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Indications and Limits of Ultrasound-Guided Cytology in the Management of Nonpalpable Thyroid Nodules

Departments of Nuclear Medicine (L.L., L.D.P.F., D.L.G., T.D., C.G., A.A.), General and Gastrointestinal Surgery (F.M.), Pathology (C.H.), and Endocrinology (G.T.) and the Quantitative Medical Imaging Research Unit, INSERM U-494 (L.L., G.H., B.F., A.A.), Pitié Hospital, 75013 Paris; the Department of Pathology (B.F.), Ambroise Paré Hospital, 92100 Boulogne-Billancourt, France

Address all correspondence and requests for reprints to: Dr. L. Leenhardt, Service Central de Médecine Nucléaire, Groupe Hospitalier Pitié-Salpêtrière, 83 boulevard de l’Hôpital, 75013 Paris, France.

Although ultrasound (US)-guided fine needle aspiration biopsy (FNAB) is widely prescribed in nonpalpable thyroid nodules, the goal of this study was to define precisely the indications and limits of US-FNAB in a series of 450 nonpalpable nodules. Among 94 surgically controlled cases, 20 (8 infracentimetric and 12 centimetric or supracentimetric) carcinomas were diagnosed. The diagnosis of malignancy was successfully made by US-FNAB in 16 of 20 carcinomas, 3 were missed because of insufficient cytological material, and 1 was misdiagnosed. US-FNAB sensitivity and specificity were 94% and 63%, respectively. A logistic model indicated that nodule size (P < 0.6) was not associated with histological diagnosis, but that solid hypoechoic features were more likely to be malignant (P < 0.0003), with US sensitivity and specificity for malignancy of 80% and 70%, respectively. Logistic regression indicated that adequate cytological material significantly increased with nodule size (P < 0.0001). This result outlined the limits of US-FNAB in small nodules. Hence, indication of US-FNAB appears judicious in centimetric or supracentimetric nodules or in solid and hypoechoic ones. Such a management would allow the discovery of 15 of 20 carcinomas and would avoid 16% of unnecessary biopsies.

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