OBJECTIVES: To compare the sampling efficiency and diagnostic performance of ultrasound (US)-guided fine-needle aspiration cytology (FNAC) and fine-needle non-aspiration cytology (FNNAC) for thyroid nodules.
MATERIALS AND METHODS: 629 thyroid nodules in 629 cases (477 females, 152 males) were randomly subjected to FNAC or FNNAC from Jun 2014 to Feb 2015. Diagnostic performance was calculated in reference to the histological findings or follow-up results.
RESULTS: 629 patients (152 men, 477 women) with 629 thyroid nodules were enrolled in the study. Pathological results were obtained in 173 nodules and benign nodules at FNA with more than six months’ follow-up were found in 65 nodules. Tumor size for FNAC ranges from 3.0 to 51.0 mm (mean±SD; 10.2±6.9 mm); whereas FNNAC (2.0–43.0 mm; 11.9±7.7 mm). Non-diagnostic results were found in 7.59% (24/316) of FNNAC procedures and 7.59% (25/313) of FNAC (P > 0.05). Determinate and indeterminate results were found in 50.63% (160/316) and 41.77% (132/316) of FNNAC procedures, whereas 58.15% (182/313) and 33.87% (106/313) of FNAC (P < 0.05). In order to obtain determinate cytological results, FNAC might be more suitable than FNNAC for diagnosis of nodules with hypovascularity (51.38% vs. 41.78%, P < 0.05) and macrocalcifications (9.72% vs. 6.50%, P < 0.05). No US and Color-Doppler US characteristics, such as the presence of hypervascularity (P > 0.05), microcalcifications (P > 0.05), internal component (P > 0.05), or size(P > 0.05), were significantly different to obtain determinate cytological results between the FNAC and FNNAC groups. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy of FNAC and FNNAC were as follows: 96.67% vs. 100%, 89.74% vs. 96.5%, 87.88% vs. 96.97%, 97.22% vs. 100%, 92.75% vs.98.36%, respectively (all P > 0.05).
CONCLUSIONS: Both FNAC and FNNAC are effective for diagnosis of thyroid nodules. However, FNAC is more effective than FNNAC to acquire determinate cytological results for nodules which US present hypovascularity and macrocalcifications.
BalochZ.W., CibasE.S., ClarkD.P., et al., The national cancer institute thyroid fine needle aspiration state of the science conference: A summation, Cytojournal5 (2008), 6.
2.
BernetV., HupartK.H., ParangiS. and WoeberK.A., AACE/ACE disease state commentary: Molecular diagnostic testing of thyroid nodules with indeterminate cytopathology, Endocr Pract20 (2014), 360–363.
3.
BongiovanniM., SpitaleA., FaquinW.C., MazzucchelliL. and BalochZ.W., The bethesda system for reporting thyroid cytopathology: A meta-analysis, Acta Cytol56 (2012), 333–339.
4.
BriffodM., GentileA. and HebertH., Cytopuncture in the follow-up of breast carcinoma, Acta Cytol26 (1982), 195–200.
5.
BritoJ.P., GionfriddoM.R., AlN.A., et al., The accuracy of thyroid nodule ultrasound to predict thyroid cancer: Systematic review and meta-analysis, J Clin Endocrinol Metab99 (2014), 1253–1263.
6.
CibasE.S. and AliS.Z., The bethesda system for reporting thyroid cytopathology, Am J Clin Pathol132 (2009), 658–665.
7.
CibasE.S. and AliS.Z., The bethesda system for reporting thyroid cytopathology, Thyroid19 (2009), 1159–1165.
8.
CooperD.S., DoheryG.M., HaugenB.R., KloosR.T., LeeS.L., et al., Revised american thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer, Thyroid19 (2009), 1167–1214.
9.
de CarvalhoG.A.,
Paz-FilhoG.,
CavalcantiT.C. and GrafH., Adequacy and diagnostic accuracy of aspiration vs. capillary fine needle thyroid biopsies, Endocr Pathol20 (2009), 204–208.
10.
DegirmenciB., HaktanirA., AlbayrakR., et al., Sonographically guided fine-needle biopsy of thyroid nodules: The effects of nodule characteristics, sampling technique, and needle size on the adequacy of cytological material, Clin Radiol62 (2007), 798–803.
11.
FerrisR.L., BalochZ., BernetV., et al., American thyroid association statement on surgical application of molecular profiling for thyroid nodules: Current impact on perioperative decision making, Thyroid25 (2015), 760–768.
12.
GiustiM., OrlandiD., MelleG., et al., Is there a real diagnostic impact of elastosonography and contrast-enhanced ultrasonography in the management of thyroid nodules?J Zhejiang Univ Sci B14 (2013), 195–206.
