Comparative analysis of accuracy between fine-needle aspiration biopsy and postoperative histopathology for detecting large thyroid nodules: A retrospective observational study

To avoid unnecessary surgeries, ultrasound-guided fine-needle aspiration biopsy (FNAB) is an effective and reliable procedure for the preoperative evaluation of thyroid nodules. However, there have been only a limited number of studies exploring the ability of preoperative FNAB to distinguish malignancy compared to postoperative histopathology in thyroid nodules larger than 4 cm. The aim of this study was to investigate the diagnostic accuracy of FNAB compared to postoperative histopathology in distinguishing malignancy in thyroid nodules larger than 4 cm. A single-center retrospective observational study was conducted at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, between January 2014 and December 2018. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. A total of 83 patients were included in the study. The results showed that preoperative FNAB may have the ability to distinguish malignancy compared to postoperative histopathology. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 42.85%, 98.38%, 90.00%, 83.56%, and 84.33%, respectively. These data suggested that ultrasound-guided preoperative FNAB is a reliable diagnostic tool in the preoperative evaluation of thyroid nodules larger than 4 cm, but it has limited capability in distinguishing malignancies. In conclusion, although FNAB may be useful in reducing unnecessary surgeries, histopathology remains the preferred method for confirming malignancy in thyroid nodules.

[1]  A. Theodoropoulou,et al.  The 2017 bethesda system for reporting thyroid cytopathology: the experience of a tertiary center , 2023, Endocrine Abstracts.

[2]  E. J. Ha,et al.  Standardized Imaging and Reporting for Thyroid Ultrasound: Korean Society of Thyroid Radiology Consensus Statement and Recommendation , 2023, Korean journal of radiology.

[3]  G. Cansu,et al.  Cytopathology-histopathology correlation and the effect of nodule diameter on diagnostic performance in patients undergoing thyroid fine-needle aspiration biopsy , 2020, Journal of cancer research and therapeutics.

[4]  L. Pantanowitz,et al.  Is thyroid core needle biopsy a valid compliment to fine-needle aspiration? , 2020, Journal of the American Society of Cytopathology.

[5]  S. Hahn,et al.  Comparison Between Fine Needle Aspiration and Core Needle Biopsy for the Diagnosis of Thyroid Nodules: Effective Indications According to US Findings , 2020, Scientific Reports.

[6]  M. Akçay,et al.  Malignancy risk for thyroid nodules larger than 4 cm and diagnostic reliability of ultrasound-guided FNAB results. , 2019, Turkish journal of surgery.

[7]  E. Cibas,et al.  The 2017 Bethesda System for Reporting Thyroid Cytopathology. , 2017, Journal of the American Society of Cytopathology.

[8]  U. Megwalu.  Risk of Malignancy in Thyroid Nodules 4 cm or Larger , 2017, Endocrinology and metabolism.

[9]  Z. Kashi,et al.  Evaluation the Relationship Between Thyroid Nodule Size with Malignancy and Accuracy of Fine Needle Aspiration Biopsy (FNAB) , 2016, Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH.

[10]  H. Min,et al.  Does Tumor Size Influence the Diagnostic Accuracy of Ultrasound-Guided Fine-Needle Aspiration Cytology for Thyroid Nodules? , 2016, International journal of endocrinology.

[11]  R. Ersoy,et al.  Malignancy risk and false-negative rate of fine needle aspiration cytology in thyroid nodules ≥4.0 cm. , 2016, Surgery.

[12]  R. Ersoy,et al.  Malignancy risk and false negative rate of fine needle aspiration cytology in thyroid nodules equal or greater than 4 cm , 2016 .

[13]  Roger Kulstad.  DO ALL THYROID NODULES >4 CM NEED TO BE REMOVED? AN EVALUATION OF THYROID FINE-NEEDLE ASPIRATION BIOPSY IN LARGE THYROID NODULES. , 2016, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[14]  Jin Hwa Kim,et al.  The Validity of Ultrasonography-Guided Fine Needle Aspiration Biopsy in Thyroid Nodules 4 cm or Larger Depends on Ultrasonography Characteristics , 2014, Endocrinology and metabolism.

