Results of preoperative ultrasound guided fine needle aspiration biopsy of solitary thyroid nodules as compared with the histology

P. Mikosch; U. Wartner; E. Kresnik; H. J. Gallowitsch; M. Heinisch; H. P. Dinges; P. Lind

doi:10.1055/s-0038-1623880

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2001; 40(05): 148-154
DOI: 10.1055/s-0038-1623880

Originalarbeiten – Original Articles

Schattauer GmbH

Results of preoperative ultrasound guided fine needle aspiration biopsy of solitary thyroid nodules as compared with the histology

A retrospective analysis of 538 patientsErgebnisse ultraschallgezielter Feinnadelpunktionen von solitären SchilddrüsenknotenEine retrospektive Analyse von 538 operierten Patienten

Authors

P. Mikosch

¹Department of Nuclear Medicine and Endocrinology, State Hospital Klagenfurt, Austria (Head of the department: Univ.-Doz. Dr. P lind)
U. Wartner

²Department of Pathology, State Hospital Klagenfurt, Austria (Head of the department: Univ.-Prof. Dr. H. P. Dinges)
E. Kresnik

¹Department of Nuclear Medicine and Endocrinology, State Hospital Klagenfurt, Austria (Head of the department: Univ.-Doz. Dr. P lind)
H. J. Gallowitsch

¹Department of Nuclear Medicine and Endocrinology, State Hospital Klagenfurt, Austria (Head of the department: Univ.-Doz. Dr. P lind)
M. Heinisch

¹Department of Nuclear Medicine and Endocrinology, State Hospital Klagenfurt, Austria (Head of the department: Univ.-Doz. Dr. P lind)
H. P. Dinges

²Department of Pathology, State Hospital Klagenfurt, Austria (Head of the department: Univ.-Prof. Dr. H. P. Dinges)
P. Lind

¹Department of Nuclear Medicine and Endocrinology, State Hospital Klagenfurt, Austria (Head of the department: Univ.-Doz. Dr. P lind)

Abstract

Summary

Aim: The goal of this study was to assess the accuracy and limitations of ultrasound guided fine-needle aspiration biopsy (ug-FNAB) of solitary thyroid nodules. Methods: The ug-FNAB results of 538 patients with solitary thyroid nodules, who afterwards underwent thyroid surgery, were compared retrospectively with the histology. Patients with multinodular goiter were excluded from the study. Ug-FNAB was performed on growing and/or hypoechoic and/or hypofunctional nodules. The ug-FNAB results were grouped as follows: group 1: malignant (n = 44); group 2: malignancy cannot be ruled out (n = 173); group 3: non-malignant (n = 296), group 4: inadequate (n = 25). Results: When the cytological results of group 1 and group 2 were interpreted os being malignant and those of group 3 as being benign, sensitivity, specificity and accuracy of ug-FNAB were 96.7%, 65.8% and 69.5% respectively. The 62 thyroid carcinomas (TO biopsied presented in 59 cases a suspicious or malignant cytology (95.2%). The smallest TC diagnosed by ug-FNAB had a diameter of 0.5cm and 36.4% of all papillary TC ≤ 1 cm displayed stage pT4. The histology verified a TC in 18 cases out of the 173 ug-FNABs in group 2. Non-malignant ug-FNABs were confirmed by histology in 294 patients (99.3%) in group 3. In 4.65% of the ug-FNABs inadequate material was aspirated. Conclusion: Nodules with non-suspicious ug-FNAB results can be safely followed-up by sonography, as the cytological diagnoses were verified in more than 99% by histology. Papillary TC can be diagnosed with ug-FNAB very accurately. As stage pT4 was present in more than one third of patients with papillary TC ≤ T cm, ug-FNAB is also recommended for thyroid nodules 0.5-1 cm in diameter located adjacent to the thyroid capsule. However, microfollicular proliferations remain the limitation of ug-FNAB, as the cytology cannot distinguish between benign adenoma and follicular TC.

