Skip to main content
SpringerLink
Log in

The effects of sonographic and demographic features and needle size on obtaining adequate cytological material in sonography-guided fine-needle aspiration biopsy of thyroid nodules

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

The aim of this study is to investigate the effects of the sonographic characteristics of the nodule, demographic features of patient, and nodule size and needle size used for sampling, on obtaining adequate cytological material (CM) in thyroid fine-needle aspiration biopsy (FNAB). We performed 270 FNAB between September 2010 and June 2012. Size, echogenicity, and localization of all nodules were evaluated by ultrasonography (US) before the biopsy. Nodules were grouped as <1, 1–3, and >3 cm according to their size and as hypoechoic, isoechoic, hyperechoic, or heterogeneous according to their US characteristics. 20-, 22-, and 24-G needles were used for the biopsies. Different sonographic characteristics of the nodules did not affect the needle selection. All specimens were classified as adequate or inadequate CM by a cytopathologist. A total of 270 nodules were biopsied, 184 (68.1 %) specimens were considered as adequate CM and 86 (31.9 %) specimens were considered as inadequate CM. Patient age and the presence of heterogeneous echogenicity were found to have prognostic significance in univariate analysis (p < 0.05). In a multivariate logistic regression model with forward stepwise method, advanced age (p = 0.001, OR = 1.042, 95CI 1.018–1.068) and heterogeneous echogenicity (p = 0.017, OR = 1.955, 95CI 1.129–3.385) remained associated with an increased risk of inadequate CM obtainment after adjustment for other potential confounders (nodule size >3 cm and needle size 20-G usage) and variables found to be statistically significant in univariate analysis. Non-diagnostic FNAB remains a significant problem in the evaluation of thyroid nodules and can be as high as 30 %. Inadequate CM rates for elderly patients and heterogeneous nodules were significantly higher than that for other factors. The nodule size and needle size used for sampling did not affect the adequacy of FNAB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. F. Pacini, M. Schlumberger, H. Dralle, R. Elisei, J.W. Smit, W. Wiersinga, European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur. J. Endocrinol. 154, 787–803 (2006)

    Article  PubMed  CAS  Google Scholar 

  2. AACE/AME Task Force on Thyroid Nodules, American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr. Pract. 12, 63–102 (2006)

    Google Scholar 

  3. D.S. Cooper, G.M. Doherty, B.R. Haugen, R.T. Kloos, S.L. Lee, S.J. Mandel et al., Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16, 109–142 (2006)

    Article  PubMed  Google Scholar 

  4. P.W. Wiest, M.F. Hartshorne, P.D. Inskip et al., Thyroid palpation versus high-resolution thyroid ultrasonography in the detection of nodules. J. Ultrasound Med. 17, 487–496 (1998)

    PubMed  CAS  Google Scholar 

  5. T. Yokozawa, S. Fukata, K. Kuma et al., Thyroid cancer detected by ultrasound-guided fine-needle aspiration biopsy. World J. Surg. 20, 848–853 (1996)

    Article  PubMed  CAS  Google Scholar 

  6. D.S. Ross, Nonpalpable thyroid nodules-managing an epidemic. J. Clin. Endocrinol. Metab. 87, 1938–1940 (2002)

    Article  PubMed  CAS  Google Scholar 

  7. F.N. Tessler, M.E. Tublin, Thyroid sonography: current applications and future directions. Am. J. Roentgenol. 173, 437–443 (1999)

    Article  CAS  Google Scholar 

  8. M. Gümüş, N. Cay, O. Algin et al., Comparison of 21 and 27 gauge needles for determining sample adequacy in the aspiration biopsy of thyroid nodules. Diagn. Interv. Radiol. 18(1), 102–105 (2012)

    PubMed  Google Scholar 

  9. B. Degirmenci, A. Haktanir, R. Albayrak 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. Radiol. 62, 798–803 (2007)

    Article  PubMed  CAS  Google Scholar 

  10. T. Lowhagen, E. Sprenger, Cytologic presentation of thyroid tumors in aspiration biopsy smear. A review of 60 cases. Acta Cytol. 18, 192–197 (1974)

    PubMed  CAS  Google Scholar 

  11. T. Lowhagen, P.O. Granberg, G. Lundell et al., Aspiration biopsy cytology (ABC) in nodules of the thyroid gland suspected to be malignant. Surg. Clin. North Am. 59, 3–18 (1979)

    PubMed  CAS  Google Scholar 

  12. M.S. Deveci, G. Deveci, V.A. LiVolsi et al., Fine-needle aspiration of follicular lesions of the thyroid. Diagnosis and follow-up. Cytojournal 3, 9 (2006)

    Article  PubMed  Google Scholar 

  13. S.R. Orell, J. Philips, The thyroid: fine-needle biopsy and cytological diagnosis of thyroid lesions. Monogr. Clin. Cytol. 14, 1–205 (1997)

    Article  Google Scholar 

  14. H. Gharib, J.R. Goellner, D.A. Johnson, Fine-needle aspiration cytology of the thyroid. A 12-year experience with 11,000 biopsies. Clin. Lab. Med. 13, 699–709 (1993)

    PubMed  CAS  Google Scholar 

  15. L.J. Layfield, E.S. Cibas, H. Gharib, S.J. Mandel, Thyroid aspiration cytology: current status. CA Cancer J. Clin. 59, 99–110 (2009)

    Article  PubMed  Google Scholar 

  16. K. Gul, R. Ersoy, A. Dirikoc, B. Korukluoglu et al., Ultrasonographic evaluation of thyroid nodules: comparison of ultrasonographic, cytological, and histopathological findings. Endocrine 36, 464–472 (2009)

