Comparison of 1869 thyroid ultrasound-guided fine-needle aspiration biopsies between general surgeons and interventional radiologists

Abstract

BackgroundThyroid nodules are commonly encountered problems in clinical practice. For patients who have a thyroid nodule, the fine-needle aspiration biopsy (FNAB) is the most important test, as it is the most reliable diagnostic method for distinguishing between benign thyroid nodules and cancerous nodules. FNAB is able to be performed either via an ultrasound (USG) or alone and is the first choice when it comes to diagnosing thyroid nodules, given that it is cheap, safe and provides accurate results.ObjectiveIn this study-a retrospective analysis of FNAB via USG - our aim is to evaluate the multiple variables related to FNAB procedures, including the experience of the person performing the biopsy, the age and gender of the patient, the number of nodules, the size of the nodule(s) and the number of lams recorded from the cytopathology report on non-diagnostic rates, conducted at an invasive radiology clinic and at a general surgery clinic.Materials and methodsA total of 1062 patients involving 1869 nodules, examined using FNAB via USG, were reviewed retrospectively from records dated between November 2011 and July 2014 and from pathology reports taken from the ANEAH General Surgery clinic and Interventional Radiology clinic. Cytopathology results were classified according to the 2007 Bethesda System for Reporting. Gender, age, number of nodules, diameter of the nodules, biopsied nodules, location of the nodules, number of lams, symptoms and the date of biopsies were the parameters used to examine the factors involved in non-diagnostic cytopathology invasive radiology. These parameters were inspected at both of the clinics (ANEAH General Surgery clinic and Interventional Radiology clinic). In analyzing the results, the statistical significance level was set at 0.05, where in cases that the p value was under 0.05 (p < 0.05), it was determined that no significant relationship existed. In this study, data were analyzed using SPSS 20 software.ResultsOf the nodules reviewed, 1620 were found on females and 249 on males. The age of the patients ranged from 10 to 87 years, with the mean age being 50 years. In the general surgery clinic, 470 nodules of 341 patients were aspirated, and in the interventional radiological clinic, 1399 nodules of 721 patients were aspirated. In the literature review conducted to compare statistical assessments of FNAB via USG, no significant difference was found between the ANEAH General Surgery clinic and the Invasive Radiology clinic (p > 0.05). In the invasive radiology clinic, non-diagnostic rates decreased with the increase in experience of the person who conducted the biopsy (p = 0.001).ConclusionThe results from both of the clinic's rates of non-diagnostic FNAB, performed via USG, were found to be acceptable. Our study also demonstrates that USG-guided FNAB can be performed with a low non-diagnostic rate as experience grows.

Can We Improve Thyroid Fine-needle Aspiration Cytology Adequacy in a Low-volume Thyroid Center?

“…28 Hilmi Bozkurt et al reported that US-guided FNAC can be performed with a low non-diagnostic rate as experience grows. 31 The following limitations were inherent in this study and may have biased the results. The first audit cycle demonstrated a very high rate of insufficiency in thyroid FNAC (higher than that reported in the literature) (see Figure 2).…”

Interventional radiology of the thyroid gland: critical review and state of the art

“…Today, FNAB represents the gold standard for the diagnosis of the nature of thyroid nodules due to its safety, reliability, low costs and high tolerability by the patients (3,20). According to the newly reviewed guidelines for thyroid nodules (<5 mm), US monitoring is always recommended.…”

“…Exclusion criteria include presence of hot nodules on scintigraphy and/or patients with severe coagulation disorders. US guidance makes FNAB safer and is now considered mandatory, allowing real-time control of the tip of the needle when approaching the target areas avoiding the vascular structures (1,3,(21)(22)(23). Five cytologic diagnostic categories are considered for the diagnosis of thyroid nodules (1): nondiagnostic, benign, indeterminate, suspicious for malignancy, and malignant.…”

“…Low rates of complications are described in literature, when the procedure is performed by expert operators, and include bleeding with risk of cervical hematoma, local infections and vasovagal syncope. Proper use of antiseptics, US assistance (for identification of intra and extra-gland vascular structures) and the manual compression of the entry site may help reduce the likelihood of complications (3,(24)(25)(26)(27)(28)(29). Still controversial is the use of antithrombotic agents to reduce the risk of post-procedural bleeding.…”

“…Palpable thyroid nodules are found in about 5% of world population in non-endemic areas with right iodine supplement, with a higher correlation with sex (prevalence in women), age, abnormal intake of iodine and ionizing radiation exposure (1)(2)(3). Thyroid nodules are a common incidental finding during routinely ultrasound (US) exams unrelated to thyroid gland in the healthy adult population with a prevalence of 20-76%.…”