Objective: We aimed to assess the adequacy and efficacy of ultrasound (US)-guided fine-needle aspiration (US-FNA) for small solid thyroid nodules (SSTNs) with the largest diameter <5 mm and compared these according to nodule size. Study Design: Among 656 SSTNs in 569 patients, each SSTN was classified into 1 of 4 groups according to the largest diameter: 1 mm ≤ group A < 2 mm; 2 mm ≤ group B < 3 mm; 3 mm ≤ group C < 4 mm, and 4 mm ≤ group D < 5 mm. We compared the adequacy and efficacy of US-FNA between these groups using histopathologic results as a reference standard. Results: 571 (87.0%) SSTNs were adequately sampled by US-FNA and 200 of these were histopathologically confirmed. The adequacy of US-FNA for SSTNs varied according to the nodule diameter: the smaller the nodule diameter, the lower the diagnostic adequacy. The diagnostic efficacy of US-FNA for SSTNs showed a significant relationship with nodule size: diagnostic efficacy in groups A and B was lower than in groups C and D. Conclusions: The adequacy of US-FNA for SSTNs tended to decrease with decreased nodule size, and diagnostic efficacy of US-FNA for SSTNs with the largest diameter <3 mm was lower than for those ≥3 mm.

Keywords:
Ultrasound-guided fine-needle aspiration, Small solid thyroid nodule, Fine-needle biopsy
1.
Yokozawa T, Miyauchi A, Kuma K, Sugawara M: Accurate and simple method of diagnosing thyroid nodules: the modified technique of ultrasound-guided fine needle aspiration biopsy. Thyroid 1995;5:141–145.
2.
Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A: Diagnostic accuracy of conventional vs sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid 1998;8:15–19.
3.
O’Malley ME, Weir MM, Hahn PF, Misdraji J, Wood BJ, Mueller PR: US-guided fine-needle aspiration biopsy of thyroid nodules: adequacy of cytologic material and procedure time with and without immediate cytologic analysis. Radiology 2002;222:383–387.
4.
Kim DW, Lee EJ, Kim SH, Kim TH, Lee SH, Kim DH, Rho MH: Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules: comparison in efficacy according to nodule size. Thyroid 2009;19:27–31.
5.
Kim SJ, Kim EK, Park CS, Chung WY, Oh KK, Yoo HS: Ultrasound-guided fine-needle aspiration biopsy in nonpalpable thyroid nodules: is it useful in infracentimetric nodules? Yonsei Med J 2003;44:635–640.
6.
Moon HJ, Son E, Kim EK, Yoon JH, Kwak JY: The diagnostic values of ultrasound and ultrasound-guided fine needle aspiration in subcentimeter-sized thyroid nodules. Ann Surg Oncol 2012;19:52–59.
7.
Berker D, Aydin Y, Ustun I, Gul K, Tutuncu Y, Isik S, Delibasi T, Guler S: The value of fine-needle aspiration biopsy in subcentimeter thyroid nodules. Thyroid 2008;18:603–608.
8.
Leenhardt L, Hejblum G, Franc B, Fediaevsky LD, Delbot T, Le Guillouzic D, Menegaux F, Guillausseau C, Hoang C, Turpin G, Aurengo A: Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules. J Clin Endocrinol Metab 1999;84:24–28.
9.
Mazzaferri EL, Sipos J: Should all patients with subcentimeter thyroid nodules undergo fine-needle aspiration biopsy and preoperative neck ultrasonography to define the extent of tumor invasion? Thyroid 2008;18:597–602.
10.
Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, Cronan JJ, Doubilet PM, Evans DB, Goellner JR, Hay ID, Hertzberg BS, Intenzo CM, Jeffrey RB, Langer JE, Larsen PR, Mandel SJ, Middleton WD, Reading CC, Sherman SI, Tessler FN: Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 2005;237:794–800.
11.
American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, Mclver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM: Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167–1214.
12.
Moon WJ, Baek JH, Jung SL, Kim DW, Kim EK, Kim JY, Kwak JY, Lee JH, Lee YH, Na DG, Park JS, Park SW, Korean Society of Thyroid Radiology (KSThR): Ultrasonography and ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean J Radiol 2011;12:1–14.
13.
Kim DW, Choo HJ, Park JS, et al: Ultrasonography-guided fine-needle aspiration cytology for thyroid nodules: an emphasis on one-sampling and biopsy techniques. Diagn Cytopathol 2012;40:e48–e54.
14.
Cibas ES, Ali SZ: The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol 2009;132:658–665.
15.
Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedus L, Vitti P, AACE/AME/ETA Task Force on Thyroid Nodules: American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. J Endocrinol Invest 2010;33:51–56.
16.
Ito Y, Uruno T, Nakano K, Takamura Y, Miya A, Kobayashi K, Yokozawa T, Matsuzuka F, Kuma S, Kuma K, Miyauchi A: An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 2003;13:381–387.
17.
Roti E, Rossi R, Trasforini G, Bertelli F, Ambrosio MR, Busutti L, Pearce EN, Braverman LE, Degli Uberti EC: Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. J Clin Endocrinol Metab 2006;91:2171–2178.
18.
VanderLaan PA, Marqusse E, Krane JF: Clinical outcome for atypia of undetermined significance in thyroid fine-needle aspirations: should repeated FNA be the preferred initial approach? Am J Clin Pathol 2011;135:770–775.
19.
Adeniran AJ, Hui P, Chhieng DC, Prasad ML, Schofield K, Theoharis C: BRAF mutation testing of thyroid fine-needle aspiration specimens enhances the predictability of malignancy in thyroid follicular lesions of undetermined significance. Acta Cytol 2011;55:570–575.
20.
Ustun H, Astarci HM, Altunkaya C, et al: Fine-needle aspiration of follicular patterned lesions of the thyroid: diagnosis, management, and follow-up according to Thyroid Bethesda System. Acta Cytol 2012;56:361–369.
21.
Kim DW, Lee EJ, Jung SJ, Ryu JH, Kim YM: Role of sonographic diagnosis in managing Bethesda class III nodules. AJNR Am J Neuroradiol 2011;32:2136–2141.
22.
Harvey AM, Truong LD, Mody DR: Diagnostic pitfalls of Hashimoto’s/lymphocytic thyroiditis on fine-needle aspirations and strategies to avoid overdiagnosis. Acta Cytol 2012;56:352–360.
© 2012 S. Karger AG, Basel
2012
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