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Thyroid Nodules with Repeat Nondiagnostic Cytologic Results: The Role of Clinical and Ultrasonographic Findings

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Abstract

Objectives

Ultrasound-guided fine-needle aspiration (FNA) is the most valuable procedure in the diagnosis of thyroid nodules. One possible result of FNA of thyroid nodules, however, is “nondiagnostic” cytology. In these cases, consensus guidelines suggest repeating FNA with ultrasound guidance, but the results obtained may continue to be nondiagnostic. These results cause confusion due to the fact that there exist conflicting potential treatment modalities, such as performing diagnostic surgery or recommending follow-up. Hence, the present study aimed to establish a protocol for performing diagnostic operations for thyroid nodules with repeat nondiagnostic cytology.

Materials and methods

This study was performed on patients who underwent ultrasound-guided FNA and molecular testing for BRAF gene mutation. Out of 1,203 patients, 84 had nondiagnostic cytology and were BRAF negative, and ultrasound-guided FNA was repeated on these patients. Out of this group, 54 patients once again had nondiagnostic cytology, and 51 of these underwent diagnostic surgery. We analyzed the characteristics and ultrasonographic findings of the group of patients with repeat nondiagnostic cytology.

Results

On the initial ultrasound-guided FNA, the percentage of patients with nondiagnostic cytology was 6.98 %, and on repeat ultrasound-guided FNA, the percentage of patients with nondiagnostic cytology was 67.5 %. The majority of these patients underwent diagnostic surgery, and 36 (70.6 %) patients were diagnosed as having a malignant thyroid nodule, while15 (29.4 %) patients were diagnosed with a benign nodule. Univariate analysis showed a significant difference in the size of the nodule, hypoechogenicity, and microcalcification in the ultrasonography findings. Multivariate analysis revealed only hypoechogenicity as a factor that showed a significant difference (p value 0.017, 95 % confidence interval 1.494-62.426).The diagnostic accuracy of the ultrasonography was 76.5 %.

Conclusions

Hypoechogenicity on ultrasonography represents an excellent parameter for the selection of those who should be referred for diagnostic operation among patients with thyroid nodules and repeat nondiagnostic cytology.

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Acknowledgments

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT, and Future Planning (2013R1A1A1012542). This research was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (MEST) (2012K1A4A3053142).

Funding

No financial or material support has been received for this work; moreover, the authors declare no financial interests in companies or other entities that could have an interest in the information within this contribution.

Conflict of interest

None of the authors have any conflicts of interest, financial or otherwise.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Gyeongsang National University, 90 Chilam-dong, Jinju, South Korea

    Seung Hoon Woo & Kyung Hee Kim

  2. Institute of Health Sciences, Gyeongsang National University, 90 Chilam-dong, Jinju, South Korea

    Seung Hoon Woo

  3. College of Nursing, Gyeongsang National University, Jinju, South Korea

    Kyung Hee Kim

  4. Dong-A University Hospital Regional Cardiocerebrovascular Center, Busan, South Korea

    Rock Bum Kim

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  1. Seung Hoon Woo
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Correspondence to Seung Hoon Woo.

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Woo, S.H., Kim, K.H. & Kim, R.B. Thyroid Nodules with Repeat Nondiagnostic Cytologic Results: The Role of Clinical and Ultrasonographic Findings. World J Surg 39, 1721–1727 (2015). https://doi.org/10.1007/s00268-015-3013-9

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