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Erschienen in: World Journal of Surgery 3/2012

01.03.2012

How to Manage Thyroid Nodules With Two Consecutive Non-Diagnostic Results on Ultrasonography-Guided Fine-Needle Aspiration

verfasst von: Hee Jung Moon, Jin Young Kwak, Yoon Seong Choi, Eun-Kyung Kim

Erschienen in: World Journal of Surgery | Ausgabe 3/2012

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Abstract

Background

The aim of this study was to investigate the factors for considering surgery on thyroid nodules that had non-diagnostic results on two consecutive cytology examinations.

Methods

A total of 104 thyroid nodules with two consecutive non-diagnostic cytology examinations in 104 patients were investigated. Nodules with one or more suspicious ultrasonography (US) features of marked hypoechogenicity, a not well defined margin, microcalcifications, or a taller-than-wide shape were assessed as sonographically suspicious. Those without any suspicious features were assessed as sonographically benign. The clinicopathologic characteristics of patients and US features of the nodules were compared according to malignancy and benignity. The odds ratio for predicting malignancy was calculated.

Results

Altogether, 12 nodules were malignant, and 92 were benign. Age, sex, nodule size, and solidness were not associated with malignancy (P = 0.73, 0.92, 0.48, and 0.73, respectively). The malignancy rate of sonographically suspicious nodules was 25.7%, higher than the 4.3% of sonographically benign nodules (P = 0.002). The odds ratio of sonographically suspicious nodules for predicting malignancy was 16.01 (95% confidence interval 2.36–108.54, P = 0.005).

