How to combine ultrasound and cytological information in decision making about thyroid nodules

Abstract

The purpose of this study was to evaluate the role of sonographic-cytological correlation in determining which nodules should be reaspirated to reduce the false-negative rate of fine-needle aspiration biopsy (FNAB). A retrospective cohort study was performed on a database of 568 patients with 672 focal thyroid nodules. An independent two-sample t-test was used to compare the risk of malignancy according to clinical factors. We evaluated the risk stratification of malignancy according to US groupings and cytological results. Additionally, we calculated the false-negative rate of FNAB and investigated the cytological results of repeat aspiration. The malignancy rate (92.2-98.5%) was high in thyroid nodules designated "malignant" or "suspicious for papillary carcinoma" on FNAB, regardless of US features. In contrast, when focal thyroid nodules had "benign" readings on FNAB, the malignancy rate was lower for the "probably benign" US features (2.9%) than for the suspicious nodules (56.6%). The false-negative rate of FNAB was 5.8%. Repeat aspiration revealed "suspicious for malignancy" or "malignancy" results in 15 (93.8%) of 16 thyroid cancers with "benign" results on initial aspirate. This study demonstrated repeat FNAB should be performed on focal thyroid nodules with suspicious US features even when initial FNAB results are benign.

American Association Of Clinical Endocrinologists, Associazione Medici Endocrinologi, And European Thyroid Association Medical Guidelines For Clinical Practice For The Diagnosis And Management Of Thyroid Nodules

“…A routine repeated FNA biopsy may be considered in patients with initially benign cytologic results because of the low, but not negligible, possibility of falsenegative results (119). Reaspiration under US guidance is recommended if a nodule significantly enlarges, if a cyst reappears, or in case of suspicious clinical or US changes (8,112).…”

“…US features and US elastography may provide adjunctive information for assessing the risk of malignancy in cases with follicular cytologic characteristics. However, the specificity and reproducibility of these tools are limited (52,112).…”

“…It is important to verify that the symptoms are associated with the nodule or goiter and not with other disease processes, such as pulmonary or cardiac disease, esophageal disorders, or other head, neck, or lung tumors (8). If a thyroid nodule shows a significant increase in volume or a change in its US features, despite benign FNA biopsy results, surgical resection should be considered (112).…”

“…Clinical management of thyroid nodules should be guided by the results of US evaluation and FNA biopsy (8,112) (Figs. 1 and 2).…”

Modern approach for the treatment of multinodular non-toxic goiter

“…По данным литературы, сов ременные методы диагностики УЗИ и прицельная ТАБ позволяют в 80-90% случаев и более на доопе рационном этапе поставить диагноз и определить тактику лечения. Чувствительность ТАБ под УЗ контролем достигает 94%, а специфичность -100% [51,68]. Тем не менее большинство клинических рекомендаций указывают на то, что УЗИ ЩЖ в об щей популяции не является скрининговым мето дом.…”