Comparison of ultrasound and fine needle aspiration biopsy in terms of determining of preoperative malignancy in thyroid nodules

To reveal the diagnostic efficacy and accuracy, compared with postoperative histopathological diagnosis, preoperative ultrasonography (US) and fine needle aspiration biopsy (FNAB) in determining benign and malignant disease in patients undergoing thyroidectomy in our clinic. Materials and methods: The research was designed with records of 95 patients who were examined thyroidectomy at our hospital Ear, Nose and Throat Clinic for five years. Preoperative ultrasound findings, FNAB results, postoperative histopathological findings, blood groups, age and sex were recorded. These data were each compared with the histopathological results in order to determine which technique was superior in distinguishing malignant from benign thyroid nodules. Ninety-five patients, aged between 21 and 76, 27 male and 68 female, were included. Mean age of male patients was 51.11±13.54 and mean age of female patients 49.18±11.92. Total thyroidectomy was performed in 82 (86.3%) cases, left lobectomy in 3 (3.2%), right lobectomy in 4 (4.2%) and total thyroidectomy plus neck dissection in 6 (6.3%). Of the cases thought to be benign at US, 76.4% were actually benign, and 83.33% of the cases thought to be malignant were actually malignant. The level of cases incorrectly identified as benign or malignant was 23.16%. Validity (test power) of US on the basis of postoperative diagnosis was 76.84%. In terms of FNAB findings, 27.78% of cases suspected of being malignant were malignant, and 72.73% of the group assessed as having benign cytology was actually benign. The level of cases incorrectly identified as being malignant or benign was 35.79%. FNAB test reliability (test power) on the basis of postoperative diagnosis was 56.1%. In addition, only US findings were significant when compared with histopathological findings in preoperative determination of malignant or benign disease (p=0.001), all other data being not significant (p˃0.05). The use of US findings in differentiating malignant from benign thyroid nodules and in accordingly planning treatment is more effective than use of FNAB.

PDF

___

Abbound B, Alam S, Chacra LA, et al. Use of fine needle aspiration cytology and frozen section in the management of nodular goiters. Head Neck. 2003;25(1):32-6.

Frates MC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of radiologist in ultrasound consensus conference statement. Radiology. 2005; 237:794-800

Ezzat S, Sarti DA, Cain DR, et al. Thyroid incidentalomas: prevalence by palpation and ultrasonography. Arch Intern Med. 1994;154(16):1838-40.

Cooper DS, Doherty GM, Haugen BR, et al. American thyroid association guidelines taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006;16:109-42.

La Rosa GL, Belfiore A, Giuffrida D, Sicurella C, Ippolito O, Russo G, Vigneri R. Evaluation of the fine needle aspiration biopsy in the preoperative selection of cold thyroid nodules. Cancer. 1991;67(8):2137-41.

Batawil N, Alkordy T. Ultrasonographic features associated with malignancy n cytologically indeterminate thyroid nodules. Eur J Surg Oncol. 2014;40(2):182-6.

apini E, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color Doppler features. J Clin Endocrinol Metab. 2002;87(5):1941-6.

Brander AE, Viikinkoski VP, Nickels JI, et al. Importance of thyroid abnormalities detected at US screening: a 5-year follow-up. Radiology 2000;215(3):801-6.

Kim EK, Park CS, Chung WY, et al. New sonographic criteria for recommending Fine Needle Aspiration Biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol. 2002;178:687-91.

Kuma K, Matsuzuka F, Yokozawa T, et al. Fate of untreated benign thyroid nodules: results of long-term follow-up. Worl J Surg. 1994;18(4):495-8.

Belfiore A, La Rosa GL, La Porta GA, et al. Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity. Am J Med. 1992;93(3):363-9.

Sahin M, Gursoy A, Tutuncu NB, et al. Prevalence and prediction of malignancy in cytologically indeterminate thyroid nodules. Clin Endocrinol (Oxf). 2006;65(4):514-8.

Porterfield JR, Grant CS, Dean DS, et al. Reliability of benign fine needle aspiration cytology of large thyroid nodules. Surgery. 2008;144(6):963-8.

Bonavita JA, Mayo J, Babb J, et al. Pattern recognition of benign nodules at ultrasound of the thyroid: which nodules can be left alone? AJR Am J Roentgenol. 2009;193(1):207-13.

Rosen IB, Azadian A, Walfish PG, et al. Ultrasound-guided fine needle aspiration biopsy in the management of thyroid disease. Am J Surg. 1993;166(4):346-9.

Alexander EK, Heering JP, Benson CB, Frates MC, Doubilet PM, Cibas ES, Marqusee E. Assessment of nondiagnostic ultrasoundguided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab. 2002;87(11):4924-7.

Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, Kim J, Kim HS, Byun JS, Lee DH; Benign and malignant thyroid nodules: US differentiation multicenter retrospective study. Radiology. 2008;247(3):762-70.

Haber RS. Role of ultrasonography in the diagnosis and management of thyroid cancer. Endocr Pract. 2000;6:396-400.

Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154(6):787803.