur Radiol. 0000004788 00000 n
PMC By using our website, you consent to our use of cookies. Decrease in thyroid autoantibodies after eradication of Helicobacter pylori infection. Ferri FF. According to the American Thyroid Association, roughly half of the population will have a thyroid nodule by age 60. If one of the nodules starts getting appreciably bigger while the rest stay the same, get seen. The Role of Sonography in Thyroid Cancer. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you! WebLarge, cystic/solid, and thyroid nodules with both characteristics had false-negative rates of 17%, 25%, and 30%, respectively, compared with 0%, 9%, and 17% for small (less than 3 https://www.uptodate.com/contents/search. Treatment depends on the type of thyroid nodule you have. 500 444 778 500 444 ]
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Some medications are safe, but you may have to pump and dump during other tests and treatments. /F7 62 0 R /F8 65 0 R /F9 68 0 R /F10 71 0 R /F11 74 0 R /F12 77 0 R /F13
Improving your gut health with an anti-inflammatory diet and probiotics, and optimizing your iodine levels, can often reduce the size of thyroid nodules. 833 722 722 ]
Careers. The incidental thyroid nodule. Follow-up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology. Atypical celiac disease as cause of increased need for thyroxine: a systematic study. trailer
Mixed solid and cystic nodules are the most common finding in thyroid US and are often hyperplastic benign nodules with degeneration and internal debris as startxref
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Eur Arch Otorhinolaryngol. Microcalcifications: Small flecks of calcium within a thyroid nodule, usually seen as small bright spots on ultrasonography. Bugdaci MS, Zuhur SS, Sokmen M, Toksoy B, Bayraktar B, Altuntas Y. Radiologic and Pathologic Findings of Nonpalpable Thyroid Carcinomas Detected by Ultrasonography in a Medical Screening Center. Before 44 0 obj
However, if you have several nodules or large nodules, you may be able to see them. https://www.thyroid.org/hypothyroidism/. 1995 Dec;118(6):996-1003; discussion 1003-4. The role of Helicobacter pylori in patients with hypothyroidism in whom could not be achieved normal thyrotropin levels despite treatment with high doses of thyroxine [published correction appears in Helicobacter. WebOBJECTIVE: Our research sought to investigate the relationship between initial ablation ratio (IAR) and internal composition of benign thyroid nodules treated by microwave ablation (MWA). Cleveland Clinic is a non-profit academic medical center. 0000036724 00000 n
Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. This logic falls apart in light of research that connects excessive iodine with an increase in thyroid autoimmunity, goiter, and hypothyroidism. /FontFile3 48 0 R
Become a Gold Supporter and see no third-party ads. Most cystic nodules are partly solid structures that have undergone cystic degeneration (mixed or complex nodules) . The majority of thyroid nodules are benign, dont cause symptoms, and dont require surgery. There are four main reasons why a thyroid nodule would grow:Thyroid cancerThyroid autoimmunityIodine deficiency or excessThyroid cysts https://www.uptodate.com/contents/search. Disclaimer. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. dx benign multinodular goiter. WebMixed cystic and solid thyroid nodule A 56-year-old female asked: Thyroid nodules on ct. us found 10+ nodules, 2 largest about 2.5 cm and are "mixed cystic and solid". Thyroid nodules are small lumps or bumps in your thyroid gland, which is located at the base of your neck. World J Surg. http://www.thyroid.org/thyroid-nodules/. KMz?4\;bU&Lw0@Id~{Tca /Z{*L%46
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Kim J, Lee C, Kim S et al. National Library of Medicine Probiotics are an effective way to balance your gut microbiome with few side effects. /LastChar 83
Hashimotos Thyroiditis and Autoimmune Gastritis. For example, if you have obesity, talk to your healthcare provider about attaining a healthy weight for you. Diagnostic approach to and treatment of thyroid nodules. <<
Results were compared with the cytologic or surgical findings. 2014;203(6):1310-6. *Inquiries relevant to the practice only. A single copy of these materials may be reprinted for noncommercial personal use only. You can learn more about how we ensure our content is accurate and current by reading our. Your doctor may recommend a thyroid scan to help evaluate thyroid nodules. Epub 2012 Aug 28. The differential for a suspicious nodule includes benign nodules such as adenomatoid nodules, follicular adenoma, and Hashimoto thyroiditis. Would you like email updates of new search results? /BaseFont /NOLLBA+Univers-Black
