Alhajlan Mana, Al-Masabi Mohammed, Al Mansour Mohammed, Saihb Abdullah, AlAyed Salem, Alwadai Rakan, Alhamami Abdullah, Alzarra Abdullah, Almarzooq Mohammed, Ahmed Faisal
Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia.
Operating Rooms Specialist, King Khalid Hospital, Najran, Saudi Arabia.
Ann Med Surg (Lond). 2024 Oct 23;86(12):7002-7009. doi: 10.1097/MS9.0000000000002676. eCollection 2024 Dec.
Accurately diagnosing thyroid nodules is vital for preventing unnecessary surgeries and providing prompt therapy. Although fine-needle aspiration cytology (FNAC) and ultrasonography (US) are widely used diagnostic methods, their reliability is questioned. This study investigates the effectiveness of US and FNAC in thyroid nodule diagnosis and differentiates benign from malignant nodules in relation to final histopathological diagnosis.
A retrospective study including 307 adult patients with thyroid diseases who underwent neck US and FNAC before surgery was conducted between April 2019 and May 2023. The diagnostic efficacy of US, FNAC, and their combination usage was compared to histopathological results.
Histopathological findings revealed that 187 (61%) cases were benign, while 120 (39%) were malignant. The US features of 'taller-than-wider' forms and hypoechoic appearance had the highest diagnostic accuracy in characterizing malignant thyroid nodules, with 83 and 73% accuracy, respectively. The combination of US parameters demonstrated high sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 88.33, 63.10, 60.6, and 89.4%, with a statistically significant area under the ROC curve (AUC: 0.828, <0.001) than individual parameters. FNAC's sensitivity, specificity, PPV NPV, and accuracy in detecting malignant lesions were 50, 95, 86, 75, and 77%, respectively, with acceptable discrimination and statistical significance (AUC: 0.723, <0.0001). The combination of US parameters and FNAC significantly improved the AUC value (AUC: 0.878, <0.0001), sensitivity (83.33%), and specificity (79.14%). Univariate analysis showed that hypoechoic appearance, heterogenicity, large mass size (>4 cm), 'taller-than-wider', infiltrative margins, and microcalcifications were risk factors for malignancy in thyroid nodules and were statistically significant (all -values <0.05).
Combining US characteristics with FNAC results can afford the maximum analytical accuracy in distinguishing benign from malignant thyroid nodules. This strategy is practical due to its simplicity, minimal invasiveness, and cost-effectiveness, enabling robust management regimens and avoiding additional surgical procedures.
准确诊断甲状腺结节对于避免不必要的手术和及时治疗至关重要。尽管细针穿刺细胞学检查（FNAC）和超声检查（US）是广泛使用的诊断方法，但其可靠性受到质疑。本研究调查了US和FNAC在甲状腺结节诊断中的有效性，并根据最终的组织病理学诊断区分良性和恶性结节。
进行了一项回顾性研究，纳入了2019年4月至2023年5月期间307例术前接受颈部US和FNAC检查的成年甲状腺疾病患者。将US、FNAC及其联合使用的诊断效能与组织病理学结果进行比较。
组织病理学结果显示，187例（61%）为良性，120例（39%）为恶性。“高大于宽”形态和低回声外观的US特征在鉴别恶性甲状腺结节方面具有最高的诊断准确性，准确率分别为83%和73%。US参数的组合显示出高敏感性、特异性、阳性预测值和阴性预测值（NPV），分别为88.33%、63.10%、60.6%和89.4%，其ROC曲线下面积（AUC：0.828，<0.001）在统计学上显著高于单个参数。FNAC检测恶性病变的敏感性、特异性、PPV、NPV和准确性分别为50%、95%、86%、75%和77%，具有可接受的鉴别能力和统计学意义（AUC：0.723，<0.0001）。US参数和FNAC的联合使用显著提高了AUC值（AUC：0.878，<0.0001）、敏感性（83.33%）和特异性（79.14%）。单因素分析显示，低回声外观、异质性、肿块较大（>4 cm）、“高大于宽”、浸润性边缘和微钙化是甲状腺结节恶性的危险因素，且具有统计学意义（所有P值<0.05）。
将US特征与FNAC结果相结合，在区分甲状腺良性和恶性结节方面可提供最大的分析准确性。该策略因其简单、微创和成本效益高而具有实用性，能够制定有力的管理方案并避免额外的手术程序。
