Utility of sonographic features and citology obtained by ultrasound-guided fine needle aspiration in preoperative management of thyroid nodules
L. Pacheco, F. Rius, M. Hernandez, P. Buetas, X. Matias-Guiu, D. Mauricio & F. Maravall
Introduction: Nodular thyroid disease is common in the general population, but only 5% of thyroid nodules are carcinomas. The diagnostic challenge is to identify those nodules that are malignant neoplasias. Some sonographic features of nodules have been correlated with the risk of malignancy, but at present, thyroid cytology obtained by ultrasound-guided FNA is probably the best tool in the preoperative management of nodular disease.
Design: We designed a prospective study that included all patients referred to our department for thyroid nodular disease, with at least one ultrasound-guided FNA. Our aims were to determine the combination of ultrasound variables that have the capacity to discriminate malignancy, and correlate the sonographic and cytologic features with histopathologic analysis after surgical excision.
Results: We present preliminary analysis after the first year of study. A total of 552 nodules were aspirated in 275 patients with ultrasound-guided FNA. The samples were representative in 82.7%. In 45.80% (243) the dominant nodule was located in the left thyroid lobe, 76% of nodules were ≥ 1 cm, 74% were solid, 91.32% had regular margins and 76% well defined, 45.47% had no perinodular halo, 67.7% had no calcifications, 47.5% were isoecogenic and 75.10% had only perinodular vascularization. Cytology suggestive of malignancy was significantly correlated with hypoecoechogenicity, and a larger nodular size. 29 patients were referred for surgery, 10 underwent surgery, (of which 6 were thyroid carcinomas), 21 are awaiting thyroid scintigraphy for surgical decision, and the remaining patients are on follow-up.
Conclusions: The hypoechogenicity and increased nodule size were significantly correlated with cytology suggestive of malignancy; therefore, this may be useful in making surgical decisions. These are preliminary results and we need to complete the study
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector