Malignancy risk and false-negative rate of fine needle aspiration cytology in thyroid nodules ≥4.0 cm

Beştepe, Nagihan; Özdemır, Didem; Tam, Abbas Ali; Dellal, Fatma Dilek; Kılıçarslan, Aydan; Parlak, Ömer; Ersoy, Reyhan; Çakır, Bekir

doi:10.1016/j.surg.2016.03.019

“…In the present study, malignancy rate was found to be 25.6% for nodules < 1 cm, 10.2% for nodules 1-3.9 cm and 8.5% for nodules ≥ 4.0 cm, showing that the risk of malignancy decreases with increasing nodule size. We have discussed these results in our previous study (29). In summary, we have indicated that this finding might be related to the selection criteria of our study, which included an operative cohort.…”

Section: Discussionmentioning

confidence: 67%

Is thyroid nodule volume predictive for malignancy?

Beştepe¹,

Özdemır²,

Başer³

et al. 2019

Archives of Endocrinology and Metabolism

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Objective: We aimed to determine the roles of preoperative thyroid nodule diameter and volume in the prediction of malignancy. Subjects and methods: The medical records of patients who underwent thyroidectomy between January 2007 and December 2014 were reviewed. The nodule diameters were grouped as < 1 cm, 1-1.9 cm, 2-3.9 cm and ≥ 4 cm, and volume was grouped as > 5 cm 3 , 5-9.9 cm 3 and > 10 cm 3. ROC (Receiver Operating Characteristic) curve analysis was performed to find the optimal cutoff value of diameter and volume that can predict malignancy. Results: There were 5561 thyroid nodules in 2463 patients. Five hundred and forty (9.7%) nodules were < 1 cm, 2,413 (43.4%) were 1-1.9 cm, 1,600 (28.8%) were 2-3.9 cm and 1,008 (18.1%) were ≥ 4 cm. Malignancy rates were 25.6%,10.6%, 9.7% and 8.5% in nodules < 1 cm, 1-1.9 cm, 2-3.9 cm and ≥ 4 cm, respectively. When classified according to volume, 3,664 (65.9%) nodules were < 5 cm 3 , 594 (10.7%) were 5-9.9 cm 3 and 1,303 (23.4%) were ≥ 10 cm 3. The malignancy rates were 12.7%, 11.4% and 7.8% for the nodules < 5 cm 3 , 5-9.9 cm 3 and ≥ 10 cm 3 , respectively (p < 0.001). In ROC curve analysis, an optimal cutoff value for diameter or volume that can predict malignancy in all thyroid nodules or nodules ≥ 4 cm could not be determined. Conclusion: In this surgical series, malignancy risk did not increase with increasing nodule diameter or volume. Although the volume of malignant nodules ≥ 4 cm was higher than that of benign nodules ≥ 4 cm, there was no optimal cutoff value. The diameter or volume of the nodule cannot be used to predict malignancy or decide on surgical resection.

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“…In this study, there was no statistically significant difference between malignant and benign nodules size. These contradictory results show that the size of the nodule is not reliable at predicting malignancy and should not be applied for medical decision making (12,13,(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

Evaluation the Relationship Between Thyroid Nodule Size with Malignancy and Accuracy of Fine Needle Aspiration Biopsy (FNAB)

Godazandeh¹,

Kashi²,

Zargarnataj³

et al. 2016

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Introduction: Some studies have shown largest thyroid nodule size, especially ≥4cm that can predict malignancy and reduce fine needle aspiration biopsy (FNAB) accuracy. Therefore, this study is designed to evaluate relationship between thyroid nodule sizes with malignancy and its effect on FNBA accuracy. Materials and Methods: a retrospective analytical study design aims to investigate all patients Positive and negative results of FNAB in all nodules were 3.5% and 6.3%, in <4cm nodules were 5.8% and 6.2% and in ≥4cm nodules were zero and 6.7%, respectively. The sensitivity, specificity, Positive predict value (PPV), negative predict value (NPV) and overall accuracy (OA) of FNAB in all nodules were 76.19%, 96.49%, 88.88%, 91.66% and 91.02%, and in <4cm nodules were 78.57%, 94.11%, 84.61%, 91.42% and 89.58%, and in ≥4cm nodules were 71.4%, 100%, 100%, 92% and 93.33%, respectively.Conclusion: the results of this study revealed that the size of the thyroid nodules is not reliable at predicting malignancy and should not be applied in medical decision making. FNAB showed good specificity but the sensitivity was low in our study. In ≥4cm nodules; FNAB sensitivity was decreased and accompanied by higher false-negative results. Furthermore, FNABs with suspicious results were associated with high probability of malignancy.

