Endocrinol Metab.  2014 Dec;29(4):545-552. 10.3803/EnM.2014.29.4.545.

The Validity of Ultrasonography-Guided Fine Needle Aspiration Biopsy in Thyroid Nodules 4 cm or Larger Depends on Ultrasonography Characteristics

• Kim JH
• Kim NK
• Oh YL
• Kim HJ
• Kim SY
• Chung JH
• Kim SW

• KMID: 2384253
• DOI: http://doi.org/10.3803/EnM.2014.29.4.545

Abstract

BACKGROUND
The objective of this study was to evaluate the validity of fine needle aspiration biopsy (FNAB) according to ultrasonography (US) characteristics in thyroid nodules 4 cm and larger.
METHODS
We retrospectively reviewed the cases of 263 patients who underwent thyroid surgery for thyroid nodules larger than 4 cm between January 2001 and December 2010.
RESULTS
The sensitivity of US-FNAB was significantly higher in nodules with calcifications (micro- or macro-) than those without (97.9% vs. 87.% P<0.05). The accuracy of US-FNAB was higher in large thyroid nodules with US features suspicious of malignancy, such as a solid component, ill-defined margin, hypoechogenicity or marked hypoechogenicity, or any calcifications (micro- or macro-) compared to thyroid nodules with none of these features. Furthermore, the accuracy improved as the number of these features increased. The overall false negative rate (FNR) was 11.9%. The FNR of thyroid nodules that appeared benign on US, such as mixed nodules (7.7%) or nodules without calcification (9.8%), trended toward being lower than that of solid nodules (17.9%) or nodules with any microcalcification or macrocalcification (33.3%). In nodules without suspicious features of malignancy, the FNR of US-FNAB was 0% (0/15).
CONCLUSION
We suggest individualized strategies for large thyroid nodules according to US features. Patients with benign FNAB can be followed in the absence of any malignant features in US. However, if patients exhibit any suspicious features, potential false negative results of FNAB should be kept in mind and surgery may be considered.

Keyword

Biopsy, fine-needle; Validity; Reliability; Ultrasonography; Thyroid nodule

MeSH Terms

Biopsy*
Biopsy, Fine-Needle*
Humans
Retrospective Studies
Thyroid Gland
Thyroid Nodule*
Ultrasonography*

Figure

• 

  Fig. 1 Malignancy rate according to ultrasonography-guided fine needle aspiration biopsy (FNAB) and ultrasonography characteristics, including component, margin, echogenicity, and calcification. SM, suspicious for malignancy; M, malignancy; Iso, isoechogenicity; Hypo, hypoechogenicity; MH, marked hypoechogenicity; Micro, microcalcification; Macro, macrocalcification.

• 

  Fig. 2 Malignancy rate according to ultrasonography-guided fine needle aspiration biopsy (FNAB) and number of ultrasonography features, including solid component, ill-defined margin, hypoechogenicity or marked hypoechogenicity, and microcalcification or macrocalcification. SM, suspicious for malignancy; M, malignancy.

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