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Initially non-diagnostic ultrasound-guided fine needle aspiration cytology of thyroid nodules: value and management.

 Jin Chung  ;  Ji Hyun Youk  ;  Jeong-Ah Kim  ;  Jin Young Kwak  ;  Eun-kyung Kim  ;  Young Hoon Ryu  ;  Eun Ju Son 
 ACTA RADIOLOGICA, Vol.53(2) : 168-173, 2012 
Journal Title
Issue Date
Biopsy, Fine-Needle ; Cytodiagnosis/methods* ; Diagnosis, Differential ; Disease Management ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Predictive Value of Tests ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland/pathology ; Thyroid Nodule/diagnostic imaging* ; Thyroid Nodule/epidemiology ; Thyroid Nodule/pathology* ; Ultrasonography, Interventional/methods*
Thyroid ; fine needle aspiration cytology ; sonography ; thyroid cancer
BACKGROUND: Ultrasound (US)-guided fine needle aspiration cytology (FNAC) is an accurate, reliable, and simple method to identify a thyroid nodule as benign or malignant. However, non-diagnostic cytology results for thyroid nodules are a major limitation of US-guided FNAC. PURPOSE: To investigate the incidence of thyroid cancer among cases with non-diagnostic results on FNAC and to provide suggestions for the management of thyroid nodules that are initially non-diagnostic by FNAC according to ultrasonographic findings. MATERIAL AND METHODS: From July 2006 to December 2009, 10,317 thyroid nodules in 6684 consecutive patients underwent US-guided FNAC at our institute. Among these, 871 thyroid nodules (8.4%) were diagnosed as non-diagnostic on initial cytologic evaluation and 196 underwent a second or third FNAC. Twenty-seven thyroid nodules (18.9%) underwent surgery, while 116 thyroid nodules were cytologically confirmed as benign with no remarkable change on follow-up US were included. We retrospectively reviewed the US findings for a total of 143 thyroid nodules (123 benign nodules and 20 malignant nodules). The US features that we compared included composition, echogenicity, margin, calcifications, shape, and underlying echogenicity. RESULTS: In total, thyroid cancer was diagnosed in 20 nodules (14.0%). The size of the nodule was significantly associated with malignancy (P < 0.05). Most of the sonographically probable benign nodules were found to be benign (97.6%). Suspicious nodules on US were thyroid cancer in 43.2% of cases. Marked hypoechogenicity, microlobulated or irregular margin, microcalcifications, and taller-than-wide shape were significant US findings that correlated with malignancy (P < 0.05). The diagnostic performance of ultrasound for initially non-diagnostic thyroid nodules was as follows: sensitivity of 90.0%, specificity of 65.0%, positive predictive value of 29.5%, and negative predictive value of 97.6%. CONCLUSION: In terms of management of thyroid nodules with non-diagnostic FNAC cytology, US evaluation is a feasible and useful method for predicting malignancy.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Jin Young(곽진영) ORCID logo https://orcid.org/0000-0002-6212-1495
Kim, Eun-Kyung(김은경) ORCID logo https://orcid.org/0000-0002-3368-5013
Kim, Jeong Ah(김정아) ORCID logo https://orcid.org/0000-0003-4949-4913
Son, Eun Ju(손은주) ORCID logo https://orcid.org/0000-0002-7895-0335
Ryu, Young Hoon(유영훈) ORCID logo https://orcid.org/0000-0002-9000-5563
Youk, Ji Hyun(육지현) ORCID logo https://orcid.org/0000-0002-7787-780X
Chung, Jin(정진)
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