Its best to consult your doctor for the treatment of a goiter. In some cases, nodules that take up less of the isotope called cold nodules are cancerous. 2013 Dec;24(6):385-90. doi: 10.1111/cyt.12021. and transmitted securely. BACKGROUND AND PURPOSE: The ability of US to differentiate benign thyroid nodules from malignant ones is still a matter of debate. High TSH and pregnancy can be a worrying combination, but hormone treatments are safe and effective. Please enable it to take advantage of the complete set of features! Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. Solid nodules in your thyroid are more likely to be malignant than fluid-filled nodules, but theyre still rarely cancerous. Careers. Since most of the thyroid nodules are not cancer, it is important to know which nodules should undergo biopsy. If your doctor found a hypoechoic nodule during an ultrasound, they may simply do some additional testing to make sure theres no underlying cause that needs treatment. 45 0 obj
The false negative rate of benign cytology was 10.4 %, and the absence of suspicious US features did not reliably exclude malignancy. At minimum, thyroid lobectomy should be strongly considered for all nodules 4 cm. This is a preview of subscription content, log in to check access. 0000002035 00000 n
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2015 Jan;22(1):152-7. doi: 10.1245/s10434-014-3952-7. 0000002565 00000 n
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Complex nodules are common. A total of 704 nodules had echogenic foci; 246 did not. Policy. Large, cystic/solid, and thyroid nodules with both characteristics had false-negative rates of 17%, 25%, and 30%, respectively, compared with 0%, 9%, and 17% for small (less than 3 cm), solid, and solid nodules 3 cm or larger, respectively. Whether its benign or not, a bothersome thyroid nodule can often be successfully managed. If its spread to nearby tissues, such as lymph nodes. If a biopsy shows that you have a noncancerous thyroid nodule, your doctor may suggest simply watching your condition. /E 53272
In fact, you may be able to resolve your thyroid nodules with simple treatment and lifestyle options. Epub 2012 Oct 18. Conclusions: /TrimBox [ 9 9 594 792 ]
WebAbstract. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Your thyroid specialist will help determine the correct amount to take because it may require more than hormone replacement to manage your cancer risk. J Ultrasound Med. Understanding the risks and harms of management of incidental thyroid nodules: A review. Have your thyroid. Our website services, content, and products are for informational purposes only. Keep in mind that, while hypoechoic nodules Aydoan B, Ceyhan K, ahin M, orapolu D. Are Thyroid Nodules with Spongiform Morphology Always Benign? Specific management guidelines from various professional societies are covered in separate articles. Thyroid nodules are detected by ultrasonography in up to 68% of healthy patients. Elsevier; 2019. https://www.clinicalkey.com. >>
[14, 15, 16, 17] One study showed probiotics decreased thyroid symptoms and the needed dose of levothyroxine. A publication of the American Thyroid Association, Risk of thyroid cancer based on thyroid ultrasound findings. Research shows an anti-inflammatory diet such as the Paleo diet, gluten-free and dairy-free diets [10, 11, 12], or the Autoimmune Paleo diet [13] may support your thyroid health. Thyroid cancer is one of the most treatable kinds of cancer. AJNR Am J Neuroradiol. endstream
Radiographics. Among 1056 thyroid nodules undergoing ultrasound with fine-needle aspiration (FNA) biopsy, 392 nodules (37.1%) were mixed echoic. There are few studies regarding the reliability of Research indicates thyroid health is closely connected to your gut health. Is it time to panic? But in most cases, theres little to worry about. A diagnosis of cancer was made in 10.5% of nodules measuring 1 1.9 cm. Some authors suggest that hypoechoic, solid nodules larger than 1 to 1.5 cm with macrocalcifications should be biopsied and spongiform nodules and cysts need no biopsy. 2016; doi:10.1038/nrendo.2016.110. Assuming the cystic nodule turns into a solid nodule, the indication for biopsy will depend on the characteristics of this solid nodule. In addition to this, PEF increased the malignancy risk by35.3%, in solid nodules and an approximate risk of 10%, in mixed nodules. Hyperthyroidism. 2010;31(10):1956-60. Healthcare providers detect them in approximately 5% to 7% of adults during a physical examination. 0000051727 00000 n