13.
HaugenB.R., AlexanderE.K., BibleK.C., et al., 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, Thyroid26 (2016), 1–133.
14.
ItoY., TomodaC., UrunoT., et al., Needle tract implantation of papillary thyroid carcinoma after fine-needle aspiration biopsy, World J Surg29 (2005), 1544–1549.
15.
KamalM.M., ArjuneD.G. and KulkarniH.R., Comparative study of fine needle aspiration and fine needle capillary sampling of thyroid lesions, Acta Cytol46 (2002), 30–34.
16.
LevineR.A., Current guidelines for the management of thyroid nodules, Endocr Pract18 (2012), 596–599.
17.
LiuX.Y., ZhuL.J., CuiD., et al., Annual financial impact of thyroidectomies for nodular thyroid disease in China, Asian Pac J Cancer Prev15 (2014), 5921–5926.
18.
MoonW.J., BaekJ.H., JungS.L., et al., Ultrasonography and the ultrasound-based management of thyroid nodules: Consensus statement and recommendations, Korean J Radiol12 (2011), 1–14.
19.
PhuttharakW., SomboonpornC. and HongdomnernG., Diagnostic performance of gray-scale versus combined gray-scale with colour doppler ultrasonography in the diagnosis of malignancy in thyroid nodules, Asian Pac J Cancer Prev10 (2009), 759–764.
20.
PinkiP., AlokD., RanjanA. and NanakC.M., Fine needle aspiration cytology versus fine needle capillary sampling in cytological diagnosis of thyroid lesions, Iran J Pathol10 (2015), 47–53.
21.
PiscagliaF., NolsoeC., DietrichC.F., et al., The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): Update 2011 on non-hepatic applications, Ultraschall Med33 (2012), 33–59.
22.
PitmanM.B., AbeleJ., AliS.Z., et al., Techniques for thyroid FNA: A synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference, Diagn Cytopathol36 (2008), 407–424.
23.
RagoT., VittiP., ChiovatoL., et al., Role of conventional ultrasonography and color flow-doppler sonography in predicting malignancy in ‘cold’ thyroid nodules, Eur J Endocrinol138 (1998), 41–46.
24.
RamachandraL., KudvaR., RaoB.H.A. and AgrawalS., A Comparative Study of Fine Needle Aspiration Cytology (FNAC) and Fine Needle Non-aspiration Cytology (FNNAC) technique in lesions of thyroid gland, Indian J Surg73 (2011), 287–290.
25.
RomitelliF., Di StasioE.,
SantoroC.,
IozzinoM.,
OrsiniA. and CesareoR., A comparative study of fine needle aspiration and fine needle non-aspiration biopsy on suspected thyroid nodules, Endocr Pathol20 (2009), 108–113.
26.
SakorafasG.H., Thyroid nodules; interpretation and importance of fine-needle aspiration (FNA) for the clinician - practical considerations, Surg Oncol19 (2010), 130–139.
27.
SantosJ.E. and LeimanG., Nonaspiration fine needle cytology. Application of a new technique to nodular thyroid disease, Acta Cytol32 (1988), 353–356.
28.
SchlederS., JankeM., AghaA., et al., Preoperative differentiation of thyroid adenomas and thyroid carcinomas using high resolution contrast-enhanced ultrasound (CEUS), Clin Hemorheol Micro61 (2015), 13–22.
29.
TauroL.F., LoboG.J., FernandesH., et al., A comparative study on fine needle aspiration cytology versus fine needle capillary cytology in thyroid nodules, Oman Med J27 (2012), 151–156.
30.
WendlC.M., JankeM., JungW., StroszczysnskiC. and JungE.M., Contrast-enhanced ultrasound with perfusion analysis for the identification of malignant and benign tumours of the thyroid gland, Clin Hemorheol Micro63 (2016), 113–121.
31.
WuQ., LiY. and WangY., Diagnostic value of “absent” pattern in contrast-enhanced ultrasound for the differentiation of thyroid nodules, Clin Hemorheol Micro63 (2016), 325–334.
32.
ZajdelaA., ZillhardtP. and VoillemotN., Cytological diagnosis by fine needle sampling without aspiration, Cancer-Am Cancer Soc59 (1987), 1201–1205.
33.
ZhongL.C., LuF., MaF., et al., Ultrasound-guided fine-needle aspiration of thyroid nodules: Does the size limit its efficiency?Int J Clin Exp Pathol8 (2015), 3155–3159.
34.
ZhouJ., ZhangJ., ZhanW., et al., 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 Cytopathol122 (2014), 266–273.
