Diagnostic Value of Ultrasound-Guided Fine Needle Aspiration Biopsy in Malignant Thyroid Nodules: Utility for Micronodules

  • Unal, Betul (Pathology, Medical School, Akdeniz University) ;
  • Sezer, Cem (Pathology, Antalya Education And Research Hospital)
  • Published : 2014.11.06


Background: The diagnostic approach to thyroid nodules involves ultrasound-guided fine needle aspiration biopsy (US-FNAB). We especially aimed to evaluate the contribution and the place of US-FNAB in preoperative evaluation of the malignant cases and draw attention to discordant cases diagnosed with papillary thyroid microcarcinoma (PTMC). Materials and Methods: A total of 276 cases were retrospectively reviewed who were subsequently diagnosed with a malignancy and who underwent US-FNAB. Results: Some 45 were found to have previously undergone the US-FNAB procedure. Of the patients in whom the surgical specimen was diagnosed with a malignancy, 21 (46.7%) were diagnosed as malignant or suspicious for malignancy, and 24 (53.3%) were concluded as benign or insufficient for diagnosis. Patients with the diagnosis of PTMC outnumbering the others was a striking finding (11 cases, 24%). Conclusions: We suggest performing repeat aspiration biopsy considering sampling errors in cases where inconsistency exists between clinical findings and cytological results in thyroid nodules smaller than 10 mm in diameter and with suspicious findings on ultrasonography.


  1. Caraway NP, Snegie N, Samaan NA (1993). Diagnostic pitfalls in thyroid fine needle aspiration, review of 394 cases. Diagn Cytopathol, 9, 345-50.
  2. Cheng P, Chen ED, Zheng HM, et al (2013). Ultrasound score to select subcentimeter-sized thyroid nodules requiring ultrasound-guided fine needle aspiration biopsy in eastern China. Asian Pac J Cancer Prev, 14, 4689-92.
  3. Chow SM, Law SC, Chan JK, et al (2003). Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality. Cancer, 98, 31-40.
  4. Cooper DS, Doherty GM, Haugen BR, et al (2009). Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 19, 1167-214.
  5. Falvo L, D'Ercole C, Sorrenti S, et al (2003). Papillary microcarcinoma of the thyroid gland, analysis of prognostic factors including histological subtype. Eur J Surg Suppl, 588, 28-32.
  6. Fukunaga FH, Yatani R, Niepolomska W (1975). Latent thyroid carcinoma in the material of the Institute of Oncology in Gliwice. Nowotwory, 25, 223-8.
  7. Geisinger KR, Rainer RO, Field AS (1999), Lymph nodes. In, Geisinger KR, Silverman JF, ed. Fine needle aspiration cytology of superficial organs and body sites, New York, Churchill-Livingstone, 85.
  8. Kilicturgay S, Ozguc H, Irgil C, Sadikoglu Y (1992). Fine-needle aspiration biopsy in thyroid nodules and the effect of surgical decision. Ulusal Cerrahi Dergisi, 9, 260-7.
  9. Gharib H, Papini E, Valcavi R, et al (2006). AACE/AME task force on thyroidnodules. american association of clinical endocrinologists and associazione medici endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract, 12, 63-102.
  10. Harach HR, Franssila KO, Wasenius VM (1985). Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study. Cancer, 56, 531-8.<531::AID-CNCR2820560321>3.0.CO;2-3
  11. Hay ID, Grant CS, van Heerden JA, et al (1992). Papillary thyroid microcarcinoma, a study of 535 cases observed in a 50-year period. Surgery, 112, 1139-46.
  12. Kim DW, Kim SH, Jung SJ (2010). Successful sonographyguided fine-needle aspiration biopsy of a 1-millimeterdiameter papillary thyroid microcarcinoma. AJNR Am J Neuroradiol, 31, 1082-4.
  13. Lantsov DS (2006). Thyroid microcarcinoma. Arkh Patol, 68, 54-7.
  14. Lin KD, Lin JD, Huang MJ, et al (1997). Clinical presentations and predictive variables of thyroid microcarcinoma with distant metastasis. Int Surg, 82, 378-81.
  15. Mazzaferri EL, Kloos RT (2001). Clinical review 128, Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab, 86, 1447-63.
  16. Nam-Goong IS, Kim HY, Gong G, et al (2004). Ultrasonographyguided fine-needle aspiration of thyroid incidentaloma, correlation with pathological findings. Clin Endocrinol, 60, 21-8.
  17. Samson RJ (1977) Prevalence and significant of occult thyroid cancer. In, DeGroot LJ (ed) Radiation-associated thyroid carcinoma. Grune&Stratton, New York, pp 137-153.
  18. Peli M, Capalbo E, Lovisatti M, et al (2012). Ultrasound guided fine-needle aspiration biopsy of thyroid nodules, Guidelines and recommendations vs clinical practice; a 12-month study of 89 patients. J Ultrasound, 15, 102-7.
  19. Rassael H, Thompson LD, Heffess CS (1998). A rationale for conservative management of microscopic papillary carcinoma of the thyroid gland, a clinicopathologic correlation of 90 cases. Eur Arch Otorhinolaryngol, 255, 462-7.
  20. Rodriguez JM, Moreno A, Parrilla P, et al (1997). Papillary thyroid microcarcinoma, clinical study and prognosis. Eur J Surg, 163, 255-9.
  21. Silverman JF, West LR, Larkin EW, Park KH (1986). The role of fine needle aspiration biopsy in the rapid diagnosis and management of thyroid neoplasm. Cancer 57, 1164-70.<1164::AID-CNCR2820570617>3.0.CO;2-S
  22. Sugitani I, Fujimoto Y (1999). Symptomatic versus asymptomatic papillary thyroid microcarcinoma, a retrospective analysis of surgical outcome and prognostic factors. Endocr J, 46, 209-16.
  23. Xie P, Deng H, Tan T (2009). Papillary thyroid microcarcinoma. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi, 26, 1167-70.
  24. Ylagan LR, Farkas T, Dehner LP (2004). Fine needle aspiration of the thyroid, a cytohistologic correlation and study of discrepant cases. Thyroid, 14, 35-41.
  25. Zhou YL, Zhang W, Gao EL, et al (2012). Preoperative BRAF mutation is predictive of occult contralateral carcinoma in patients with unilateral papillary thyroid microcarcinoma. Asian Pac J Cancer Prev, 13, 1267-72.

Cited by

  1. Thyroid Fine-Needle Aspiration Biopsy and Thyroid Cancer Diagnosis: A Nationwide Population-Based Study vol.10, pp.5, 2015,