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

2002; Elsevier BV; Volume: 8; Issue: 4 Linguagem: Inglês

10.4158/ep.8.4.282

1934-2403

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

Thyroid and Parathyroid Surgery

Objective To describe our experience with fine-needle aspiration biopsy (FNAB) of the thyroid and compare our results with direct palpation versus ultrasound scanning (USS) in an area of endemic goiter in Italy. Methods We considered all patients submitted to ultrasound-guided FNAB of thyroid nodules during a 10-month period at our outpatient clinic and analyzed the following: ( 1. Mazzaferri E.L. de los Santos ET, Rofagha-Keyhani S. Solitary thyroid nodule: diagnosis and management. Med Clin North Am. 1988; : 1177-1211 Crossref PubMed Scopus (136) Google Scholar ) clinical data (number of nodules and identification of the nodule for FNAB); ( 2. Belfiore A. La Rosa G.L. La Porta G.A. et al. Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity. Am J Med. 1992; 93: 363-369 Abstract Full Text PDF PubMed Scopus (419) Google Scholar ) USS data (number of nodules and identification of the nodule for FNAB on the basis of hypoechoic pattern + blurred perinodal halo + microcalcifications or intranodal color Doppler signal indicative of blood flow); ( 3. Giuffrida D. Gharib H. Controversies in the management of cold, hot, and occult thyroid nodules. Am J Med. 1995; 99: 642-650 Abstract Full Text PDF PubMed Scopus (187) Google Scholar ) cytologic specimens, categorized as suspicious, malignant, negative, or nondiagnos-tic; and ( 4. Mortensen J.D. Woolner L.B. Bennett W.A. Gross and microscopic findings in clinically normal thyroid glands. J Clin Endocrinol Metab. 1955; 15: 1270-1280 Crossref PubMed Scopus (553) Google Scholar ) histologic final report of the cytologically positive nodules. Results The study group consisted of 348 female and 72 male patients who underwent FNAB of the thyroid at our institution. Among the 140 patients with no palpable thyroid nodules, USS showed that 106 had a single nodule and 34 had multinodular goiters. Among the 182 patients with a single palpable thyroid nodule, USS revealed that 138 had a single nodule, 42 had a multinodular goiter, and 2 had lobe enlargement without detectable nodules. All 98 patients with multinodular palpable goiter had a similar pattern on USS. Of the 420 cytologic specimens, 46 (11.0%) were positive for thyroid cancer, 313 (74.5%) were negative, and 61 (14.5%) were nondiagnostic. Histologic malignant growth was confirmed in 27 cytologically positive nodules. Of these histologically malignant nodules, 12 (45%) were nonpalpable, 9 (33%) were single palpable nodules, and 6 (22%) were from a nodule with a suspicious ultrasound pattern within a multinodular goiter. Conclusion Manually guided FNAB is not feasible in nonpalpable nodules and not accurate in a multinodular goiter. Both situations are clinical challenges, and USS should be performed for accurate FNAB under these circumstances. Because 52% of histologically malignant nodules in our study were found only with the aid of ultrasound-guided FNAB, this procedure should be used where multinodular goiter is endemic. Our overall rate of nondi-agnostic specimens was comparable to that reported in the literature. (Endocr Pract. 2002;8:282-286)