The influence of thyroid nodule size on the diagnostic efficacy and accuracy of ultrasound guided fine-needle aspiration cytology

Aydogan B. I., Şahin M., Ceyhan K., Deniz O., Demir Ö., Emral R., ...Daha Fazla

DIAGNOSTIC CYTOPATHOLOGY, cilt.47, sa.7, ss.682-687, 2019 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 47 Sayı: 7
  • Basım Tarihi: 2019
  • Doi Numarası: 10.1002/dc.24170
  • Dergi Adı: DIAGNOSTIC CYTOPATHOLOGY
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Sayfa Sayıları: ss.682-687
  • Anahtar Kelimeler: B-mode grayscale ultrasound, fine-needle aspiration cytology, thyroid cancer, thyroid nodule size, BETHESDA SYSTEM, HASHIMOTOS-THYROIDITIS, MANAGEMENT GUIDELINES, PREDICTIVE-VALUE, 4 CM, MALIGNANCY, RISK, CANCER, CARCINOMA, BIOPSY
  • Ankara Üniversitesi Adresli: Evet

Özet

Background Diagnostic accuracy of fine-needle aspiration cytology (FNAC) in large and subcentimeter nodules is still debated. We aimed to evaluate the impact of nodule size on efficacy of the ultrasound-guided FNAC. Methods B-mode grayscale ultrasound (US), US-guided FNAC according to Bethesda system and histopathological data of 514 nodules from 371 patients, who underwent thyroidectomy were examined retrospectively. Nodules were grouped by maximal diameter; group A nodules were smaller than 10 mm (n = 59), group B nodules were between 10 and 29 mm (n = 218), and group C nodules were 30 mm or greater (n = 130). Results Sensitivity, specificity, and accuracy of FNAC was 92.0%, 100%, and 95.1% in group A, 80.7%, 99.1%, and %92.9 in group B, 70.0%, 98.9%, and 95.8% in group C nodules, respectively. The prevalence of papillary thyroid cancer (PTC) and incidental PTC were 44.2% (n = 164) and 6.4% (n = 24), respectively. Malignancy rate was more frequent in group A when compared to groups B and C (P < 0.01). Nodule size was positively associated with follicular cancer risk (P = 0.009). The thyroid stimulating hormone level was positively associated with malignancy (P = 0.02) and optimal cut-off value was 0.96 mIU/L. False-negative rate was 8.0%, 19.3%, and 30.0% in groups A, B, and C nodules, respectively. Conclusions Although the malignancy rate was low in nodules >= 30 mm, diagnostic surgery for large nodules should be considered because of decreased reliability of FNAC, ineffectiveness of clinical and sonographic criteria. False-negative rate was relatively low and malignancy rate was high in subcentimeter nodules, supporting the accuracy of FNAC.