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“…In this study, there was no statistically significant difference between malignant and benign nodules size. These contradictory results show that the size of the nodule is not reliable at predicting malignancy and should not be applied for medical decision making (12, 13, 22-24). …”

Section: Discussionmentioning

confidence: 99%

“…But, McCoy et al shown a high rate of (16%) false-negative FNABs in ≥4cm nodules and suggested that FNAB is not a reliable procedure on these patients and diagnostic lobectomy is required too (9). Bestepe et al reported the rate of false-negative FNAB in nodules ≥4.0 cm was twice as high as in nodules 1.0–3.9 cm (24). In addition, in different studies false-negative rate of FNAB has been reported between 4 and 21% (25-28); and false-positive rate of FNAB has been reported between 0 and 28% (27-29).…”

Section: Discussionmentioning

confidence: 99%

Evaluation the Relationship Between Thyroid Nodule Size with Malignancy and Accuracy of Fine Needle Aspiration Biopsy (FNAB)

Godazandeh

¹

,

Kashi

²

,

Zargarnataj

³

et al. 2016

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Introduction:Some studies have shown largest thyroid nodule size, especially ≥4cm that can predict malignancy and reduce fine needle aspiration biopsy (FNAB) accuracy. Therefore, this study is designed to evaluate relationship between thyroid nodule sizes with malignancy and its effect on FNBA accuracy.Materials and Methods:a retrospective analytical study design aims to investigate all patients with thyroid nodules who referred to surgery department of Imam-Khomeini Hospital of Mazandaran University of Medical Sciences in Sari from 20 March 2008 to 22 March 2014. We collected patient’s demographic data, nodules size, FNAB reports and final pathology (after surgery) reports from their medical records. All data were analyses performed by SPSS18.Results:167 patients (153 women) with mean age of 41.56±13.24 years old were enrolled for this study. In final pathology; 38 patients (22.8%) had malignant nodules. The mean age of patients with or without malignant nodules were 34.93±11.86 and 42.37±12.26 years old, respectively (P=0.002). The mean size of benign and malignant nodules were 2.91±1.29 cm and 3.38±1.86 cm, respectively (P=0.15). 25.2% of <4 cm nodules and 17.9% of ≥4 cm nodules were diagnosed as a malignant (P=0.29). FNAB was done on 95 patients that reported benign in 60 patients (63.2%), malignant in 18 patients (18.9%) and suspicious in 17 patients (17.9%). Positive and negative results of FNAB in all nodules were 3.5% and 6.3%, in <4cm nodules were 5.8% and 6.2% and in ≥4cm nodules were zero and 6.7%, respectively. The sensitivity, specificity, Positive predict value (PPV), negative predict value (NPV) and overall accuracy (OA) of FNAB in all nodules were 76.19%, 96.49%, 88.88%, 91.66% and 91.02%, and in <4cm nodules were 78.57%, 94.11%, 84.61%, 91.42% and 89.58%, and in ≥4cm nodules were 71.4%, 100%, 100%, 92% and 93.33%, respectively.Conclusion:the results of this study revealed that the size of the thyroid nodules is not reliable at predicting malignancy and should not be applied in medical decision making. FNAB showed good specificity but the sensitivity was low in our study. In ≥4cm nodules; FNAB sensitivity was decreased and accompanied by higher false-negative results. Furthermore, FNABs with suspicious results were associated with high probability of malignancy.

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Malignancy risk and false-negative rate of fine needle aspiration cytology in thyroid nodules ≥4.0 cm

Cited by 17 publications

References 34 publications

Is thyroid nodule volume predictive for malignancy?

Is thyroid nodule volume predictive for malignancy?

Evaluation the Relationship Between Thyroid Nodule Size with Malignancy and Accuracy of Fine Needle Aspiration Biopsy (FNAB)

Evaluation the Relationship Between Thyroid Nodule Size with Malignancy and Accuracy of Fine Needle Aspiration Biopsy (FNAB)

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