Zusammenfassung

Ziel: Evaluierung von Effektivität und Grenzen der Ultraschall-gezielten Feinnadelaspirationsbiopsie (ug-FNAB) von solitären Schilddrüsenknoten. Methodik: Die präoperativen ug-FNAB-Ergebnisse von 538 Patienten mit sonographisch beschriebener Struma uninodosa wurden retrospektiv mit der Histologie verglichen. Multinodöse Strumen wurden aus der Studie exkludiert. Die ug-FNAB wurde bei Knoten mit Wachstumstendenz bzw. bei echoarmen und/oder hypofunktionellen Schilddrüsenknoten durchgeführt. Einteilung der ug-FNAB-Ergebnisse: Gruppe 1: maligne (n = 44), Gruppe 2: suspekt, Malignität nicht ausgeschlossen (n = 173), Gruppe 3: benigne (n =296), Gruppe 4: nicht beurteilbar (n = 25) Ergebnisse: Bei Bewertung der Gruppen 1 und 2 als maligne und Gruppe 3 als benigne Resultate ergaben sich folgende Werte für Sensit», Spezifität, Effektivität der ug-FNAB: 96,7%, 65,8%, 69,5%. Von 62 punktierten Schilddrüsenkarzinomen (TC) wiesen 59 TC eine maligne oder suspekte Zytologie auf (95,2%). Das kleinste punktierte TC hatte einen Durchmesser von 0,5 cm und 36,4% aller papillären TC ≤ lern stellten ein pT4-Stadium dar. Unter 173 suspekten ug-FNABs fanden sich 18 TC. Benigne ug-FNAB-Ergebnisse wurden histologisch in 294 Fällen (99,3%) bestätigt, 4,65% der ug-FNAB waren nicht beurteilbar. Schlussfolgerungen: Da sich benigne ug-FNAB-Ergebnisse in über 99% histologisch bestätigten, gestattet der Einsatz der ug-FNAB für solche Fälle ein konservatives Vorgehen mit sonographischen Verlaufskontrollen. Papilläre TC können präoperativ mit hoher Sicherheit erkannt werden. Da mehr als ein Drittel aller Patienten mit papillären TC ≤ 1 cm ein pT4-Stodium aufwiesen, wird die ug-FNAB auch bei Schilddrüsenknoten von 0,5-1 cm mit kapselnaher Lage empfohlen. Als eine der wesentlichen Einschränkungen der ug-FNAB bleiben jedoch zytologische Befunde mit mikrofollikulären Proliferationen bestehen, die zytologisch eine Unterscheidung, zwischen benignen Adenomen und follikulären TC nicht gestatten.

Keywords

Thyroid carcinoma - thyroid nodules - fine needle aspiration biopsy - sonographic guidance - preoperative management of thyroid nodules

Schlüsselwörter

Schilddrüsenkarzinom - Schilddrüsenknoten - Feinnadelpunktion - sonographisch gezielte Punktion - präoperatives Management von Schilddrüsenknoten

