How to approach thyroid nodules with indeterminate cytology.
BACKGROUND
Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is an accurate, reliable, and simple procedure to perform, and it is nowadays accepted as a standard diagnostic method for the differential diagnosis of thyroid nodules. However, a major limitation of US-FNAB is indeterminate cytology results at a thyroid nodule. This study investigated the clinical and US characteristics that predict malignancy, as well as the role of intraoperative frozen sections (FS) in the treatment of thyroid nodules with indeterminate cytology.


METHODS
From September 2002 to December 2007, the medical records of 181 patients (185 nodules) with indeterminate FNAB cytology results were retrospectively reviewed. Among them, 99 patients (M:F = 13:86; mean age, 43.71 years) with 99 thyroid nodules underwent subsequent surgery with pathologic confirmation. Seventy-eight patients (78.8%) underwent intraoperative FS. US findings of the surgically proven thyroid nodules were retrospectively reviewed. US features, clinical characteristics, and FS results were compared to the surgically proven pathologic results.


RESULTS
Nineteen nodules (19.2%) with indeterminate FNAB cytology were diagnosed as malignant. Lesion size varied from 4 to 70 mm (mean, 27.0 mm). Male patients (46.2%) were more significantly associated with malignancy than female patients (15.1%, P < 0.05). Microlobulated or ill-defined margins (87.5%), microcalcifications (50.0%), and taller-than-wide shape (80.0%) were US features showing correlations with malignancy (P < 0.05). Intraoperative FS significantly predicted malignancy (P < 0.05). Of the 78 cases with FS, 29 cases (37.2%) were deferred. Among the remaining 49 cases, 4 (5.1%) were malignant on FS and subsequent surgical pathology. Forty-five cases (57.7%) were diagnosed as benign on FS, but only two cases were diagnosed as malignant on surgical pathology.


CONCLUSIONS
Ultrasound is a feasible method in predicting malignancy in thyroid nodules with indeterminate FNAB cytology. Also, intraoperative FS is a supportive method with high specificity that may guide the treatment of thyroid nodule with indeterminate cytology.
Yoon
Jung Hyun
JH
Research Institute of Radiological Science, Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea.
Kwak
Jin Young
JY
Kim
Eun-Kyung
EK
Moon
Hee Jung
HJ
Kim
Min Jung
MJ
Kim
Ji Youn
JY
Koo
Hye Ryoung
HR
Kim
Myung Hyun
MH
D000328:Adult; D044963:Biopsy, Fine-Needle / Q000379:methods*; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005260:Female; D005629:Frozen Sections / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012737:Sex Factors; D013964:Thyroid Neoplasms / Q000175:diagnosis*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D018084:Ultrasonography, Interventional