Conclusions

Based on sonographic features, surgery can be performed selectively on nodules with two consecutive non-diagnostic cytology results.
Literatur
1.
Zurück zum Zitat Danese D, Sciacchitano S, Farsetti A et al (1998) Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid 8:15–21PubMedCrossRef Danese D, Sciacchitano S, Farsetti A et al (1998) Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid 8:15–21PubMedCrossRef
2.
Zurück zum Zitat Gharib H (1994) Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clin Proc 69:44–49PubMed Gharib H (1994) Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clin Proc 69:44–49PubMed
3.
Zurück zum Zitat Rosen IB, Azadian A, Walfish PG et al (1993) Ultrasound-guided fine-needle aspiration biopsy in the management of thyroid disease. Am J Surg 166:346–349PubMedCrossRef Rosen IB, Azadian A, Walfish PG et al (1993) Ultrasound-guided fine-needle aspiration biopsy in the management of thyroid disease. Am J Surg 166:346–349PubMedCrossRef
4.
Zurück zum Zitat Yokozawa T, Miyauchi A, Kuma K et al (1995) Accurate and simple method of diagnosing thyroid nodules the modified technique of ultrasound-guided fine needle aspiration biopsy. Thyroid 5:141–145PubMedCrossRef Yokozawa T, Miyauchi A, Kuma K et al (1995) Accurate and simple method of diagnosing thyroid nodules the modified technique of ultrasound-guided fine needle aspiration biopsy. Thyroid 5:141–145PubMedCrossRef
5.
Zurück zum Zitat Asp AA, Georgitis W, Waldron EJ et al (1987) Fine-needle aspiration of the thyroid: use in an average health care facility. Am J Med 83:489–493PubMedCrossRef Asp AA, Georgitis W, Waldron EJ et al (1987) Fine-needle aspiration of the thyroid: use in an average health care facility. Am J Med 83:489–493PubMedCrossRef
6.
Zurück zum Zitat Castro MR, Gharib H (2003) Thyroid fine-needle aspiration biopsy: progress, practice, and pitfalls. Endocr Pract 9:128–136PubMed Castro MR, Gharib H (2003) Thyroid fine-needle aspiration biopsy: progress, practice, and pitfalls. Endocr Pract 9:128–136PubMed
7.
Zurück zum Zitat Castro MR, Gharib H (2005) Continuing controversies in the management of thyroid nodules. Ann Intern Med 142:926–931PubMed Castro MR, Gharib H (2005) Continuing controversies in the management of thyroid nodules. Ann Intern Med 142:926–931PubMed
8.
Zurück zum Zitat Hamburger JI (1987) Consistency of sequential needle biopsy findings for thyroid nodules: management implications. Arch Intern Med 147:97–99PubMedCrossRef Hamburger JI (1987) Consistency of sequential needle biopsy findings for thyroid nodules: management implications. Arch Intern Med 147:97–99PubMedCrossRef
9.
Zurück zum Zitat Pepper GM, Zwickler D, Rosen Y (1989) Fine-needle aspiration biopsy of the thyroid nodule: results of a start-up project in a general teaching hospital setting. Arch Intern Med 149:594–596PubMedCrossRef Pepper GM, Zwickler D, Rosen Y (1989) Fine-needle aspiration biopsy of the thyroid nodule: results of a start-up project in a general teaching hospital setting. Arch Intern Med 149:594–596PubMedCrossRef
10.
Zurück zum Zitat Werk EE, Vernon BM, Gonzalez JJ et al (1984) Cancer in thyroid nodules: a community hospital survey. Arch Intern Med 144:474–476PubMedCrossRef Werk EE, Vernon BM, Gonzalez JJ et al (1984) Cancer in thyroid nodules: a community hospital survey. Arch Intern Med 144:474–476PubMedCrossRef
11.
Zurück zum Zitat Anonymous (1996) Guidelines of the papanicolaou society of cytopathology for the examination of fine-needle aspiration specimens from thyroid nodules: the papanicolaou society of cytopathology task force on standards of practice. Diagn Cytopathol 15:84–89CrossRef Anonymous (1996) Guidelines of the papanicolaou society of cytopathology for the examination of fine-needle aspiration specimens from thyroid nodules: the papanicolaou society of cytopathology task force on standards of practice. Diagn Cytopathol 15:84–89CrossRef
12.
Zurück zum Zitat Goellner JR, Gharib H, Grant CS et al (1987) Fine-needle aspiration cytology of the thyroid, 1980 to 1986. Acta Cytol 31:587–590PubMed Goellner JR, Gharib H, Grant CS et al (1987) Fine-needle aspiration cytology of the thyroid, 1980 to 1986. Acta Cytol 31:587–590PubMed
13.
Zurück zum Zitat Hall TL, Layfield LJ, Philippe A et al (1989) Sources of diagnostic error in fine-needle aspiration of the thyroid. Cancer 63:718–725PubMedCrossRef Hall TL, Layfield LJ, Philippe A et al (1989) Sources of diagnostic error in fine-needle aspiration of the thyroid. Cancer 63:718–725PubMedCrossRef
14.
Zurück zum Zitat Hamburger J, Hamburger SW (1991) Use of needle biopsy data in diagnosis and management of thyroid nodules. In: Cady B, Rossi RL (eds) Surgery of the thyroid and parathyroid glands, 3rd edn. Saunders, Philadelphia Hamburger J, Hamburger SW (1991) Use of needle biopsy data in diagnosis and management of thyroid nodules. In: Cady B, Rossi RL (eds) Surgery of the thyroid and parathyroid glands, 3rd edn. Saunders, Philadelphia
15.
Zurück zum Zitat McHenry CR, Walfish PG, Rosen IB (1993) Non-diagnostic fine needle aspiration biopsy: a dilemma in management of nodular thyroid disease. Am Surg 59:415–419PubMed McHenry CR, Walfish PG, Rosen IB (1993) Non-diagnostic fine needle aspiration biopsy: a dilemma in management of nodular thyroid disease. Am Surg 59:415–419PubMed
16.
