Fine-Needle Aspiration Biopsy of the Thyroid: Comparison Between Thyroid Palpation and Ultrasonography

Deandrea, Maurilio; Mormile, Alberto; Veglio, M; Motta, Manuela; Pellerito, R.; Gallone, G.; Grassi, Aurora; Torchio, Bruno; R, Bradac; Garberoglio, R; D, Fonzo

doi:10.4158/ep.8.4.282

Cited by 65 publications

(42 citation statements)

References 19 publications

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“…The overall percentage of malignancy in our series is lower (4.6%) than previously reported in studies of smaller size (32,33) but similar to that observed in recent study by Lin et al (31) in a very large series of more than 20 000 patients (3.6%). Accordingly, it is highly unlikely that a relevant number of malignant nodules have not been identified in our study.…”

Section: Discussionsupporting

confidence: 90%

Thyroid nodule shape suggests malignancy

Cappelli¹,

Castellano²,

Pirola³

et al. 2006

eur j endocrinol

184

146

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Objective: To evaluate if a nodule with shape taller than wide (anteroposterior/transverse diameter ratio, A/TR1) is a good predictor of malignancy independent of the size. Methods: We retrospectively examined the cytological and histological results of 7455 nodules (5198 patients) referred for ultrasound-guided-fine needle aspiration cytology (US-FNAC) in our hospital from January 1991 to September 2004. Results: A suitable FNAC was obtained from 6135 nodules (4495 patients); 34.6% were less than 1 cm in diameter (small nodules, SN). A diagnosis of carcinoma was histologically confirmed in 284/349 suspicious lesions after FNAC. The size of carcinoma nodules was not significantly associated with the occurrence of extracapsular growth (large nodules (LN): 10.5%, SN: 4.9%, NS) and lymph node metastasis (LN: 23.6%, SN: 25.0%, NS). Malignant lesions showed microcalcifications more frequently than benign nodules (72.2 vs 28.7%; P!0.001; (odds ratio, OR(confidence intervals, CI)Z9.9(7.2-13.4)). Similarly, A/TR1 (76 vs 40%; P!0.001; OR(CI)Z8.6(5.5-13.1)), blurred margins (52.8 vs 18.8%; P!0.001; OR(CI)Z7.7(5.6-10.2)), solid hypo-echoic appearance (80.6 vs 52.4%; P!0.001; OR(CI)Z 3.2(2.2-4.3)) and intranodular vascular pattern (type 2) (61.6 vs 49.7%; P!0.001; OR(CI)Z 1.7(1.3-2.3)) were significantly more frequent in malignant than in benign nodules. Conclusions: Our data show that no single parameter, including nodule size, satisfactorily identifies a subset of patients to be electively investigated by FNAC. We concluded that A/TR1 with at least two of US features (microcalcification, blurred margins, hypo-echoic pattern) is today the best compromise between missing cancers and cost-benefit.

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Section: Discussionsupporting

confidence: 90%

Thyroid nodule shape suggests malignancy

Cappelli¹,

Castellano²,

Pirola³

et al. 2006

eur j endocrinol

184

146

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“…43,44 Specific ultrasound findings, such as irregular margins, microcalcifications, and intranodular vascularity, can identify nodules at increased risk for malignancy and aid in the interpretation of FNA results. 3,46,47 Despite the potential advantages of ultrasound-guided FNA, palpation-guided FNA has been performed on many patients with a high level of success. 9,40,42,48 In addition, palpation-guided FNA is less costly and more convenient compared with ultrasound-guided FNA, and palpation-guided FNA is preferred in areas of the world where health care resources are limited.…”

Section: Indications For Performing An Fna Of a Thyroid Nodulementioning

confidence: 99%

“…Sonographic evaluation is often helpful, because physical examination may be imprecise in determining nodule size and location, confirming its origin within the thyroid rather than in adjacent tissues. [45][46][47][48][49] Thyroid glands that are enlarged because of diffuse or asymmetrical goiter without a discrete nodule on physical examination are suboptimal targets for palpation-guided FNA. Ultrasound guidance is preferred to and appears to be more sensitive 45,46,[49][50][51] than palpation-guided FNA for poorly palpable nodules, those that are predominately cystic (Ͼ25%), [48][49][50][51] small nodules Ͻ1 cm, and when a prior FNA was nondiagnostic.…”

Section: Indications For Performing An Fna Of a Thyroid Nodulementioning

confidence: 99%

Thyroid Aspiration Cytology: Current Status

Layfield¹,

Cibas²,

Gharib³

et al. 2009

CA: A Cancer Journal for Clinicians

154

115

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In the adult population, thyroid nodules are common and are increasingly detected by ultrasound examination or other scanning techniques. Depending on their size and ultrasonographic features, these nodules may require further investigation, including tissue diagnosis. Fine-needle aspiration (FNA) has become the predominant method to obtain tissue for microscopic analysis. In October 2007, the National Cancer Institute sponsored a conference to review the state of the science for the use of FNA in the management of thyroid nodules. This conference reviewed indications for thyroid FNA and pre-FNA requirements, training and credentialing, techniques for thyroid FNA, diagnostic terminology and morphologic criteria, utilization of ancillary studies, and post-FNA testing and treatment options. The results of those discussions have been published in both print and electronic versions. The aim of the current article was to discuss indications for FNA, diagnostic terminology, and post-FNA options, issues that are important to physicians who are managing patients with thyroid nodules. CA Cancer J Clin 2009;59: 99-110.

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“…Finally, in recent years tru-cut biopsy offers a higher diagnostic efficacy without important adverse effects and no reported cases of malignant seeding, 41 showing a sensitivity as high as 98% and specificity of 100%. The procedure involves the use of an 18G tru-cut needle usually performed under ultrasound guidance after application of local anaesthesia.…”

Section: Ultrasonographymentioning

confidence: 99%