Ultrasonographic Risk Factors for Non-Diagnostic Cytology and Malignant Histopathology in Thyroid Nodules: Results of 607 Biopsies, 138 Thyroidectomies Performed by a Single Surgeon

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Mehmet İlker Turan, Nedim Akgül

Volume 9 · Issue 1 · pp. 81–86

Received: 20251224  Accepted: 20260204  Published: 20260317

Abstract

Introduction: Ultrasound-guided fine-needle aspiration biopsy (US-FNAB) is the cornerstone of thyroid nodule evaluation. Although traditionally performed by radiologists, the increasing involvement of endocrine surgeons in this procedure necessitates assessment of its effectiveness. This study aims to evaluate the diagnostic adequacy of US-FNAB performed by a single endocrine surgeon and to identify ultrasonographic risk factors associated with non-diagnostic cytology and malignancy.Materials and Methods: Data from 607 US-FNAB procedures performed by a single surgeon and histopathology of 161 nodules from 138 thyroidectomies were retrospectively reviewed. Nodule characteristics (composition, location, echogenicity, shape, margins, echogenic foci) were correlated with Bethesda cytology categories and final histopathology. Statistical analyses were performed to identify factors associated with non-diagnostic results and malignancy.Results: The non-diagnostic cytology rate was 8.73%. Anterior location was associated with reduced risk of non-diagnostic cytology (p=0.019), while peripheral calcification significantly increased this risk (p=0.0039). Malignancy rates were consistent with Bethesda categories, ranging from 13.69% (Bethesda 2) to 100% (Bethesda 6). Marked hypoechogenicity (43.08%, p

