Which thyroid nodules should biopsy be performed: a comparison of three recommendations from the literature

Abstract

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[영문]

Purpose: To compare the results of three guidelines for fine needle aspiration biopsy (FNAB) of thyroid nodules.Materials and Methods: A total of 1398 nodules, confirmed by FNAB or surgery, were included. We compared the diagnostic performance of several guidelines: 1) Kim’s Criteria: a nodule with at least one of the following findings: marked hypoechogenicity, irregular or microlobulated margin, microcalcifications, or taller than wide shape; 2) the Society of Radiologists in Ultrasound (SRU): a nodule ≥ 1 cm with microcalcifications, a nodule ≥ 1.5 cm which is solid or has coarse calcifications, or a nodule ≥ 2 cm with a solid component; 3) American Association of Clinical Endocrinologists (AACE): a hypoechoic nodule with at least one additional feature such as irregular margins, taller than wide shape, or microcalcifications. The diagnostic value of these criteria was assessed.Results: For all nodules, the diagnostic accuracy of Kim’s criteria (0.868) and AACE (0.85) were more superior to that of SRU (0.551). Number of performing FNAB was lowest in AACE criteria (25.6%), whereas the number of missed malignancy was lowest in Kim’s criteria (7.3%). When considering nodules larger than 1 cm, the results did not change. Conclusions: Kim’s criteria and AACE criteria are more accurate than SRU criteria. AACE’s guideline is recommended to achieve high specificity, whereas Kim’s criteria may be chosen for its higher sensitivity.