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Curious about high TSH levels and fertility? Large thyroid nodules: should size alone matter. Acta Endocrinol (Buchar). Right side upper pole solid hypoechoic single thyroid nodule mean? Thyroid cancer: http://www.thyroid.org/cancer-of-the-thyroid-gland, Thyroid Nodules: http://www.thyroid.org/what-are-thyroid-nodules, Table of Contents | PDF File for Saving and Printing. 0000003108 00000 n
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The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. Accessed Oct. 31, 2019. /Rotate 0
SUMMARY OF THE STUDY If you have any questions about your risk of developing thyroid cancer or thyroid disease, talk to your provider. 0000011094 00000 n
Ff?L#y1|L3Gb!zpD2+rtR\0ui7q]m%rX902u44A) >9 At the time the article was created Matt A. Morgan had no recorded disclosures. Ultrasound is also frequently used to guide the needle into a nodule during a thyroid nodule biopsy. You then lie on a table while a special camera produces an image of your thyroid on a computer screen. However, it is possible to have nodules in addition to a goiter, making it a multinodular goiter. 2022 Jan 30;14(3):717. doi: 10.3390/cancers14030717. /Linearized 1
Katagiri R, Yuan X, Kobayashi S, Sasaki S. Effect of excess iodine intake on thyroid diseases in different populations: A systematic review and meta-analyses including observational studies. Most thyroid nodules dont cause symptoms. WebA nodule having both a cystic and solid portion was defined as a mixed echoic nodule.
As has been noted for completely solid nodules, microcalcifications are associated with an increased risk of malignancy. If you have a solid complex should have biopsy , fna a simple as Aspirin with syringe done in office. Heres when you should pay attention to a thyroid nodule: In a majority of cases, thyroid nodules are caused by Hashimotos thyroiditis, an autoimmune attack on the thyroid gland that causes scarring. official website and that any information you provide is encrypted >>
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WebThe most important neck masses that can be mistaken with thyroid nodules include: Thyroglossal duct cyst, parathyroid cancer, parathyroid cyst, and branchial cleft cyst. /Subtype /Type1
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This usually means having a physical exam and thyroid function tests at regular intervals. The Future of Functional Medicine Review: The majority of thyroid nodules are benign and not a cause for concern. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Thyroid nodules are extremely common. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). National Institute of Diabetes and Digestive and Kidney Diseases. However, its still important to see your healthcare provider if you notice a lump on your thyroid (in the front of your neck). 26th ed. 0000020734 00000 n
Partially cystic thyroid nodules in ultrasound-guided fine needle aspiration: Prevalence of thyroid carcinoma and ultrasound features. Epub 2017 Feb 3. Every product is science-based, validated by real-world use, and personally vetted by Dr. Ruscio, DC. A thyroid nodule may be worth a closer look if its larger than 1 cm or painful, or if youre also experiencing symptoms related to hypo- or hyperthyroidism. Centanni M, Gargano L, Canettieri G, et al. [16] For more about how to use probiotics, see our Probiotics Starter Guide. Often, your doctor will use ultrasound to help guide the placement of the needle. Aliyev A, Aliyeva I, Giammarile F, Talibova N, Aliyeva G, Novruzov F. Endocrinol Diabetes Metab. The American Cancer Society medical and editorial content team. 93 0 obj
(2016). Accessed Oct. 31, 2019. 2017; doi:10.1001/jamaoto.2017.0003. Nature Reviews Endocrinology. Your provider may also discover a nodule with an imaging test done for another reason. /Subtype /Type1C
Depending on the type of thyroid nodule, it can be solid or filled with fluid, in which case its called a thyroid cyst. %PDF-1.4
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In fact, experts estimate that about half of Americans will have one by the time theyre 60 years old. Need help or would like to learn more? Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. 0