[15]  M. Tublin,et al.  Thyroid Nodules (≥4 cm): Can Ultrasound and Cytology Reliably Exclude Cancer? , 2014, World Journal of Surgery.

[16]  V. Montori,et al.  Prevalence of thyroid cancer in multinodular goiter versus single nodule: a systematic review and meta-analysis. , 2013, Thyroid : official journal of the American Thyroid Association.

[17]  A. Tuthill,et al.  False negatives in thyroid cytology: Impact of large nodule size and follicular variant of papillary carcinoma , 2013, The Laryngoscope.

[18]  B. Crothers,et al.  The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-needle aspiration: a 10-year study from a single institution. , 2012, Thyroid : official journal of the American Thyroid Association.

[19]  N. Ezzat,et al.  Diagnostic accuracy of fine needle aspiration cytology in thyroid lesions. , 2012, Journal of the Egyptian National Cancer Institute.

[20]  M. Henry,et al.  Correlation of thyroid nodule fine‐needle aspiration cytology with corresponding histology at Mayo Clinic, 2001–2007: An institutional experience of 1,945 cases , 2012, Diagnostic cytopathology.

[21]  J. Lew,et al.  Reliability of fine-needle aspiration for thyroid nodules greater than or equal to 4 cm. , 2012, The Journal of surgical research.

[22]  A. Renshaw.  Sensitivity of fine‐needle aspiration for papillary carcinoma of the thyroid correlates with tumor size , 2011, Diagnostic cytopathology.

[23]  B. Kuru,et al.  The false-negative rate of fine-needle aspiration cytology for diagnosing thyroid carcinoma in thyroid nodules , 2010, Langenbeck's Archives of Surgery.

[24]  S. Purisch,et al.  Low false-negative rate of cytology in thyroid nodules >or= 4 cm. , 2009, Arquivos brasileiros de endocrinologia e metabologia.

[25]  S. Uğraş,et al.  Ultrasonographic evaluation of thyroid nodules: comparison of ultrasonographic, cytological, and histopathological findings , 2009, Endocrine.

[26]  Herb Chen,et al.  Accuracy of fine-needle aspiration biopsy for predicting neoplasm or carcinoma in thyroid nodules 4 cm or larger. , 2009, Archives of surgery.

[27]  S. Carty,et al.  The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. , 2007, Surgery.

[28]  Jack Yang,et al.  Fine‐needle aspiration of thyroid nodules: A study of 4703 patients with histologic and clinical correlations , 2007, Cancer.

[29]  O. Clark,et al.  False-negative fine-needle aspiration cytology results delay treatment and adversely affect outcome in patients with thyroid carcinoma. , 2004, Thyroid : official journal of the American Thyroid Association.

[30]  J. Carrillo,et al.  Accuracy of Fine-Needle Aspiration Biopsy of the Thyroid Combined with an Evaluation of Clinical and Radiologic Factors , 2000, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[31]  J. Mandal,et al.  Prevalence of , 2021 .

[32]  A. Gawande,et al.  False Negative Cytology in Large Thyroid Nodules , 2014, Annals of Surgical Oncology.

[33]  G. Stuart,et al.  Cytopathology , 2014, Modern Pathology.

[34]  E. Paul,et al.  Diagnostic lobectomy is not routinely required to exclude malignancy in thyroid nodules greater than four centimetres , 2012, ANZ journal of surgery.

[35]  S. Purisch,et al.  Low false-negative rate of cytology in thyroid nodules ≥ 4 cm Baixa taxa de falso-negativo da citologia em nódulos tireoidianos ≥ 4 cm , 2009 .

[36]  [Carcinoma]. , 1955, Die Medizinische.