Advertisement

CardioVascular and Interventional Radiology

, Volume 33, Issue 4, pp 800–805 | Cite as

How to Interpret Thyroid Biopsy Results: A Three-Year Retrospective Interventional Radiology Experience

  • Jason D. Oppenheimer
  • Deepa Kasuganti
  • Ritu Nayar
  • Howard B. Chrisman
  • Robert J. Lewandowski
  • Albert A. NemcekJr.
  • Robert K. RyuEmail author
Clinical Investigation

Abstract

Results of thyroid biopsy determine whether thyroid nodule resection is appropriate and the extent of thyroid surgery. At our institution we use 20/22-gauge core biopsy (CBx) in conjunction with fine-needle aspiration (FNA) to decrease the number of passes and improve adequacy. Occasionally, both ultrasound (US)-guided FNA and CBx yield unsatisfactory specimens. To justify clinical recommendations for these unsatisfactory thyroid biopsies, we compare rates of malignancy at surgical resection for unsatisfactory biopsy results against definitive biopsy results. We retrospectively reviewed a database of 1979 patients who had a total of 2677 FNA and 663 CBx performed by experienced interventional radiologists under US guidance from 2003 to 2006 at a tertiary-care academic center. In 451 patients who had surgery following biopsy, Fisher’s exact test was used to compare surgical malignancy rates between unsatisfactory and malignant biopsy cohorts as well as between unsatisfactory and benign biopsy cohorts. We defined statistical significance at P = 0.05. We reported an overall unsatisfactory thyroid biopsy rate of 3.7% (100/2677). A statistically significant higher rate of surgically proven malignancies was found in malignant biopsy patients compared to unsatisfactory biopsy patients (P = 0.0001). The incidence of surgically proven malignancy in unsatisfactory biopsy patients was not significantly different from that in benign biopsy patients (P = 0.8625). In conclusion, an extremely low incidence of malignancy was associated with both benign and unsatisfactory thyroid biopsy results. The difference in incidence between these two groups was not statistically significant. Therefore, patients with unsatisfactory biopsy specimens can be reassured and counseled accordingly.

Keywords

Interventional radiology Thyroid nodule Ultrasound-guided biopsy Fine-needle aspiration Core biopsy 

Notes

Acknowledgment

The Feinberg School of Medicine, Northwestern University, Medical Student Summer Research Program helped to fund this project.