Zurück zum Zitat Pitman MB, Abele J, Ali SZ et al (2008) Techniques for thyroid FNA: a synopsis of the national cancer institute thyroid fine-needle aspiration state of the science conference. Diagn Cytopathol 36:407–424PubMedCrossRef Pitman MB, Abele J, Ali SZ et al (2008) Techniques for thyroid FNA: a synopsis of the national cancer institute thyroid fine-needle aspiration state of the science conference. Diagn Cytopathol 36:407–424PubMedCrossRef
17.
Zurück zum Zitat Ylagan LR, Farkas T, Dehner LP (2004) Fine-needle aspiration of the thyroid: a cytohistologic correlation and study of discrepant cases. Thyroid 14:35–41PubMedCrossRef Ylagan LR, Farkas T, Dehner LP (2004) Fine-needle aspiration of the thyroid: a cytohistologic correlation and study of discrepant cases. Thyroid 14:35–41PubMedCrossRef
18.
Zurück zum Zitat Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214PubMedCrossRef Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214PubMedCrossRef
19.
Zurück zum Zitat Gharib H, Papini E, Paschke R et al (2010) American association of clinical endocrinologists, associazione medici endocrinologi, and European thyroid association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. J Endocrinol Invest 16:1–43 Gharib H, Papini E, Paschke R et al (2010) American association of clinical endocrinologists, associazione medici endocrinologi, and European thyroid association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. J Endocrinol Invest 16:1–43
20.
Zurück zum Zitat Kim EK, Park CS, Chung WY et al (2002) New sonographic criteria for recommending fine-needle aspiration biopsy of non-palpable solid nodules of the thyroid. AJR Am J Roentgenol 178:687–691PubMed Kim EK, Park CS, Chung WY et al (2002) New sonographic criteria for recommending fine-needle aspiration biopsy of non-palpable solid nodules of the thyroid. AJR Am J Roentgenol 178:687–691PubMed
21.
Zurück zum Zitat Moon HJ, Kwak JY, Kim MJ et al (2010) Can vascularity at power Doppler US help predict thyroid malignancy? Radiology 255:260–269PubMedCrossRef Moon HJ, Kwak JY, Kim MJ et al (2010) Can vascularity at power Doppler US help predict thyroid malignancy? Radiology 255:260–269PubMedCrossRef
22.
Zurück zum Zitat Kwak JY, Kim E, Kim HJ et al (2009) How to combine ultrasound and cytological information in decision making about thyroid nodules. Eur Radiol 19:1923–1931PubMedCrossRef Kwak JY, Kim E, Kim HJ et al (2009) How to combine ultrasound and cytological information in decision making about thyroid nodules. Eur Radiol 19:1923–1931PubMedCrossRef
23.
Zurück zum Zitat Hamburger JI, Husain M, Nishiyama R et al (1989) Increasing the accuracy of fine-needle biopsy for thyroid nodules. Arch Pathol Lab Med 113:1035–1041PubMed Hamburger JI, Husain M, Nishiyama R et al (1989) Increasing the accuracy of fine-needle biopsy for thyroid nodules. Arch Pathol Lab Med 113:1035–1041PubMed
24.
Zurück zum Zitat Alexander EK, Heering JP, Benson CB et al (2002) Assessment of non-diagnostic ultrasound-guided fine-needle aspirations of thyroid nodules. J Clin Endocrinol Metab 87:4924–4927PubMedCrossRef Alexander EK, Heering JP, Benson CB et al (2002) Assessment of non-diagnostic ultrasound-guided fine-needle aspirations of thyroid nodules. J Clin Endocrinol Metab 87:4924–4927PubMedCrossRef
25.
Zurück zum Zitat Baskin HJ (2004) Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules and multinodular goiters. Endocr Pract 10:242–245PubMed Baskin HJ (2004) Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules and multinodular goiters. Endocr Pract 10:242–245PubMed
26.
Zurück zum Zitat Chow LS, Gharib H, Goellner JR et al (2001) Non-diagnostic thyroid fine-needle aspiration cytology: management dilemmas. Thyroid 11:1147–1151PubMedCrossRef Chow LS, Gharib H, Goellner JR et al (2001) Non-diagnostic thyroid fine-needle aspiration cytology: management dilemmas. Thyroid 11:1147–1151PubMedCrossRef
27.
Zurück zum Zitat Richards ML, Bohnenblust E, Sirinek K et al (2008) Non-diagnostic thyroid fine-needle aspiration biopsies are no longer a dilemma. Am J Surg 196:398–402PubMedCrossRef Richards ML, Bohnenblust E, Sirinek K et al (2008) Non-diagnostic thyroid fine-needle aspiration biopsies are no longer a dilemma. Am J Surg 196:398–402PubMedCrossRef
28.
Zurück zum Zitat Gharib H, Goellner JR (1995) Fine-needle aspiration biopsy of thyroid nodules. Endocr Pract 1:410–417PubMed Gharib H, Goellner JR (1995) Fine-needle aspiration biopsy of thyroid nodules. Endocr Pract 1:410–417PubMed
29.
Zurück zum Zitat Kini S (2008) Thyroid cytopathology: an atlas and text. Lippincott Williams & Wilkins, Philadelphia Kini S (2008) Thyroid cytopathology: an atlas and text. Lippincott Williams & Wilkins, Philadelphia
30.
Zurück zum Zitat Bukhari MH, Niazi S, Hanif G et al (2008) An updated audit of fine-needle aspiration cytology procedure of solitary thyroid nodule. Diagn Cytopathol 36:104–112PubMedCrossRef Bukhari MH, Niazi S, Hanif G et al (2008) An updated audit of fine-needle aspiration cytology procedure of solitary thyroid nodule. Diagn Cytopathol 36:104–112PubMedCrossRef
31.
Zurück zum Zitat Cibas ES, Ali SZ (2009) The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol 132:658–665PubMedCrossRef Cibas ES, Ali SZ (2009) The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol 132:658–665PubMedCrossRef
Metadaten
Titel
How to Manage Thyroid Nodules With Two Consecutive Non-Diagnostic Results on Ultrasonography-Guided Fine-Needle Aspiration
verfasst von
Hee Jung Moon
Jin Young Kwak
Yoon Seong Choi
Eun-Kyung Kim
Publikationsdatum
01.03.2012
Verlag
Springer-Verlag
Erschienen in
World Journal of Surgery / Ausgabe 3/2012
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-011-1397-8

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