J Korean Thyroid Assoc.  2013 Nov;6(2):110-114. 10.11106/jkta.2013.6.2.110.

Otolaryngologist-Performed Ultrasound and Ultrasound-Guided Fine Needle Aspiration for Thyroid Nodule and Meaningful Ultrasound Finding

• Ha SY
• Lee YC
• Jung YG
• Kim MG
• Eun YG

• KMID: 1845382
• DOI: http://doi.org/10.11106/jkta.2013.6.2.110

Abstract

BACKGROUND AND OBJECTIVES
Ultrasonography is a safe and noninvasive imaging modality with high sensitivity that can be used to identify the presence, location, and size of thyroid nodules. Fine-needle aspiration (FNA) biopsy of thyroid nodules is a minimally invasive and safe procedure that is usually performed on an outpatient basis. The purpose of this study was to investigate the diagnostic efficacy of ultrasonography performed by an otolaryngologist (OUS) and OUS-guided FNA for the thyroid and determine the clinical value of OUS in predicting the presence of malignancy in thyroid nodules.
MATERIALS AND METHODS
A single otolaryngologist examined 151 consecutive patients referred to our institution and performed OUS or OUS-guided FNA biopsies on all of them in an office setting. Final diagnosis was based on the FNA biopsy or pathological result of operation. We used the following parameters to assess the relevance of the sonographic findings in the prediction of thyroid malignancy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and relative risk (RR).
RESULTS
In total, 12.9% of all the patients showed malignancy. The PPVs for the sonographic features were as follows: a taller-than-wide shape, 63.6%; marked hypoechogenicity, 61.5%; microcalcification, 46.7%; microcalcification or macrocalcification, 44.0%; and spiculated margin, 38.2%. The RR values showed that microcalcification or macrocalcification (p<0.05, RR=7.2) and marked hypoechogenicity (p<0.05, RR=6.7) are significant findings that indicate thyroid malignancy.
CONCLUSION
Microcalcification or macrocalcification and marked hypoechogenicity observed on OUS are significant finding that indicate thyroid malignancy, and the most reliable finding are microcalcification or macrocalcification.

Keyword

Fine needle aspiration biopsy; Thyroid; Ultrasound; Otolaryngologist

MeSH Terms

Biopsy
Biopsy, Fine-Needle*
Diagnosis
Humans
Outpatients
Sensitivity and Specificity
Thyroid Gland*
Thyroid Nodule*
Ultrasonography*

Reference

References

1. Bhatki AM, Brewer B, Robinson-Smith T, Nikiforov Y, Steward DL. Adequacy of surgeon-performed ultrasound-guided thyroid fine-needle aspiration biopsy. Otolaryngol Head Neck Surg. 2008; 139(1):27–31.

2. Cannon CR, Replogle WH. Fine-needle aspiration: survey of clinical utility. Otolaryngol Head Neck Surg. 2000; 123(5):563–5.

3. Kraft M, Lang F, Mihaescu A, Wolfensberger M. Evaluation of clinician-operated sonography and fine-needle aspiration in the assessment of salivary gland tumours. Clin Otolaryngol. 2008; 33(1):18–24.

4. Kwak JY, Kim EK, Kim HJ, Kim MJ, Son EJ, Moon HJ. How to combine ultrasound and cytological information in decision making about thyroid nodules. Eur Radiol. 2009; 19(8):1923–31.

5. Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al. Benign and malignant thyroid nodules: US differentiationmulticenter retrospective study. Radiology. 2008; 247(3):762–70.

6. Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2005; 237(3):794–800.

7. Cappelli C, Pirola I, Cumetti D, Micheletti L, Tironi A, Gandossi E. et al. Is the anteroposterior and transverse diameter ratio of nonpalpable thyroid nodules a sonographic criteria for recommending fine-needle aspiration cytology? Clin Endocrinol (Oxf). 2005; 63(6):689–93.

8. Takashima S, Fukuda H, Nomura N, Kishimoto H, Kim T, Kobayashi T. Thyroid nodules: re-evaluation with ultrasound. J Clin Ultrasound. 1995; 23(3):179–84.

9. Ahn SS, Kim EK, Kang DR, Lim SK, Kwak JY, Kim MJ. Biopsy of thyroid nodules: comparison of three sets of guidelines. AJR Am J Roentgenol. 2010; 194(1):31–7.

10. Hong YJ, Son EJ, Kim EK, Kwak JY, Hong SW, Chang HS. Positive predictive values of sonographic features of solid thyroid nodule. Clin Imaging. 2010; 34(2):127–33.

11. Mendez W, Rodgers SE, Lew JI, Montano R, Solorzano CC. Role of surgeon-performed ultrasound in predicting malignancy in patients with indeterminate thyroid nodules. Ann Surg Oncol. 2008; 15(9):2487–92.