References

  1. 1.
    Ravetto C, Colombo L, Dottorini ME (2000) Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37, 895 patients. Cancer 90:357–363CrossRefPubMedGoogle Scholar
  2. 2.
    Sangalli G, Serio G, Zampatti C, Bellotti M, Lomuscio G (2006) Fine needle aspiration cytology of the thyroid: a comparison of 5469 cytological and final histological diagnoses. Cytopathology 17:245–250CrossRefPubMedGoogle Scholar
  3. 3.
    de Vos tot Nederveen Cappel RJ, Bouvy ND, Bonjer HJ, van Muiswinkel JM, Chadha S (2001) Fine needle aspiration cytology of thyroid nodules: how accurate is it and what are the causes of discrepant cases? Cytopathology 12:399–405CrossRefPubMedGoogle Scholar
  4. 4.
    Morayati SJ, Freitas JE (1991) Guiding thyroid nodule management by fine-needle aspiration. Fam Pract 11:379–386Google Scholar
  5. 5.
    Ortiz R, Hupart KH, DeFesi CR, Surks MI (1998) Effect of early referral to an endocrinologist on efficiency and cost of evaluation and development of treatment plan in patients with thyroid nodules. J Clin Endocrinol Metab 83:3803–3807CrossRefPubMedGoogle Scholar
  6. 6.
    Khalid AN, Hollenbeak CS, Quraishi SA, Fan CY, Stack BC Jr (2006) The cost-effectiveness of iodine 131 scintigraphy, ultrasonography, and fine-needle aspiration biopsy in the initial diagnosis of solitary thyroid nodules. Arch Otolaryngol Head Neck Surg 132:244–250CrossRefPubMedGoogle Scholar
  7. 7.
    Supit E, Peiris AN (2002) Cost-effective management of thyroid nodules and nodular thyroid goiters. South Med J 95:514–519PubMedGoogle Scholar
  8. 8.
    Woeber KA (1995) Cost-effective evaluation of the patient with a thyroid nodule. Surg Clin North Am 75:357–363PubMedGoogle Scholar
  9. 9.
    Wong CK, Wheeler MH (2000) Thyroid nodules: rational management. World J Surg 24:934–941CrossRefPubMedGoogle Scholar
  10. 10.
    Werga P, Wallin G, Skoog L, Hamberger B (2000) Expanding role of fine-needle aspiration cytology in thyroid diagnosis and management. World J Surg 24:907–912CrossRefPubMedGoogle Scholar
  11. 11.
    Hegedus L (2004) Clinical practice. The thyroid nodule. N Engl J Med 351:1764–1771CrossRefPubMedGoogle Scholar
  12. 12.
    Castro MR, Gharib H (2000) Thyroid nodules and cancer. When to wait and watch, when to refer. Postgrad Med J 107:113–116Google Scholar
  13. 13.
    Frates MC, Benson CB, Charboneau JW et al (2005) Management of thyroid nodules detected at US: society of radiologists in ultrasound consensus conference statement. Radiology 237:794–800CrossRefPubMedGoogle Scholar
  14. 14.
    Gharib H, Goellner JR (1993) Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med 118:282–289 [see comment]PubMedGoogle Scholar
  15. 15.
    Kim MJ, Kim EK, Park SI et al (2008) US-guided fine-needle aspiration of thyroid nodules: indications, techniques, results. Radiographics 28:1869–1886CrossRefPubMedGoogle Scholar
  16. 16.
    Mehrotra P, Hubbard JG, Johnson SJ, Richardson DL, Bliss R, Lennard TW (2005) Ultrasound scan-guided core sampling for diagnosis versus freehand FNAC of the thyroid gland. Surgeon 3:1–5CrossRefPubMedGoogle Scholar
  17. 17.
    Chow LS, Gharib H, Goellner JR, van Heerden JA (2001) Nondiagnostic thyroid fine-needle aspiration cytology: management dilemmas. Thyroid 11:1147–1151CrossRefPubMedGoogle Scholar
  18. 18.
    Ogawa Y, Kato Y, Ikeda K et al (2001) The value of ultrasound-guided fine-needle aspiration cytology for thyroid nodules: an assessment of its diagnostic potential and pitfalls. Surg Today 31:97–101CrossRefPubMedGoogle Scholar
  19. 19.
    Liu Q, Castelli M, Gattuso P, Prinz RA (1995) Simultaneous fine-needle aspiration and core-needle biopsy of thyroid nodules. Am Surg 61:628–632PubMedGoogle Scholar
  20. 20.
    Screaton NJ, Berman LH, Grant JW (2003) US-guided core-needle biopsy of the thyroid gland. Radiology 226:827–832CrossRefPubMedGoogle Scholar
  21. 21.
    Renshaw AA, Pinnar N (2007) Comparison of thyroid fine-needle aspiration and core needle biopsy. Am J Clin Pathol 128:365–366CrossRefGoogle Scholar
  22. 22.
    Baloch ZW, Tam D, Langer J et al (2000) Ultrasound-guided fine-needle aspiration biopsy of the thyroid: role of on-site assessment and multiple cytologic preparations. Diagn Cytopathol 23:425–429CrossRefPubMedGoogle Scholar
  23. 23.
    Zhang S, Ivanovic M, Nemcek AA Jr, Defrias DV, Lucas E, Nayar R (2008) Thin core needle biopsy crush preparations in conjunction with fine needle aspiration for the evaluation of thyroid nodules: a complementary approach. Cancer 114:512–518CrossRefPubMedGoogle Scholar
  24. 24.
    Baloch ZW, Cibas ES, Clark DP et al (2008) The National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference: a summation. CytoJournal 5:6CrossRefPubMedGoogle Scholar
  25. 25.
    Nayar R, Ivanovic M (2009) The indeterminate thyroid fine-needle aspiration. Cancer Cytopathol 3:195–202CrossRefGoogle Scholar
  26. 26.
    Cai XJ, Valiyaparambath N, Nixon P, Waghorn A, Giles T, Helliwell T (2006) Ultrasound-guided fine needle aspiration cytology in the diagnosis and management of thyroid nodules. Cytopathology 17:251–256CrossRefPubMedGoogle Scholar
  27. 27.
    Braga M, Cavalcanti TC, Collaco LM, Graf H (2001) Efficacy of ultrasound-guided fine-needle aspiration biopsy in the diagnosis of complex thyroid nodules. J Clin Endocrinol Metab 86:4089–4091CrossRefPubMedGoogle Scholar
  28. 28.
    Morgan JL, Serpell JW, Cheng MS (2003) Fine-needle aspiration cytology of thyroid nodules: how useful is it? Aust NZ J Surg 73:480–483CrossRefGoogle Scholar
  29. 29.
    Cheung YS, Poon CM, Mak SM et al (2007) Fine-needle aspiration cytology of thyroid nodules-how well are we doing. Hong Kong Med J 13:12–15PubMedGoogle Scholar
  30. 30.
    Hooft L, Hoekstra OS, Boers M et al (2004) Practice, efficacy, and costs of thyroid nodule evaluation: a retrospective study in a Dutch university hospital. Thyroid 14:287–293CrossRefPubMedGoogle Scholar
  31. 31.
    Pitman MB, Abele J, Ali SZ et al (2008) Techniques for thyroid FNA: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol 36:407–424CrossRefPubMedGoogle Scholar
  32. 32.
    Wu HH, Jones JN, Osman J (2006) Fine-needle aspiration cytology of the thyroid: ten years experience in a community teaching hospital. Diagn Cytopathol 34:93–96CrossRefPubMedGoogle Scholar
  33. 33.
    Mehrotra P, Viswanathan H, Johnson SJ, Wadehra V, Richardson DL, Lennard TW (2006) Ultrasound guidance improves the adequacy of our preoperative thyroid cytology but not its accuracy. Cytopathology 17:137–144CrossRefPubMedGoogle Scholar
  34. 34.
    Cooper DS, Doherty GM, Haugen BR et al (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:1–33CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2009

Authors and Affiliations

  • Jason D. Oppenheimer
    • 1
  • Deepa Kasuganti
    • 1
  • Ritu Nayar
    • 1
  • Howard B. Chrisman
    • 1
  • Robert J. Lewandowski
    • 1
  • Albert A. NemcekJr.
    • 1
  • Robert K. Ryu
    • 1
    Email author
  1. 1.Department of RadiologyNorthwestern Medical Faculty FoundationChicagoUSA

Personalised recommendations