title: Preoperative assessment of thyroid nodules: role of ultrasonography and fine needle aspiration biopsy followed by cytology.
abstract: OBJECTIVE
  To evaluate the preoperative assessment of thyroid nodules using ultrasound studies and cytology of nodular aspirates.
  
  
  METHODS
  2,468 patients with thyroid nodules were examined from 1999 to 2005. All patients were clinically examined and underwent ultrasonography followed by fine-needle aspiration biopsy (FNAB) and cytology.
  
  
  RESULTS
  Nodules larger than 10 mm were classified ultrasonographically in a 4-tier system and received a score according to the criterion of possible malignancy. Cytological examinations were conducted independently by 2 cytologists and classified as benign (score 1), indeterminate (score 2), suspicious (score 3), and malignant (score 6). Combining both scores, an index was generated that would indicate a higher probability of malignancy (benign, doubtful, suspicious, and malignant). Thyroid surgery was performed in 274 patients. Of those, 115 patients had a score of 2 to 5 and only 8 had a histological diagnosis of thyroid cancer (6.9%). For patients with a score of 5 (n = 51), 11.5% had a malignant lesion, and 51% of the 61 patients with a score of 6 had confirmed thyroid cancer. Of the 98 patients with a combined score of 7 to 10, 99% had a histological confirmation of malignancy.
  
  
  CONCLUSIONS
  The index score had a sensitivity of 94.1% and specificity of 77.5%. The overall accuracy was 85.8%. Therefore, we concluded that this methodology may improve the preoperative diagnosis of thyroid cancer in nodules larger than 10 mm. Association with other methods such as color Doppler echography, serum TSH concentration, galectin-3 expression analysis, and FDG/PET scan would be useful in avoiding the higher costs of thyroid surgical procedures.
authors.affiliation: Hospital das Clínicas, Endocrinology, Thyroid Unit (LIM25), Brazil.
authors.forename: Rosalinda Ya
authors.initials: RY
authors.lastname: Camargo
authors.forename: Eduardo K
authors.initials: EK
authors.lastname: Tomimori
authors.forename: Meyer
authors.initials: M
authors.lastname: Knobel
authors.forename: Geraldo
authors.initials: G
authors.lastname: Medeiros-Neto
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy; D014463:Ultrasonography