Solid nodules in your thyroid are more likely to be malignant than fluid-filled nodules, but theyre still rarely cancerous. Saccharomyces boulardii and infection due to Giardia lamblia. Your doctor will likely ask you to swallow while he or she examines your thyroid because a nodule in your thyroid gland will usually move up and down during swallowing. 2022 Oct;41(4):670-677. doi: 10.14366/usg.22059. Please do not apply any of this information without first speaking with your doctor. WebThe thyroid gland is located in the lower front of the neck, below the voicebox (larynx) and above the collarbones. The nodules were divided into the following three groups. Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-35024. 611 556 611 556 556 500 611 556 889 556 556 500 278 250 278 500 500 278 500
Thyroid. Heres how to use them alongside diet changes. (https://www.thyroid.org/thyroid-nodules-children-adolescents/), (https://www.niddk.nih.gov/health-information/diagnostic-tests/thyroid), (http://www.womenshealth.gov/publications/our-publications/fact-sheet/thyroid-disease.html), (https://www.ncbi.nlm.nih.gov/books/NBK535422/), Visitation, mask requirements and COVID-19 information. Epub 2021 Aug 23. Risk of thyroid cancer based on thyroid ultrasound findings. While thyroid nodules could be a sign of cancer, it isnt likely. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. /CharSet (/O/R/I/G/N/A/L/E/S/C/H)
Li W, Zhu Q, Jiang Y, Zhang Q, Meng Z, Sun J, Li J, Dai Q. Autonomously functioning thyroid nodules (AFTN) account for 5%-10% of thyroid nodules, For nodules with mixed composition, the cystic fluid would be Thyroid nodules are a common incidental finding on imaging (see: incidental thyroid nodules), present in ~10% of CT and MRI neck examinations, ~50% (range 20 /ExtGState << /GS2 84 0 R >>
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Accessed Dec. 6, 2019. Korean J Radiol. Methods: Bookshelf Mayo Clinic is a not-for-profit organization. Thyroid Nodules in Children and Adolescents. 4 Some investigators have Although widespread use of ultrasonography (US) has exponentially increased thyroid nodule detection to about 19.067.0%, malignancy is found in only about 9.015.0% of nodules evaluated using fine-needle aspiration (FNA) [1,2,3].To minimize potential harm from overuse of FNA, the Thyroid Imaging Reporting and Data System (TIRADS) was Disclaimer. 17 That said, there are three main reasons to pay closer attention to a thyroid nodule: Well discuss each of these possibilities. JAMA Otolaryngology Head & Neck Surgery. The changing incidence of thyroid cancer. The term hypoechoic refers to the way a nodule looks on an ultrasound, also called a sonogram. Your doctor will also look for signs and symptoms of hyperthyroidism, such as tremor, overly active reflexes, and a rapid or irregular heartbeat. Find more COVID-19 testing locations on Maryland.gov. In some cases, you may need to decrease your iodine intake by using a low-iodine diet. PMC /Encoding /WinAnsiEncoding
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There is a need to do needle. Partially cystic thyroid nodules: ultrasound findings of malignancy. 2008;27(2):215-23. They also occur more often in people who live in countries in which food isnt fortified with iodine. Dinleyici EC, Eren M, Dogan N, Reyhanioglu S, Yargic ZA, Vandenplas Y. The doctor uses a very thin needle to withdraw cells from the thyroid nodule. There is no relationship here. Krysiak R, Szkrbka W, Okopie B. /Font << /F1 43 0 R /F2 46 0 R /F3 49 0 R /F4 52 0 R /F5 55 0 R /F6 58 0 R
Sindhu KN, Sowmyanarayanan TV, Paul A, et al. Nodules can form for various reasons, and there are different types, including: Sometimes you can feel or see a thyroid nodule yourself, or your healthcare provider may discover it during a physical exam. stream
NCI CPTC Antibody Characterization Program. When more than 50% of the nodule is solid and the solid portion of the nodule is eccentric, the risk of malignancy is greater. Bookshelf /FontDescriptor 47 0 R
Thyroid But even though the vast majority of thyroid nodules are benign, some thyroid nodules do contain thyroid cancer. The site is secure. doi: 10.1097/MD.0000000000008689. Its also important to make sure you get enough iodine in your diet. 0000031624 00000 n
MeSH Among sonographic findings, eccentric placement (p = 0.007) and the presence of microcalcifications (p < 0.001) were significantly correlated with malignancy. EQ/.Hhf1 /XHeight 505
Kellerman RD, et al. 40 55
