Journal of Korean Society of Ultrasound in Medicine 2011;30(3): 179-185.
US Diagnosis for Thyroid Nodules with an Indeterminate Cytology.
Jong Geun Ha, Dong Wook Kim, Tae Woo Kang
1Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea. dwultra@lycos.co.kr
2Department of General Surgery, Saegyaero Hospital, Busan, Korea.
  Published online: September 1, 2011.
ABSTRACT
PURPOSE: We wanted to assess the diagnostic efficacy of thyroid ultrasound (US) for evaluating thyroid nodules with indeterminate cytology. MATERIALS AND METHODS: Among 1865 nodules in 1278 patients who received a prospective US diagnosis of their thyroid nodule(s) and who subsequently underwent US-guided fine-needle aspiration, 130 nodules with indeterminate cytology were enrolled in the study. Each thyroid nodule was prospectively classified by a single radiologist into 1 of 5 diagnostic categories: "benign", "probably benign", "indeterminate", "suspicious for malignancy" and "malignant." The solid nodules were classified using all 5 categories and the partially cystic nodules classified using 4 categories ("indeterminate" was omitted). We calculated the diagnostic efficacy of thyroid US by comparing the US diagnoses with the pathology results. RESULTS: Of 130 nodules with indeterminate cytology (130/1865, 7.0%), 62 nodules were surgically removed. Nineteen nodules were assigned to the indeterminate category on US. The malignantly rate of the US-indeterminate category was 56.5% (35/62). The sensitivity, specificity and positive and negative predictive values were 81.0%, 81.8%, 81.0%, 81.8% and 81.4%, respectively, when US-indeterminate nodules were excluded. There was no significant difference of diagnostic efficacy when these nodules were reclassified as malignant, but there was a significant difference of diagnostic efficacy when these nodules were reclassified as benign. CONCLUSION: Our US classification may be a feasible method for managing thyroid nodules with indeterminate cytology.
Keywords: Thyroid nodule; Ultrasound; Fine-needle aspiration; Indeterminate; Malignancy
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