Journal of Korean Society of Ultrasound in Medicine 2008;27(4): 213-219.
Analysis of the Malignancy Rate for Thyroid Nodules based on the Use of a Fine Needle Aspiration Biopsy and Ultrasonography.
Ju Wan Choi, Ji Won Park, Han Young Jeong, Hye Jung Kim, Gab Chul Kim, Yong Sun Kim, Ji Young Park, Hui Joong Lee
1Department of Radiology, Kyungpook National University Hospital, Daegu, Korea. knuhrad@yahoo.co.kr
2Department of Pathology, Kyungpook National University Hospital, Daegu, Korea.
  Published online: December 1, 2008.
ABSTRACT
PURPOSE: This study was designed to analyze the malignancy rate for thyroid nodules determined after a fine needle aspiration biopsy (FNAB) and ultrasonography (US) and to propose follow-up FNAB indications. MATERIALS AND METHODS: A total of 287 patients (265 female, 22 male) who underwent repeated US-guided FNABs were included in the cohort study. The results of the FNABs were classified as inadequate, benign, indeterminate, suspicious for a malignancy and a malignancy. The US findings were assigned five grades according to the possibility of a malignancy present. The frequency of a malignant nodule was evaluated by the use of the Kaplan-Meier method and Cox proportional risk model. RESULTS: The malignancy rates of inadequate, benign, and indeterminate nodules were 12.8%, 8.2% and 37.5%, respectively, for the FNAB findings. The rates of grades 3, 4 and 5 were 38.6%, 50.0% and 53.8%, respectively, for the US findings. Inadequate and indeterminate nodules as determined by an FNAB and grades 3, 4 and 5 assigned after US showed a higher malignancy rate than other nodules and would be regarded as high risk lesions. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 93.3%, 38.4%, 22.0%, 96.9% and 47.0%, respectively, if the nodule was considered a high-risk lesion, based on the FNAB or US findings. CONCLUSION: Thyroid nodules should be evaluated based on an FNAB and US findings. If a thyroid nodule is classified as a high-risk lesion, a follow-up study is needed due to the high malignancy rate.
Keywords: Thyroid nodule; Fine needle aspiration biopsy; Thyroid US
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