Korean J Radiol.  2009 Oct;10(5):435-440. 10.3348/kjr.2009.10.5.435.

Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules Smaller Than 5 mm in the Maximum Diameter: Assessment of Efficacy and Pathological Findings

Affiliations
  • 1Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan 614-735, Korea. dwultra@lycos.co.kr
  • 2Department of General Surgery (Thyroid and Breast Clinic), Busan Paik Hospital, Inje University College of Medicine, Busan 614-735, Korea.
  • 3Department of Otorhinolaryngology-Head and Neck Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan 614-735, Korea.

Abstract


OBJECTIVE
The aim of this study was to determine the efficacy of the use of an ultrasound-guided fine-needle aspiration biopsy (US-FNAB) to diagnose thyroid nodules smaller than 5 mm in the maximum diameter and to evaluate pathological findings of small thyroid malignancies. MATERIALS AND METHODS: From May 2007 to April 2008, we evaluated the findings of US-FNABs of small thyroid nodules less than 5 mm in the maximum diameter. The cytopathological findings were retrospectively reviewed and the diagnostic performance of the use of an US-FNAB was examined in all patients. RESULTS: Of 201 small thyroid nodules in 180 patients, there were 162 adequate specimens (81%). Among 180 patients, 75 patients underwent thyroid surgery and 50 malignant and 33 benign nodules were identified based on a pathological examination. All small malignant thyroid nodules were identified as papillary thyroid microcarcinomas (PTMCs). There were 34 (55%) true positive, 0 (0%) false positive, 23 (37%) true negative and five (8%) false negative results for malignancy after performing a first US-FNAB in 62 surgically confirmed nodules. The sensitivity (87%), specificity (100%), positive predictive value (100%), negative predictive value (82%), accuracy (92%), false positive rate (0%) and false negative rate (8%) for an US-FNAB were determined. In 23 patients with a primary PTMC, capsular invasion (9%, 2 of 23), a perithyroidal lymph node metastasis (30%, 7 of 23), the rate of multifocality (9%, 2 of 23) and bilaterality (4%, 1 of 23) were also determined. CONCLUSION: An US-FNAB of thyroid nodules smaller than 5 mm in the maximum diameter is an effective diagnostic procedure.

Keyword

Thyroid, nodule; Fine-needle biopsies; Ultrasound (US); Microcarcinoma

MeSH Terms

Adolescent
Adult
Aged
*Biopsy, Fine-Needle
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Retrospective Studies
Sensitivity and Specificity
Thyroid Neoplasms/*pathology/ultrasonography
Thyroid Nodule/*pathology/ultrasonography
*Ultrasonography, Interventional

Figure

  • Fig. 1 Imaging findings are shown for solitary papillary thyroid microcarcinoma (approximately 3.0 mm in maximum diameter). A. Transverse sonogram of right lobe of thyroid shows presence of markedly hypoechoic nodule (arrow) with ill-defined margin and taller-than-wide shape. B. Transverse sonogram shows echogenic dot (arrow) within same nodule due to needle tip during US-fine needle aspiration biopsy.


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