The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy for thyroid nodules three centimeters or larger in size

Diagn Cytopathol. 2015 Aug;43(8):622-8. doi: 10.1002/dc.23289. Epub 2015 Apr 25.


Background and purpose: Whether under ultrasonography (US) guidance or not, fine-needle aspiration biopsy (FNAB) has some limitations, particularly in larger nodules. In this study, we aimed to evaluate the diagnostic value of US-guided fine-needle aspiration biopsy (US-FNAB) in thyroid nodules equal to or larger than 3 cm.

Materials and methods: Data of 267 patients operated for nodular goiter in the period of January 2006 and March 2012 were reviewed retrospectively. The study group (40 males, 104 females; mean age 42.3 ± 12.3, between 17 and 71) consisted of patients with nodules with a diameter of 3 cm or larger. Patients with nodules less than 3 cm in diameter were considered as the control group (27 males, 96 females; mean age 44.4 ± 11.9, between 18 and 71).

Results: For nodules smaller than 3 cm, US-FNAB had an accuracy rate of 60% and a false negativity rate of 21.9%. In nodules equal to or larger than 3 cm, the accuracy rate of US-FNAB was 80%, with a false negativity rate of 6.7%. Malignancy was observed in 16% of the study group and 42.3% of the control group.

Conclusion: This study showed that increased nodule diameter is not associated with limitations in the diagnostic value of US-FNAB. We also found that the malignancy rate was smaller for larger nodules. This finding reflects the importance of accurate and rational diagnostic work-up and clinical management for detecting malignancy and surgical decision-making.

Keywords: diagnostic accuracy; fine-needle aspiration biopsy; histopathology; thyroid nodule; ultrasonography.

MeSH terms

  • Adenocarcinoma, Follicular / diagnosis*
  • Adenocarcinoma, Follicular / pathology
  • Adenocarcinoma, Follicular / surgery
  • Adenocarcinoma, Papillary / diagnosis*
  • Adenocarcinoma, Papillary / pathology
  • Adenocarcinoma, Papillary / surgery
  • Adolescent
  • Adult
  • Aged
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration
  • False Negative Reactions
  • Female
  • Goiter, Nodular / diagnosis*
  • Goiter, Nodular / pathology
  • Goiter, Nodular / surgery
  • Histocytochemistry
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Sensitivity and Specificity
  • Thyroid Gland / pathology
  • Thyroid Gland / surgery
  • Thyroid Neoplasms / diagnosis*
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / surgery
  • Thyroid Nodule / diagnosis*
  • Thyroid Nodule / pathology
  • Thyroid Nodule / surgery
  • Thyroidectomy*
  • Tumor Burden