Association of the Thyroid Nodules' Sonographic Features With Fine Needle Aspiration (FNA) Cytology Results
-
Hossein Ghanaati
,
ALireza Arefzadeh
,
Hamidreza Hosseinpour
,
Mahsa Alborzi Avanaki
,
Alireza Abrishami
,
Amir Hossein Jalali
Abstract
Thyroid nodules are a common finding in clinical practice. Although ultrasonography is an accepted method for evaluating these nodules, Fine Needle Aspiration (FNA) is the procedure of choice for assessing the risk of malignancy. This study aims to determine the association between sonographic features of thyroid nodules based on Thyroid Imaging Reporting and Data System classification and the cytology results. In this prospective cohort study, 147 patients from Tehran Medical Imaging Center who had thyroid nodules underwent ultrasonography-guided FNA, and their sonographic features were recorded. The pathologic findings were also obtained according to the Bethesda system. Finally, the association between sonographic features and cytological results was analyzed. Eighteen (12.3%) nodules were malignant, and 129 nodules (87.7%) were benign. The association of TIRADS categories with the risk of malignancy is as follows: TIRADS 1 (n=0, 0%), TIRADS 2 (n=10, 16.9%), TIRADS 3 (n=6, 10.5%), TIRADS 4 (n=2, 16.7%), and TIRADS 5 (n=0, 0%). The bloody lamellae of thyroid nodules were significantly correlated with the risk of malignancy (P<0.05). However, there was no statistically significant association between the risk of malignancy and gender (P=0.47), calcification (P=0.9), firmness (P=0.19), halo sign (P=0.95), location of nodules (P=0.35), and nodules' echogenicity (P=0.058). Although there are trusted classifications such as TIRADS for categorizing thyroid nodules, there is still uncertainty in utilizing them, especially in the management of nodules classified as TIRADS 2, in which various sonographic features are shared between benign and malignant nodules.
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24. Jasim S, Baranski TJ, Teefey SA, Middleton WD. Investigating the effect of thyroid nodule location on the risk of thyroid cancer. Thyroid2020;30(3):401-7.
25. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, Orcutt J, Moore Jr FD, Larsen PR, Marqusee E. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. The Journal of Clinical Endocrinology & Metabolism2006;91(9):3411-7.
26. Rago T, Vitti P, Chiovato L, Mazzeo S, De Liperi A, Miccoli P, Viacava P, Bogazzi F, Martino E, Pinchera A. Role of conventional ultrasonography and color flow-doppler sonography in predicting malignancy in'cold'thyroid nodules. European journal of endocrinology1998;138(1):41-6.
27. Wienke JR, Chong WK, Fielding JR, Zou KH, Mittelstaedt CA. Sonographic features of benign thyroid nodules: interobserver reliability and overlap with malignancy. Journal of Ultrasound in Medicine2003;22(10):1027-31.
28. Chan BK, Desser TS, McDougall IR, Weigel RJ, Jeffrey Jr RB. Common and uncommon sonographic features of papillary thyroid carcinoma. Journal of Ultrasound in Medicine2003;22(10):1083-90.
29. Tublin ME, Martin JA, Rollin LJ, Pealer K, Kurs-Lasky M, Ohori NP. Ultrasound‐guided fine‐needle aspiration versus fine‐needle capillary sampling biopsy of thyroid nodules: does technique matter? Journal of Ultrasound in Medicine2007;26(12):1697-701.
30. Zhou JQ, Zhang JW, Zhan WW, Zhou W, Ye TJ, Zhu Y, Yao JJ, Liu J, Hu YY, Grant EG. Comparison of fine‐needle aspiration and fine‐needle capillary sampling of thyroid nodules: A prospective study with emphasis on the influence of nodule size. Cancer cytopathology2014;122(4):266-73.
2. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M. 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. Thyroid2016;26(1):1-133.
3. Hong YJ, Son EJ, Kim E-K, Kwak JY, Hong SW, Chang H-S. Positive predictive values of sonographic features of solid thyroid nodule. Clinical imaging2010;34(2):127-33.
4. Anitha S, Ravimohan T. A study of incidence of malignancy in solitary nodule of thyroid. J Contemp Med Res2016;3(4):993-5.
5. Morris LG, Sikora AG, Tosteson TD, Davies L. The increasing incidence of thyroid cancer: the influence of access to care. Thyroid2013;23(7):885-91.
6. Reading CC, Charboneau JW, Hay ID, Sebo TJ. Sonography of thyroid nodules: a “classic pattern” diagnostic approach. Ultrasound quarterly2005;21(3):157-65.
7. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, Panunzi C, Rinaldi R, Toscano V, Pacella CM. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. The Journal of Clinical Endocrinology & Metabolism2002;87(5):1941-6.
8. Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, Dominguez M. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. The Journal of Clinical Endocrinology & Metabolism2009;94(5):1748-51.
9. Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, Cronan JJ, Beland MD, Desser TS, Frates MC. ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS committee. Journal of the American college of radiology2017;14(5):587-95.
10. Hamberger B, Gharib H, Melton III LJ, Goellner JR, Zinsmeister AR. Fine-needle aspiration biopsy of thyroid nodules: impact on thyroid practice and cost of care. The American journal of medicine1982;73(3):381-4.
11. Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid1998;8(1):15-21.
12. Lin J-D, Chao T-C, Huang B-Y, Chen S-T, Chang H-Y, Hsueh C. Thyroid cancer in the thyroid nodules evaluated by ultrasonography and fine-needle aspiration cytology. Thyroid2005;15(7):708-17.
13. Kim E-K, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, Yoo HS. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. American Journal of Roentgenology2002;178(3):687-91.
14. Dean DS, Gharib H. Epidemiology of thyroid nodules. Best practice & research Clinical endocrinology & metabolism2008;22(6):901-11.
15. Vanderpump MP. The epidemiology of thyroid disease. British medical bulletin2011;99(1).
16. Mendelson AA, Tamilia M, Rivera J, Hier MP, Sherman M, Garfield N, Black MJ, Rochon L, Gologan O, Payne RJ. Predictors of Malignancy in Preoperative Nondiagnostic Biopsies of the Thyroid. Journal of Otolaryngology--Head & Neck Surgery2009;38(3).
17. Nabahati M, Moazezi Z, Fartookzadeh S, Mehraeen R, Ghaemian N, Sharbatdaran M. The comparison of accuracy of ultrasonographic features versus ultrasound-guided fine-needle aspiration cytology in diagnosis of malignant thyroid nodules. Journal of Ultrasound2019;22(3):315-21.
18. Raparia K, Min SK, Mody DR, Anton R, Amrikachi M. Clinical outcomes for “suspicious” category in thyroid fine-needle aspiration biopsy: patient's sex and nodule size are possible predictors of malignancy. Archives of pathology & laboratory medicine2009;133(5):787-90.
19. Kamran SC, Marqusee E, Kim MI, Frates MC, Ritner J, Peters H, Benson CB, Doubilet PM, Cibas ES, Barletta J. Thyroid nodule size and prediction of cancer. The Journal of Clinical Endocrinology & Metabolism2013;98(2):564-70.
20. Singaporewalla R, Hwee J, Lang T, Desai V. Clinico-pathological correlation of thyroid nodule ultrasound and cytology using the TIRADS and Bethesda classifications. World Journal of Surgery2017;41(7):1807-11.
21. Park J-Y, Lee HJ, Jang HW, Kim HK, Yi JH, Lee W, Kim SH. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Thyroid2009;19(11):1257-64.
22. Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, Jung HK, Choi JS, Kim BM, Kim E-K. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology2011;260(3):892-9.
23. Ramundo V, Lamartina L, Falcone R, Ciotti L, Lomonaco C, Biffoni M, Giacomelli L, Maranghi M, Durante C, Grani G. Is thyroid nodule location associated with malignancy risk? Ultrasonography2019;38(3):231.
24. Jasim S, Baranski TJ, Teefey SA, Middleton WD. Investigating the effect of thyroid nodule location on the risk of thyroid cancer. Thyroid2020;30(3):401-7.
25. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, Orcutt J, Moore Jr FD, Larsen PR, Marqusee E. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. The Journal of Clinical Endocrinology & Metabolism2006;91(9):3411-7.
26. Rago T, Vitti P, Chiovato L, Mazzeo S, De Liperi A, Miccoli P, Viacava P, Bogazzi F, Martino E, Pinchera A. Role of conventional ultrasonography and color flow-doppler sonography in predicting malignancy in'cold'thyroid nodules. European journal of endocrinology1998;138(1):41-6.
27. Wienke JR, Chong WK, Fielding JR, Zou KH, Mittelstaedt CA. Sonographic features of benign thyroid nodules: interobserver reliability and overlap with malignancy. Journal of Ultrasound in Medicine2003;22(10):1027-31.
28. Chan BK, Desser TS, McDougall IR, Weigel RJ, Jeffrey Jr RB. Common and uncommon sonographic features of papillary thyroid carcinoma. Journal of Ultrasound in Medicine2003;22(10):1083-90.
29. Tublin ME, Martin JA, Rollin LJ, Pealer K, Kurs-Lasky M, Ohori NP. Ultrasound‐guided fine‐needle aspiration versus fine‐needle capillary sampling biopsy of thyroid nodules: does technique matter? Journal of Ultrasound in Medicine2007;26(12):1697-701.
30. Zhou JQ, Zhang JW, Zhan WW, Zhou W, Ye TJ, Zhu Y, Yao JJ, Liu J, Hu YY, Grant EG. Comparison of fine‐needle aspiration and fine‐needle capillary sampling of thyroid nodules: A prospective study with emphasis on the influence of nodule size. Cancer cytopathology2014;122(4):266-73.
| Files | ||
| Issue | Vol 61 No 3 (2023) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v61i3.12738 | |
| Keywords | ||
| Cytology Fine needle aspiration Sonographic features Thyroid nodule Thyroid imaging reporting and data systems (TIRADS) | ||
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How to Cite
1.
Ghanaati H, Arefzadeh A, Hosseinpour H, Alborzi Avanaki M, Abrishami A, Jalali AH. Association of the Thyroid Nodules’ Sonographic Features With Fine Needle Aspiration (FNA) Cytology Results. Acta Med Iran. 2023;61(3):161-167.
