Comparison of palpation-versus ultrasound-guided fine-needle aspiration biopsies in the evaluation of thyroid nodules

Abstract

BackgroundThe aim of this study was to compare the results of palpation-versus ultrasound-guided thyroid fine-needle aspiration (FNA) biopsies.FindingsClinical data, cytology and histopathology results were retrospectively analyzed on all patients who underwent thyroid FNA biopsy in our outpatient endocrinology clinic between January 1998 and April 2003. The same investigators performed all thyroid FNAs (ASC) and cytological evaluations (KP). Subjects in the ultrasound-guided group were older, otherwise there were no differences in baseline characteristics (gender, thyroid function, the frequency of multinodular goiter, nodule diameter and nodule location) between groups. Cytology results in nodules aspirated by palpation (n = 202) versus ultrasound guidance (n = 184) were as follows: malignant 2.0% versus 2.7% (p = 0.74), benign 69.8% versus 79.9% (p = 0.02), indeterminate 1.0% versus 4.9% (p = 0.02), inadequate 27.2% versus 12.5% (p < 0.01). Malignant results were compared with Fisher's exact test. Other cytology categories were compared with chi-square test. Eighteen patients from the palpation- and 23 from ultrasound-guided group underwent surgery. In the palpation-guided group, the sensitivity of FNA was 100%, specificity 94%, positive predictive value 67% and negative predictive value 100%. In the ultrasound-guided group, the sensitivity of FNA was 100%, specificity 80%, positive predictive value 73% and negative predictive value 100%.ConclusionWe demonstrate that ultrasound guidance for thyroid FNA significantly decreases inadequate for evaluation category. We also confirm the high sensitivity and specificity of thyroid FNA biopsy in the diagnosis of thyroid cancer. Where available, we recommend universal application of ultrasound guidance for thyroid FNA biopsy as a standard component of this diagnostic technique.

A comparative evaluation of USG-guided FNAC with conventional FNAC in the preoperative assessment of thyroid lesions: A particular reference to cyto-histologically discordant cases.

“…The causes of inadequacy may be failure to aspirate from the proper site, cystic papillary carcinoma, technical error, variable criteria adopted for adequacy in different institutions. (16) Secondly, categorising thyroid follicular lesions into benign and malignant neoplasm is very difficult by cytology. This is unavoidable as the distinction requires demonstration of capsular and vascular invasion by histology.…”

“…13 So, we included both lesions under umbrella term follicular neoplasm, according to standard guidelines. USG examination of thyroid and neck is a basic diagnostic imaging method providing information on structure of parenchyma of thyroid gland, its relationship to its surroundings and on regional lymph nodes 16 . Modern high resolution and Doppler ultrasound has allowed the definition of suspicious features over & above description as solid or cystic and these include microcalcification, the irregularity of the nodule margin and intralesional vascularity (13) .…”

Early Detection of Thyroid Gland Disorders for Students in the Faculty of Applied Medical Sciences

“…However, the presence of a cyst does not exclude neoplasia, especially if the mass is mixed. Desjardins et al found that one half of their patients with thyroid carcinoma had a cystic component in the tumor [2].…”

Pre-operative diagnosis of thyroid cancer: Clinical, radiological and pathological correlation

“…A prospective trial from Istanbul compared the accuracy of palpation vs US-FNA and found the inadequate rate was 27% vs 13% for the US-FNA group 51 . The usefulness of US-FNA has reached such acceptance that most published trials in the last few years use US-FNA exclusively regardless of whether nodules are solitary, multiple, palpable or impalpable.…”