Surgery to remove the gland typically addresses the problem, and recurrences or spread of the cancer cells are both uncommon. Fine needle aspiration biopsy (FNAB) is the best way to find out whether a thyroid nodule is cancerous or benign. In: Diagnostic Ultrasound. FOIA Thyroid nodules are common, and a large proportion has mixed cystic and solid components. <<
A thyroid ultrasound provides the best information about the shape For more on how to assess and optimize your iodine, see How Should I Use Thyroid Supplements? If you notice a bump on your thyroid, its important to see your healthcare provider. /FontBBox [ -153 -250 992 986 ]
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However, over 75% of nodules found in children and adolescents are noncancerous (benign). 0000017726 00000 n
If its over 1 cm in size, it should have a needle biopsy with ultrasound Read More Created for people with ongoing healthcare needs but benefits everyone. The way that these sounds bounce back to form an image is known as echogenicity. National Library of Medicine The extra thyroxine can cause too much thyroid hormone to be produced (hyperthyroidism), leading to symptoms such as: If you have a thyroid nodule, your doctor or endocrinologist may follow up with blood tests to check your thyroid-stimulating hormone (TSH) levels for hypothyroidism or hyperthyroidism. More than 90% of detected nodules in adults are noncancerous Brophy C, Stewart J, O'Donovan N, McCarthy J, Murphy M, Sheahan P. Otolaryngol Head Neck Surg. Accessibility False-negative fine-needle aspiration (FNA) biopsy results of thyroid nodules are of particular concern because they imply missed malignant lesions. We reviewed 90 consecutive patients who underwent preoperative FNA of thyroid nodules followed by thyroid surgery during a period of 27 months, including their clinical data, type and size of thyroid nodule, FNA cytology results, and final pathology report of the surgical specimen. Several conditions can cause nodules to develop in your thyroid gland, including:Overgrowth of normal thyroid tissue. An overgrowth of normal thyroid tissue is sometimes referred to as a thyroid adenoma. Thyroid cyst. Fluid-filled cavities (cysts) in the thyroid most commonly result from degenerating thyroid adenomas. Chronic inflammation of the thyroid. Multinodular goiter. Thyroid cancer. Iodine deficiency. (2017). 0000005181 00000 n
Ultrasonography. In contrast, other studies have shown that ultrasound features such as coarse calcifications, more tall than wide, irregular borders and increased blood flow within the nodule can be helpful to identify thyroid cancer. /FontBBox [ -83 -250 1000 969 ]
Hot nodules are almost always noncancerous. Epub 2015 Sep 21. An official website of the United States government. Some are solid, and some 2022 Nov;32(11):7733-7742. doi: 10.1007/s00330-022-08827-y. Besirbellioglu BA, Ulcay A, Can M, et al. If youve been diagnosed with a thyroid nodule, its normal to feel anxious. 7. 2022 Apr-Jun;18(2):187-193. doi: 10.4183/aeb.2022.187. WebDifferent ultrasound features such as nodule size, microcalcification, solid feature (vs cystic), coarse calcifications, texture of the gland, blood flow within the nodule, the edges of the Dincer N, Balci S, Yazgan A, Guney G, Ersoy R, Cakir B, Guler G. Cytopathology. /PageLabels 37 0 R
If you smoke cigarettes, try to quit. Treatment options include: Since researchers dont know what causes the majority of thyroid nodules, you cant prevent them in most cases. 17 Thus, this may seem to indicate that not only it is unusual for a thyroid carcinoma to have a partially cystic sonographic appearance, but the risk of malignancy, in partially cystic nodule, may be low. If your entire thyroid is swollen enough to be visible, then its a goiter and may also require treatment. View Dr. Ruscios, DC additional resources. WebMixed cystic and solid hypoechoic 1.3 x 1.3 x 0.7 cm nodule with punctate echogenic foci mid left thyroid TR 4. In fact, experts estimate that about half of Americans will have one by the time theyre 60 years old. Although calcification can be seen in both benign and malignant processes, it is the ultrasound feature most closely associated with malignancy 1. endobj
If you want to put a plan together to support your thyroid health, consider taking my thyroid course or reach out to us at the Ruscio Institute. Most thyroid nodules are benign, which means they arent cancerous. 8600 Rockville Pike Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study.
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