Volltext

Referenzen

References
1 Akslen LA, Haldorsen T, Thoresen SO, Glattre E. Survival and causes of death in thyroid cancer: a population-based study of 2479 cases from Norway. Cancer Res 1991; 51: 1234-41.
2 Ashcraft MW, Van Herle AJ. Management of thyroid nodules. I: History and physical examination, blood tests, X-ray tests and sonography. Head Neck Surg 1981; 3: 216-30.
3 Beahrs OH, Henson DE, Hutter RUR. et al. Manual for staging of cancer. American Joint Commission on Cancer. 3rd ed. Philadelphia: JB Lippincott; 1988
4 Bennedbaeck FN, Perrild HJ, Hegedüs L. Diagnosis and treatment of the solitary thyroid nodule. Results of a European survey. Clin Endocrinol (Oxf) 1999; 50: 357-63.
5 Bennedbaeck FN, Perrild HJ, Hegedüs L. Investigation and treatment of solitary thyroid nodules by Danish endocrinologists. A question-aire study. Ugeskr Laeger 1999; 161: 1264-9.
6 Brander A, Viikinkoski P, Nickels J, Kivisaari L. Thyroid gland: US screening in a random adult population. Radiology 1991; 181: 683-7.
7 Campbell JP, Pillsbury 3rd HC. Management of the thyroid nodule. Head Neck 1989; 11: 414-25.
8 Carmeci C, Jeffrey RB, McDougall IR, Nowels KW, Weigel RJ. Ultrasound-guided fine-needle aspiration biopsy of thyroid masses. Thyroid 1998; 8: 283-9.
9 Caruso D, Mazzaferri EL. Fine needle aspiration biopsy in the management of thyroid nodules. The Endocrinologist 1991; 194-202.
10 Cochand-Priollet B, Guillausseau PJ, Chagon S, Hoang C, Guillausseau-Scholer C, Chanson P, Dahan H, Warnet A, Tran Ba Huy P, Valleur P. The diagnostic value of fine-needle aspiration biopsy under ultrasonography in nonfunctional thyroid nodules: a prospective study comparing cytologic and histologic findings. Am J Med 1994; 97: 152-7.
11 Dáñese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid 1998; 8: 15-21.
12 DeMay RM. The art and science of cytopathol-ogy. Chicago: ASCP Press:; 1996: 704-78.
13 De Roy van Zuidewijn DBW, Dongun I, Hamming J, Kievit J, van de Velde CJH, Veselie M. Preooperative diagnostic tests for operable thyroid disease. World J Surg 1994; 18: 506-11.
14 Dietlein M, Dressler J, Joseph K, Leisner B, Moser E, Reiners C, Rendí J, Scicha H, Schober O. Leitlinie zur Schilddrüsendiagnostik (Guidelines in thyroid diagnosis). Nuklearmedizin 1999; 38: 215-8.
15 Fukunaga FH, Yatani R. Geographie pathology of occult thyroid carcinomas. Cancer 1975; 36: 1095-9.
16 Galera H, Gonzalez-Campora R. Thyroid. In: Comprehensive cytopathology 2nd edition. Bibbo M. eds. Philadelphia: WB. Saunders Company; 1997: 673-701.
17 Galvan G, Pohl GB, Skerbisch I. Die Feinnadelpunktion “kalter” Strumaknoten bei 4555 Patienten eines Strumaendemiegebietes: Ergebnisse und klinische Bedeutung. Schweiz Med Wschr 1976; 106: 1247-51.
18 Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Annals Internal Med 1993; 118: 282-9.
19 Hall TL, Layfield LJ, Philippe A, Rosenthal DL. Sources of diagnostic error in fine needle aspiration of the thyroid. Cancer 1989; 63: 718-25.
20 Hamburger JI. Diagnosis of thyroid nodules by fine needle biopsy: use and abuse. J Clin Endocrinol Metab 1994; 79: 335-9.
21 Hatada T, Okada K, Ishii H, Ichii S, Utsuno-miya J. Evaluation of ultrasound-guided fine-needle aspiration biopsy for thyroid nodules. Am J Surg 1998; 175: 133-6.
22 Hegedüs L, Karstrup S. Ultrasonography in the evaluation of cold thyroid nodules. Eur J Endocrinology 1998; 138: 30-1.
23 Khurana KK, Richards VI, Chopra PS, Izquierdo R, Rubens D, Mesonero C. The role of ultrasonography-guided fine-needle aspiration biopsy in the management of nonpalpable and palpable thyroid nodules. Thyroid 1998; 8: 511-5.
24 Kini SR. The thyroid. In: Guides to clinical aspiration biopsy. Kline TS. eds. New York: Igaku Shoin; 1987
25 Kresnik E, Gallowitsch HJ, Mikosch P, Unterweger O, Gomez I, Lind P. Scintigraphic and ultrasonographic appearance in different tumor stages of thyroid carcinoma. Acta Med Austriaca 2000; 27: 32-5.
26 Kuma K, Matsuzuka F, Yokozawa T, Miyauchi A, Sugawara M. Fate of untreated benign thyroid nodules: results of long-term follow-up. World J Surg 1994; 18: 495-9.
27 Lang W, Borrusch H, Bauer L. Occult carcinomas of the thyroid. Evaluation of 1.020 sequential autopsies. Am J Clin Pathol 1988; 90: 72-6.
28 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: 24-8.
29 Martinez-Tello FJ, Martinez-Cabruja R, Fernandez-Martin J, Lasso-Oria C, Ballestin-Carca-villa C. Occult carcinoma of the thyroid. A systematic autopsy study from Spain of two series performed with two different methods. Cancer 1993; 71: 4022-9.
30 Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med 1993; 328: 553-9.
31 Mikosch P, Gallowitsch HJ, Kresnik E, Jester J, Würtz FG, Kerschbaumer K, Unterweger O, Dinges HP, Lind P. Value of ultrasound-guided fine needle aspiration biopsy of thyroid nodules in an endemic goitre area. Eur J Nucl Med 2000; 27: 62-9.
32 Morengo Egea A, Rodriguez Gonzalez JM, Sola Perez J, Soria Cogollos T, Parrilla Paricio P. Multivariate analysis of histopathological features as prognostic factors in patients with papillary thyroid carcinoma. Br J Surg 1995; 82: 1092-4.
33 Nguyen GK, Ginsberg J, Crockford PM. Fine-needle aspiration biopsy cytology of the thyroid. Pathol Annu 1991; 26: 63-92.
34 Oertel YC. A pathologist’s comments on diagnosis of thyroid nodules by fine needle aspiration (letter). J Clin Endocrinol Metab 1995; 80: 1467-8.
35 Pristautz H, Petritsch W, Schreiber F, Warnkross H, Pietsch B, Passath A, Leb G, Tilz GP, Kellner A. Sonography and cytology of cold thyroid nodules. Fortschr Rontgenstr 1989; 150: 250-4.
36 Rago T, Vitti P, Chiovato L, Mazzeo S, De Liperi A, Miccoli P, Viacava P, Bogazzi F, Martino E, Pinchera A. Role of conventional ultrasonography and color flow-doppler sonography in predicting malignancy in “cold” thyroid nodules. Eur J Endocinology 1998; 138: 41-6.
37 Rosen IB, Azadian A, Walfish PG, Salem S, Lansdown E, Bedard YC. Ultrasound-guided fine-needle aspiration biopsy in the management of thyroid disease. Am J Surg 1993; 166: 346-9.
38 Salvesen H, Njolstad PR, Akslen LA, Albrektsen G, Soreide O, Varhaug JE. Papillary thyroid carcinoma: a multivariate analysis of prognostic factors including an evaluation of the p-TNM staging system. Eur J Surg 1992; 158: 583-9.
39 Takashima S, Fukada H, Kobayashi T. thyroid nodules: clinical effect of ultrasound-guided fine-needle aspiration biopsy. J Clin Ultrasound 1994; 22: 535-42.
40 Yokozawa T, Miyauchi A, Kuma K, Sugawara M. Accurate and simple method of diagnosing thyroid nodules by modified technique of ultrasound-guided fine needle aspiration biopsy. Thyroid 1995; 5: 141-5.