Thyroid fine needle aspiration biopsies performed in the office under ultrasound guidance in a low volume center: The cytological and the histopathological results
Ahmet Cem Dural1, Candaş Erçetin2, TuganTezcaner3, Mahir Kırnap3, Z. Çiler Tezcaner4, H. Gözde M. Dada5, Tuna Şahin6, Ö. Funca Yazıcı7, Özlem Ergül8
1Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, İstanbul
2Tuzluca Devlet Hastanesi, Genel Cerrahi Kliniği, Iğdır
3Başkent Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Ankara
4Özel Polatlı Can Hastanesi, Kulak Burun Boğaz Kliniği, Ankara
5Iğdır Devlet Hastanesi, Patoloji Birimi, Iğdır
6Iğdır Devlet Hastanesi, Radyoloji Birimi, Iğdır
7Arnavutköy Devlet Hastanesi, Radyoloji Birimi, İstanbul
8Kırıkkale Devlet Hastanesi, Patoloji Birimi, Kırıkkale
Keywords: Office-fine needle aspiration biopsy, diagnostic sensitivity, thyroid nodule
Objective: To evaluate the results of thyroid fine needle aspiration biopsies (FNAB) performed in the office under ultrasound guidance by surgeons instead of referring patients to a radiologist for the procedure to free up time for both patient and surgeon.
Methods: From October 2009 to October 2011, thyroid FNABs were performed consecutively on 57 patients who had an ultrasonographic examination by a single radyologist and any sonographically suspicious nodules (hypoechoic appearance, micro or peripheral calcifications, blurred nodular margins) by four general surgeons and one otolaryngologist in the office under US guidance and examined cytologically by a single pathologist. FNAB samples were categorized into those that were non-diagnostic, benign or malignant cytology, cells with atypical or suspicious features. In the patients who underwent total or near total thyroidectomy, FNAB results were compared with final surgical pathology.
Results: The mean age was 38±12.1 (17–61), with a female/male ratio of 52/5. A total of 73 FNABs performed. Malignancy rate was 26.3% (n=15). Among the non-diagnostic specimens (n=2) , the benign cytology (n=37), the cells with suspicious (n=10) or atypical features (n=3), malignancy was detected; 25%, 13.5%, 50%, 100%, respectively with final histopathology. Repeat FNAB was performed in 7 patients (31.8%) with <2cm nodule (n=22) and in one patient (2.8%) with >2cm nodule (n=35) (p=0.02). Sensitivity, specificity, positive and negative predictive value, accuracy were 66.7%, 88%, 66.7%, 82.4%, respectively.
Conclusion: This study supports that a trained surgeon may perform FNAB under sonographic guidance in the office with results less accurate but comparable to skilled and experienced clinicians.