Ha, Eun Ju1, Na, Dong Gyu 2, Baek, Jung Hwan 3, Kim, Ji-hoon4, Sung, Jin Yong5
1 Radiology, Ajou University Medical Center, Suwon
2 Radiology, Human Medical Imaging and Intervention Center
3 Radiology, Asan Medical Center
4 Radiology, Seoul National University Medical Center
5 Radiology, Thyroid Center, Daerim St. Mary’s Hospital, Seoul, Republic Of Korea
Purpose: To investigate the diagnostic performances of ultrasound (US)-based fine needle aspiration (FNA) criteria for detecting thyroid cancer and to compare the unnecessary FNA rates based on six international society guidelines (ATA, AACE/AME/ETA, FSE, KTA/ KSThR, NCCN, and SRU)
Materials and Methods: From January 2010 to May 2011, a total of consecutive 2000 thyroid nodules (?1 cm) with final diagnoses in 1802 patients were included in this study. US features of the thyroid nodules were retrospectively reviewed and classified according to the categories defined by the six international society guidelines. The diagnostic performance of US-based FNA criteria for detecting thyroid cancer and unnecessary FNA rate was calculated and compared by using the generalized estimating equation method.
Results: Of the 2000 thyroid nodules, 1546 (78.3%) were benign and 454 (22.7%) were malignant. Sensitivity and negative predictive value (NPV) for detecting thyroid cancer was the highest with KTA/KSThR guideline (94.5% and 94.2%, P <0.001) followed by NCCN (92.5% and 93.2%), ATA (87.6% and 91.6%), AACE/AME/ETA (80.4% and 91.0%), FSE (72.7% and 88.6%), and SRU guidelines (70.9% and 82.9%). The unnecessary FNA rates was the lowest in FSE (29.1%, P <0.001) followed by AACE/AME/ETA (32.5%), SRU (45.2%), ATA (51.7%), NCCN (54.0%), and KTA/KSThR guidelines (56.9%).
Conclusion: Since the diagnostic performance of US-based FNA criteria are different based on the international society guidelines, we have to be aware of its strength and weakness in the management of thyroid nodules.