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The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy and the sonographic differences between benign and malignant thyroid nodules 3 cm or larger

 Jung Hyun Yoon  ;  Jin Young Kwak  ;  Hee Jung Moon  ;  Min Jung Kim  ;  Eun-Kyung Kim 
 THYROID, Vol.21(9) : 993-1000, 2011 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy, Fine-Needle* ; Chi-Square Distribution ; False Negative Reactions ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Republic of Korea ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Neoplasms/diagnosis* ; Thyroid Neoplasms/diagnostic imaging ; Thyroid Neoplasms/pathology ; Thyroid Neoplasms/surgery ; Thyroid Nodule/diagnosis* ; Thyroid Nodule/diagnostic imaging ; Thyroid Nodule/pathology ; Thyroid Nodule/surgery ; Thyroidectomy ; Tumor Burden ; Ultrasonography, Interventional* ; Young Adult
BACKGROUND: Although fine-needle aspiration biopsy (FNAB) is considered the standard for preoperative evaluation of thyroid nodules, the value of this has been questioned for large thyroid nodules. Here, we evaluated the diagnostic accuracy of ultrasound-guided FNAB (US-FNAB) for thyroid nodules that were 3 cm or larger as well as the sonographic differences between benign and malignant nodules in this size group. MATERIALS AND METHODS: There were 661 thyroid masses equal to or larger than 3 cm who underwent US-FNAB from February 2002 to December 2006 and were included in this study. The cytology and surgical pathology readings in these patients were reviewed along with the ultrasonography features, the last from the retrospective review by one radiologist. Histopathology was used to calculate accuracy parameters for the US-FNAB cytology readings. In addition, the likely diagnoses for patients with a benign cytology reading were ascertained. RESULTS: Thyroid surgery was performed for 206 of the 661 nodules in the same number of patients (31.2%). All subjects who had inadequate, indeterminate, or suspicious for malignancy cytology readings had thyroid surgery. All of the patients who did not have thyroid surgery were considered likely to have benign disease because of their initial cytology reading and follow-up, and finally, 587 (88.8%) were benign and 74 (11.2%) were malignant. When considering malignant, suspicious for malignancy, and indeterminate cytology readings as positive and benign cytology as negative, the sensitivity was 96.7%, specificity 85.9%, positive predictive value 76.6%, negative predictive value 98.2%, and accuracy 89.4%. Ultrasonography features of malignancy were more prevalent in thyroid nodules that were malignant compared with those that were benign or considered likely to be benign (70.3% vs. 1.2%, p < 0.001), and ultrasonography features of a benign nodule were more prevalent in thyroid nodules that were benign or considered likely to be benign than those that were malignant (94.9% vs. 29.7%, p < 0.001). CONCLUSION: In this study, US-FNAB appeared to be a relatively accurate method to evaluate thyroid nodules larger than 3 cm, with false-negative rates of about 2%. Much larger series would be required to determine its utility in this setting.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Jin Young(곽진영) ORCID logo https://orcid.org/0000-0002-6212-1495
Kim, Min Jung(김민정) ORCID logo https://orcid.org/0000-0003-4949-1237
Kim, Eun-Kyung(김은경) ORCID logo https://orcid.org/0000-0002-3368-5013
Moon, Hee Jung(문희정) ORCID logo https://orcid.org/0000-0002-5643-5885
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