    Article  PubMed  CAS  Google Scholar 

  17. P. Mavec, Cytological diagnosis from tumor tissue using the ‘‘quick method’’ during operation. Acta Cytol. 11, 229–230 (1967)

    PubMed  CAS  Google Scholar 

  18. J.T. Godwin, Rapid cytological diagnosis of surgical specimens. Acta Cytol. 20, 111–115 (1976)

    PubMed  CAS  Google Scholar 

  19. C. Carmeci, R.B. Jeffrey, I.R. McDougall et al., Ultrasoundguided fine-needle aspiration biopsy of thyroid masses. Thyroid 8, 283–289 (1998)

    Article  PubMed  CAS  Google Scholar 

  20. M.S. Sabel, D. Haque, J.M. Velasco et al., Use of ultrasound guided fine needle aspiration biopsy in the management of thyroid disease. Am. Surg. 64, 738–741 (1998)

    PubMed  CAS  Google Scholar 

  21. E.K. Kim, C.S. Park, W.Y. Chung et al., New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. Am. J. Roentgenol. 178, 687–691 (2002)

    Article  Google Scholar 

  22. I.S. Nam-Goong, H.Y. Kim, G.I. Gong et al., Ultrasonography guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings. Clin. Endocrinol. 60, 21–28 (2004)

    Article  Google Scholar 

  23. O. Algin, E. Algin, G. Gokalp et al., Role of duplex power Doppler ultrasound in differentiation between malignant and benign thyroid nodules. Korean J. Radiol. 11, 1–5 (2010)

    Article  Google Scholar 

  24. I.B. Rosen, A. Azadian, P.G. Walfish et al., Ultrasound-guided fine-needle aspiration biopsy in the management of thyroid disease. Am. J. Surg. 166, 346–349 (1993)

    Article  PubMed  CAS  Google Scholar 

  25. D. Danese, S. Sciacchitano, A. Farsetti et al., Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid 8, 15–21 (1998)

    Article  PubMed  CAS  Google Scholar 

  26. C. Ravetto, L. Colombo, M.E. Dottorini, Usefulness of fine needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients. Cancer 90, 357–363 (2000)

    Article  PubMed  CAS  Google Scholar 

  27. D.N. Poller, A.K. Ibrahim, M.H. Cummings et al., Fine-needle aspiration of the thyroid. Cancer 90, 239–244 (2000)

    Article  PubMed  CAS  Google Scholar 

  28. Z.W. Baloch, D. Tam, J. Langer et al., Ultrasound-guided fine needle aspiration biopsy of the thyroid: role of on-site assessment and multiple cytological preparations. Diagn. Cytopathol. 23, 425–429 (2000)

    Article  PubMed  CAS  Google Scholar 

  29. V. Tangpricha, B.J. Chen, N.C. Swan et al., Twenty-one-gauge needles provide more cellular samples than twenty-five-gauge needles in fine-needle aspiration biopsy of the thyroid but may not provide increased diagnostic accuracy. Thyroid 11, 973–976 (2001)

    Article  PubMed  CAS  Google Scholar 

  30. K.C. Suen, Fine-needle aspiration biopsy of the thyroid. CMAJ 167, 491–495 (2002)

    PubMed  Google Scholar 

  31. A.E. Hanbidge, A.M. Arenson, P.A. Shaw, J.P. Szalai, P.A. Hamilton, C. Leonhardt, Needle size and sample adequacy in ultrasound-guided biopsy of thyroid nodules. Can. Assoc. Radiol. J. 46, 199–201 (1995)

    PubMed  CAS  Google Scholar 

  32. W.J. Moon, S.L. Jung, J.H. Lee, D.G. Na, J.H. Baek, Y.H. Lee et al., Benign and malignant thyroid nodules: US differentiation-multicenter retrospective study. Radiology 247, 762–770 (2008)

    Article  PubMed  Google Scholar 

  33. E.K. Alexander, J.P. Heering, C.B. Benson, M.C. Frates, P.M. Doubilet, E.S. Cibas et al., Assessment of nondiagnostic ultrasound guided fine needle aspirations of thyroid nodules. J. Clin. Endocrinol. Metab. 87, 4924–4927 (2002)

    Article  PubMed  CAS  Google Scholar 

  34. G. Ceresini, L. Corcione, S. Morganti, B. Milli, L. Bertone, R. Prampolini, S. Petrazzoli, M. Saccani, G.P. Ceda, G. Valenti, Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules, coupled with on-site cytologic review, improves results. Thyroid 14, 385–389 (2004)

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declared no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, School of Medicine, Sütçü İmam University, Kahramanmaraş, Turkey

    Mehmet Fatih İnci, Fuat Özkan & Mürvet Yüksel

  2. Department of Radiology, School of Medicine, Cumhuriyet University, Sivas, Turkey

    İsmail Şalk

  3. Department of Endocrinology, School of Medicine, Sütçü İmam University, Kahramanmaraş, Turkey

    Murat Şahin

Authors
  1. Mehmet Fatih İnci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fuat Özkan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mürvet Yüksel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. İsmail Şalk
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Murat Şahin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mehmet Fatih İnci.

Rights and permissions

Reprints and permissions

About this article

Cite this article

İnci, M.F., Özkan, F., Yüksel, M. et al. The effects of sonographic and demographic features and needle size on obtaining adequate cytological material in sonography-guided fine-needle aspiration biopsy of thyroid nodules. Endocrine 43, 424–429 (2013). https://doi.org/10.1007/s12020-012-9784-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-012-9784-y

Keywords

Search

Navigation