Keywords: Thyroid nodule; US-FNAB; Cytology; Malignancy; Ultrasonography

References

  1. Dhingra JK. Ultrasound-Guided Fine-Needle Biopsy of First 1000 Consecutive Thyroid Nodules: Single-Surgeon Experience. OTO Open. 2020;4(2):2473974X20929008. Crossref
  2. Ali SZ, Baloch ZW, Cochand-Priollet B, Schmitt FC, Vielh P, VanderLaan PA. The 2023 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2023;33(9):1039-1044. Crossref
  3. Bellantone R, Lombardi CP, Raffaelli M, Traini E, De Crea C, Rossi ED, et al. Management of cystic or predominantly cystic thyroid nodules: the role of ultrasound-guided fine-needle aspiration biopsy. Thyroid. 2004;14(1):43-47. Crossref
  4. Grani G, Calvanese A, Carbotta G, D'Alessandri M, Nesca A, Bianchini M, et al. Intrinsic factors affecting adequacy of thyroid nodule fine-needle aspiration cytology. Clin Endocrinol (Oxf). 2013;78(1):141-144. Crossref
  5. Fernandes VT, Magarey MJ, Kamdar DP, Freeman JL. Surgeon performed ultrasound-guided fine-needle aspirates of the thyroid: 1067 biopsies and learning curve in a teaching center. Head Neck. 2016;38(Suppl 1):E1281-E1284. Crossref
  6. Seiberling KA, Dutra JC, Gunn J. Ultrasound-guided fine needle aspiration biopsy of thyroid nodules performed in the office. Laryngoscope. 2008;118(2):228-231. Crossref
  7. Milas M, Stephen A, Berber E, Wagner K, Miskulin J, Siperstein A. Ultrasonography for the endocrine surgeon: a valuable clinical tool that enhances diagnostic and therapeutic outcomes. Surgery. 2005;138(6):1193-1200; discussion 1200-1201. Crossref
  8. Al-azawi D, Mann GB, Judson RT, Miller JA. Endocrine surgeon-performed US guided thyroid FNAC is accurate and efficient. World J Surg. 2012;36(8):1947-1952. Crossref
  9. Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017;14(5):587-595. Crossref
  10. Ljung BM, Drejet A, Chiampi N, Jeffrey J, Goodson WH 3rd, Chew K, et al. Diagnostic accuracy of fine-needle aspiration biopsy is determined by physician training in sampling technique. Cancer. 2001;93(4):263-268. Crossref
  11. Choi SH, Han KH, Yoon JH, Moon HJ, Son EJ, Youk JH, et al. Factors affecting inadequate sampling of ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf). 2011;74(6):776-782. Crossref
  12. Moon HJ, Kwak JY, Kim EK, Kim MJ. Ultrasonographic characteristics predictive of nondiagnostic results for fine-needle aspiration biopsies of thyroid nodules. Ultrasound Med Biol. 2011;37(4):549-555. Crossref
  13. Choi YS, Hong SW, Kwak JY, Moon HJ, Kim EK. Clinical and ultrasonographic findings affecting nondiagnostic results upon the second fine needle aspiration for thyroid nodules. Ann Surg Oncol. 2012;19(7):2304-2309. Crossref
  14. McIvor NP, Freeman JL, Salem S, Elden L, Noyek AM, Bedard YC. Ultrasonography and ultrasound-guided fine-needle aspiration biopsy of head and neck lesions: a surgical perspective. Laryngoscope. 1994;104(6 Pt 1):669-674. Crossref
  15. Marqusee E, Benson CB, Frates MC, Doubilet PM, Larsen PR, Cibas ES, et al. Usefulness of ultrasonography in the management of nodular thyroid disease. Ann Intern Med. 2000;133(9):696-700. Crossref
  16. Patel KN, Yip L, Lubitz CC, Grubbs EG, Miller BS, Shen W, et al. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg. 2020;271(3):e21-e93. Crossref
  17. Xia JJ, Li MS, Zheng L, Shi YZ. Nondiagnostic cytological results on ultrasound-guided fine needle aspiration: Does the thyroid nodule depth matter? Clin Hemorheol Microcirc. 2017;67(2):115-124. Crossref
  18. Alexander EK, Heering JP, Benson CB, Frates MC, Doubilet PM, Cibas ES, et al. Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab. 2002;87(11):4924-4927. Crossref
  19. Redman R, Zalaznick H, Mazzaferri EL, Massoll NA. The impact of assessing specimen adequacy and number of needle passes for fine-needle aspiration biopsy of thyroid nodules. Thyroid. 2006;16(1):55-60. Crossref
  20. Jaume JC, Chen H. Inadequate cytology of thyroid nodules. Repeat it or live with it. Indian J Surg Oncol. 2011;2(2):76-77. Crossref
  21. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133. Crossref
  22. Zhang F, Oluwo O, Castillo FB, Gangula P, Castillo M, Farag F, et al. Thyroid nodule location on ultrasonography as a predictor of malignancy. Endocr Pract. 2019;25(2):131-137. Crossref
  23. Baradaranfar M, Zand V, Meybodian M, Vaziribozorg S, Fazilati M. Investigating the possible association between thyroid nodule location and the malignancy risk of the nodules in FNA samples. Am J Otolaryngol. 2022;43(5):103589. Crossref
  24. Ramundo V, Lamartina L, Falcone R, Ciotti L, Lomonaco C, Biffoni M, et al. Is thyroid nodule location associated with malignancy risk? Ultrasonography. 2019;38(3):231-235. Crossref
  25. Ha EJ, Chung SR, Na DG, Ahn HS, Chung J, Lee JY, et al. 2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol. 2021;22(12):2094-2123. Crossref

Cite this article

Mehmet İlker Turan, Nedim Akgül. Ultrasonographic Risk Factors for Non-Diagnostic Cytology and Malignant Histopathology in Thyroid Nodules: Results of 607 Biopsies, 138 Thyroidectomies Performed by a Single Surgeon. Journal of Cukurova Anesthesia and Surgical Sciences. 9(1):81-86. https://doi.org/10.36516/jocass.1848305

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