Erkan Serkan, Yabanoğlu Hakan, Avci Tevfik, Gündoğdu Ramazan, Kuş Murat, Erkent Murathan, İncekaş Caner
Başkent University Dr. Turgut Noyan Training and Research Hospital General Surgery Clinic, Adana, Turkey.
General Surgery Clinic, Başkent University Ankara Hospital Ankara, Turkey.
Medicine (Baltimore). 2024 Dec 20;103(51):e40373. doi: 10.1097/MD.0000000000040373.
Ultrasound-guided fine-needle aspiration biopsy (FNAB) is an essential diagnostic tool for detecting malignancy in thyroid nodules. The objective of this study was to evaluate the necessity of FNAB in the treatment decision-making process for thyroid nodules exceeding 3 cm in size. The records of patients who underwent thyroidectomy in our center between 2018 and 2023 were retrospectively reviewed. The study included patients with an index nodule size exceeding 3 cm. Exclusion criteria were missing data, treatment for a different oncological condition, recurrent disease, and purely cystic nodule. Patients were categorized into 2 groups based on the size of the index nodule: Group 1 included nodules measuring between 3 to 4 cm, and Group 2 included nodules 4 cm and larger. Demographic data, FNAB results, and histopathological findings were recorded. The specificity, sensitivity, false negative, and false positive rates of FNAB were calculated. There were 1935 patients who underwent thyroidectomy within the specified date range. In 359 of these patients, the index nodule size was 3 cm or more. There were 188 patients with nodule size between 3 and 4 cm. The mean age was 50.42 ± 13.34 years, and 257 patients were female (F/M ratio = 2.5/1). Fine needle aspiration biopsy was performed on 237 patients, resulting in 65 false negatives. Both the incidence of malignancy and the rate of FNAB false negatives were higher in nodules measuring 4 cm or larger. This study identified a high malignancy rate and a significant rate of false negatives in FNAB of thyroid nodules larger than 3 cm. These findings highlight the importance of carefully considering these factors in the surgical planning of such nodules.
超声引导下细针穿刺活检（FNAB）是检测甲状腺结节恶性病变的重要诊断工具。本研究的目的是评估FNAB在大小超过3厘米的甲状腺结节治疗决策过程中的必要性。回顾性分析了2018年至2023年期间在本中心接受甲状腺切除术的患者记录。该研究纳入了索引结节大小超过3厘米的患者。排除标准为数据缺失、因其他肿瘤疾病接受治疗、复发性疾病和单纯性囊性结节。根据索引结节的大小将患者分为两组：第1组包括直径在3至4厘米之间的结节，第2组包括直径4厘米及以上的结节。记录人口统计学数据、FNAB结果和组织病理学发现。计算FNAB的特异性、敏感性、假阴性和假阳性率。在指定日期范围内有1935例患者接受了甲状腺切除术。其中359例患者的索引结节大小为3厘米或更大。有188例患者的结节大小在3至4厘米之间。平均年龄为50.42±13.34岁，女性患者257例（女/男比例=2.5/1）。对237例患者进行了细针穿刺活检，结果有65例假阴性。直径4厘米及以上的结节中恶性肿瘤发生率和FNAB假阴性率均较高。本研究发现，大于3厘米的甲状腺结节FNAB的恶性率较高，假阴性率也较高。这些发现凸显了在对此类结节进行手术规划时仔细考虑这些因素的重要性。
