Ultrasound guided fine-needle aspiration biopsy of thyroid nodules: Guidelines and recommendations vs clinical practice; a 12-month study of 89 patients

Abstract

Introduction: Given the high prevalence of thyroid nodules in the general population it is essential to develop a method for identifying those nodules which require fine-needle aspiration biopsy (FNAB) due to suspicion for malignancy in order to avoid over-or under treatment of this disease. The ultrasound (US) criteria identified by Kim et al. and the American Association of Clinical Endocrinologists appear to be the most sensitive and most specific. The purpose of this study was to analyze a sample of patients who underwent FNAB of the thyroid and to compare the obtained data with the international guidelines and the recommendations for management of thyroid nodules. Materials and methods: This study analyzed the clinical, anamnestic and US reasons for which 97 nodules located in 89 patients underwent FNAB, and the data were compared with the criteria set by the guidelines and with the cytological results. Results: Echogenicity was indication for FNAB in 99% of cases, appearance of the margins in 75.3%, presence of calcifications in 93.8% and presence of vascularity in 73.2%. In a total of 4.1% of cases, cytological outcome was positive for malignancy, 21.6% necessitated monitoring, 4.1% were referred to surgery and histological examination of the surgical specimen and 63.9% resulted negative for malignancy. Discussion: The finding of hypoechoic nodules often leads to continued investigation; the presence of intranodular vascularization detected at Doppler US is perceived as suspicious and the presence of microcalcifications always leads to further investigation. On the request of the endocrinologist the dominant nodule in a goiter is in most cases subjected to FNAB even if the volume has not increased. Adequate US criteria can help identify potentially malignant nodules and guide implementation of FNAB. However, identification of malignant nodules using instrumental investigation cannot disregard medical records and clinical laboratory tests. According to the authors' experience, a close collaboration between endocrinologists, radiologists and pathologists is essential for a correct evaluation of patients with thyroid nodules in order to avoid over or under estimation of the risk of malignancy of a nodule and therefore of the necessity to perform further examinations.Sommario Introduzione: Data l'elevata prevalenza di noduli tiroidei nella popolazione generale è indispensabile un metodo di individuazione dei noduli sospetti per neoplasia da sottoporre an FNAB per evitare un sovra o sotto trattamento della patologia. I criteri ecografici individuati da Dizionario -Visualizza dizionario dettaglKim et al e dall'American Association of Clinical Endocrinologists risultano essere rispettivamente i più sensibili e più specifici. Lo scopo dello studio è di analizzare un campione di pazienti sottoposti a biopsia tiroidea con ago sottile (Fine-Needle Aspiration Biopsy -FNAB) e verificare quanto nella pratica clinica si faccia riferimento alle linee guida. Materiali e metodi: Sono state analizzate le motivazion...

Primary Thyroid Lymphoma Has Different Sonographic and Color Doppler Features Compared to Nodular Goiter

“…According to most clinical practice guidelines for the diagnosis and management of thyroid nodules, essential initial evaluations include measurement of serum thyrotropin levels and sonographic assessment of the thyroid 14 . The role of sonography is important for estimating the risk of malignancy of a nodule 15 . Although nearly all cases of primary thyroid lymphoma were identified as candidates for further investigation according to the Korean Society of Thyroid Radiology, American Association of Clinical Endocrinologists/Association Medici Endocrinologi/European Thyroid Association, and American Thyroid Association guidelines, 11 – 13 some of the sonographic features suggesting malignancy, such as microcalcification and marked hypoecogenicity, 16 , 17 have limited diagnostic value for identification of primary thyroid lymphoma.…”

<p>Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules &lt;10 mm in the maximum diameter: does size matter?</p>

“…Similarly, the Society of Radiologists in Ultrasound recommend performing US-FNAB on thyroid nodules that are >10 mm and when there are suspicious US features suggesting cancer 21. On the other hand, for nodules <10 mm, ATA recommends further evaluation only for patients with clinical symptoms or associated lymphadenopathy and no routine sonographic follow-up for those with very low suspicious US pattern (weak recommendation, low-quality evidence) 22. Therefore, for nodules ≤10 mm that exhibit intermediate to highly suspicious US patterns, routine US follow-ups are justifiable.…”

Malignant Tumors of Thyroid Gland

“…Úspešnosť FNAC v predoperačnej diagnostike uzlov štítnej žľazy je podľa literárnych údajov 75-95 % [26,27]. Aj v našom súbore sme zaznamenali vy-nutým uzlom štítnej žľazy.…”