title: Ultrasound-guided fine-needle aspiration of thyroid nodules: does size matter?
abstract: OBJECTIVE
  Some authors have questioned the benefit of fine-needle aspiration (FNA) of thyroid nodules ≥ 4 cm. They report that the results of the FNA are not as reliable when compared to nodules <4 cm. The aims of this study are to evaluate the accuracy and predictive values of ultrasound-guided FNA (USFNA) of thyroid nodules ≥ 4 cm and compare these findings to nodules <4 cm.
  
  
  METHODS
  A retrospective study of 998 patients who underwent thyroid surgery between 2006 and 2012 at the McGill University Thyroid Cancer Center was performed. USFNA and post-operative pathology diagnoses of nodules ≥ 4 cm versus those <4 cm were compared. Pre-operative USFNA results were divided into three groups: benign, indeterminate, and malignant/suspicious for malignancy subgroups. Post-operative results were separated into benign and malignant groups.
  
  
  RESULTS
  There were 225 patients with nodules ≥ 4 cm and 773 patients with nodules <4 cm. The sensitivity, specificity, positive predictive value and negative predictive value for USFNA of nodules ≥ 4 cm were 84.62% (CI 71.91-93.10), 91.49% (CI 79.6-97.58), 91.67% (CI 80.0-97.63) and 84.31% (CI 71.4-92.95), respectively. The sensitivity, specificity, positive predictive value and negative predictive value for USFNA of nodules <4 cm were 90.48% (CI 86.1-93.8), 85.92% (CI 75.6-93.02), 95.8% (CI 92.41-97.96) and 71.76% (CI 60.95-81.0), respectively. The difference in diagnostic accuracy of USFNA between both groups was not statistically significant (p>0.05).
  
  
  CONCLUSIONS
  This study shows that the sensitivity, specificity, positive predictive value and negative predictive value for USFNA of nodules ≥ 4 cm are similar to that of smaller nodules. It is therefore suggested that these nodules undergo USFNA.
authors: McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, Montreal, QC, Canada. Electronic address: Rickul.varshey@gmail.com.
authors: Rickul
authors: R
authors: Varshney
authors: McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, Montreal, QC, Canada.
authors: Veronique-Isabelle
authors: VI
authors: Forest
authors: McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, Montreal, QC, Canada.
authors: Faisal
authors: F
authors: Zawawi
authors: McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, Montreal, QC, Canada.
authors: Louise
authors: L
authors: Rochon
authors: McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, Montreal, QC, Canada.
authors: Michael P
authors: MP
authors: Hier
authors: McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, Montreal, QC, Canada.
authors: Alexander
authors: A
authors: Mlynarek
authors: McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, Montreal, QC, Canada.
authors: Michael
authors: M
authors: Tamilia
authors: McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, Montreal, QC, Canada.
authors: Richard J
authors: RJ
authors: Payne
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography