Effect of nodule size on the reliability of fine-needle aspiration biopsy in thyroid nodules

Uçar, Ali Erkan; Sarikaya, Seyyit Muhsin; Parlak, Ömer; Yalçın, Abdussamed

doi:10.3906/sag-1312-56

Cited by 7 publications

(4 citation statements)

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“…Some authors have suggested that the nodule dimension strongly influences the reliability of FNAB results. Ucar et al [ 35 ] have reported that the false-negative rate of FNAB is higher for the larger nodules than for minor ones. They have concluded that this diagnostic evaluation is significant in the case of positive FNAB results for malignancy; however, it is not very reliable in the case of negative (benign) results.…”

Section: Discussionmentioning

confidence: 99%

Fine-Needle Aspiration Biopsy as a Preoperative Procedure in Patients with Malignancy in Solitary and Multiple Thyroid Nodules

et al. 2016

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BackgroundFine-needle aspiration biopsy (FNAB) is a recognized technique for the basic, preoperative cytological diagnosis of thyroid nodules.Aim of the StudyTo analyze the accuracy of FNAB in the diagnosis of thyroid cancer in patients with solitary and multiple thyroid nodules and to compare the demographic, clinical and pathological characteristics of patients with thyroid carcinoma in solitary and multiple tumors.Materials and MethodsThe case records of 2,403 patients with solitary and multiple thyroid tumors treated consecutively between 2008 and 2013 were analyzed retrospectively. We selected 1,645 for further analysis. A solitary thyroid nodule was observed in 493 patients, and multiple nodules were detected in 1,152 patients. Further classification of the patients in these two groups was performed on the basis of the FNAB results, type of surgery performed and histopathology. TC was histopathologically confirmed in 166 patients, and benign disease was found in 1,479. The TC patients were assigned to the study group, and those with benign thyroid disease were placed into the control group. The study group was divided into two subgroups according to the presence of cancer in a single thyroid nodule or in multiple nodules. Malignancy in a solitary thyroid nodule was diagnosed in 98 (59.0%) patients, and cancer in multiple nodules was diagnosed in 68 (41.0%). Comparative analyses of the demographic, clinical and histopathological characteristics were performed for both subgroups. The following statistical analyses were performed: comparative characteristic of subgroups, ROC analysis for study group and subgroup of patients, and multivariable logistic regression analysis for study group.ResultsThe rate of prediction of TC by FNAB was three times higher in the patients with a solitary thyroid nodule compared with those with multiple thyroid nodules and it was statistically significant (p<0.001). The rate of total thyroid resection and lack of necessity for reoperation were also significantly higher in the TC patients with a solitary nodule. The histopathological results showed that significantly more patients with a solitary nodule had advanced-stage TC (stage III or IV) and tumor progression (pT3 or pT4) (p = 0.002 for both). ROC analysis demonstrated that the overall accuracy of FNAB as a predictor of thyroid cancer presence was high, especially for the subgroup of patients with a solitary thyroid nodule (AUC = 0.958, p<0.0001). Multivariable logistic regression analysis confirmed that a positive FNAB result was the sole predictor of the performance of total resection in the TC study group (p<0.0001), while a negative FNAB result and the presence of a papillary cancer type were independent predictors of the risk of reoperation (p<0.0001 and p = 0.002, respectively).ConclusionsFNAB often produces false-negative results in patients with multiple malignant thyroid tumors, which results in reoperation in many cases. False-negative FNAB results are rare in patients with a solitary tumor. Because of the low predict...

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Section: Discussionmentioning

confidence: 99%

Fine-Needle Aspiration Biopsy as a Preoperative Procedure in Patients with Malignancy in Solitary and Multiple Thyroid Nodules

et al. 2016

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“…Dong et al 29 found that smaller nodules (5 mm) are more often the cause of FPs than large nodules (>20 mm), which in turn are a source of increased false‐negative rates. Uçar et al 30 also found that the rate of FPs in cytology is increased in larger nodules (>30 mm). Zhong et al 31 however, demonstrated in their series that nodule size does not influence the diagnostic accuracy of thyroid FNA.…”

Section: Discussionmentioning

confidence: 92%

False positive cases in thyroid cytopathology – the experience of a single laboratory and a systematic review

et al. 2021

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Introduction Fine needle aspiration (FNA) is fundamental in the pre‐operative assessment of thyroid nodules. However, the shining success of thyroid FNA is occasionally eclipsed by false positive (FP) cytological diagnoses. We describe our experience regarding FP cytological diagnoses and present a literature review concerning FP rates. Materials and methods We retrospectively analyzed 2031 consecutive cytology reports. FP was defined as a case with “suspicious for malignancy” or “malignant” cytology, whose surgical follow‐up failed to confirm the initial diagnosis of malignancy. We used the PubMed database for the literature review using specific search terms (“thyroid”, “cytology”, “false positive”). Results Out of 2031 FNA reports, 93 cases with “suspicious for malignancy” or “malignant” cytology underwent surgical excision. Histopathology did not confirm malignancy in 10 cases (0.6% FP rate). Nodules with FP cytology were significantly larger (P = 0.0024) than those with with TP (true positive) cytology. A review of 25 publications shows comparable results to ours with some slight differences. The majority of studies achieve a FP rate below 3%. Most FP cytological diagnoses turn out to be non‐neoplastic lesions (nodular hyperplasia, adenomatous nodule, lymphocytic thyroiditis), which combined account for 80.5% of all histological diagnoses. Conclusions Thyroid nodules with FP cytology were larger than nodules with TP cytology. Most studies manage to adhere to the recommended FP rates, or values close to them, with some outliers. Nevertheless, the mean FP rate values are very close to the value recommended by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The FP rate value depends on how one defines true negative cases, which can be either histologically proven benign cases, via a benign clinical course, or by assuming that cytologically benign cases remain as such.

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“…It has good sensitivity and specificity and has contributed significantly to the reduction of unnecessary surgeries, especially with the introduction of the US to guide the procedure (35)(36)(37). Although FNAB is an excellent diagnostic tool for TNs, some researchers believe the procedure has limitations, as it presents a high rate of false negatives, especially in nodules with diameters ≥ 3-4 cm (38,39). This subject has been widely discussed in the literature, but no consensus has been reached (40).…”

Section: Discussionmentioning

confidence: 99%

Risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy in thyroid nodules with diameters greater than 4 centimeters

Barcelos¹,

Camacho²,

Mamone³

et al. 2023

Archives of Endocrinology and Metabolism

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Objective: The risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy (FNAB) of thyroid nodules (TN) with diameters ≥ 3-4 cm remains controversial. However, some groups have indicated surgical treatment in these patients regardless of the FNAB results. We aimed to evaluate the diagnostic accuracy of the FNAB in systematically resected ≥4 cm TN and if the risk of malignancy is higher in these patients. Subjects and methods: We retrospectively evaluated 138 patients (142 nodules) with TN with diameters ≥4 cm who underwent thyroidectomy. Results: The FNAB results were nondiagnostic/unsatisfactory (ND/UNS) in 2.1% of the cases and benign in 51.4%. They indicated atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 23.9% of cases, follicular neoplasia/suspicious for a follicular neoplasm (FN/SFN) in 9.2%, suspicion of malignancy (SUS) in 8.5%, and malignant in 4.9%. The histopathological analysis after thyroidectomy revealed a thyroid cancer rate of 100% in the FNABs classified as malignant, 33.3% in SUS cases, 7.7% in FN/SFN, 17.6% in AUS/FLUS, and 4.1% in benign FNABs. None of the ND/UNS FNABs were malignant. The global malignancy diagnosis was 14.8% (n = 21). However, the rate of false negatives for FNAB was low (4.1%). Conclusion: We showed that the risk of malignancy in nodules with diameters ≥4 cm was higher compared to the risk of thyroid cancer in TN in general. However, we found a low rate of false-negative cytological results; therefore, our data do not justify the orientation of routine resection for these larger nodules.

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Effect of nodule size on the reliability of fine-needle aspiration biopsy in thyroid nodules

Cited by 7 publications

References 32 publications

Fine-Needle Aspiration Biopsy as a Preoperative Procedure in Patients with Malignancy in Solitary and Multiple Thyroid Nodules

Fine-Needle Aspiration Biopsy as a Preoperative Procedure in Patients with Malignancy in Solitary and Multiple Thyroid Nodules

False positive cases in thyroid cytopathology – the experience of a single laboratory and a systematic review

Risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy in thyroid nodules with diameters greater than 4 centimeters

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