Samargandy Saad, Khedher Yousef Zaki, Samargandy Shaza Ahmed, Alzahrani Ghaida Ahmed, Nahhas Hesham Tariq, Alshaikh Mohammed Abdulrahman, Alzahrani Khalid Abdulaziz, Saharti Samah
Department of Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Medicine, Endocrinology Unit, King Abdulaziz University, Jeddah, Saudi Arabia.
Cytojournal. 2025 Apr 17;22:44. doi: 10.25259/Cytojournal_206_2024. eCollection 2025.
Thyroid nodules are frequently encountered in medical practice. Fine needle aspiration cytology (FNAC) is used to rule out malignant nodules, but few studies have questioned the accuracy of FNAC in larger thyroid nodules compared to smaller ones. We, therefore, aim to compare the diagnostic performance of FNAC based on nodule size and whether larger nodule size increases the possibility of obtaining indeterminate or non-diagnostic results.
Adult patients with thyroid nodules who underwent thyroid biopsy and surgery from 2016 to 2022 were included in the study. We assessed the proportion of benign, malignant, indeterminate, and non-diagnostic FNAC in relation to the nodule size. We then divided cytology into true positive (malignant FNAC and histology), and true negative (benign FNAC and histology) and examined whether the proportion of true FNAC would be affected by different thyroid nodule cutoffs. The study used mean and frequency to describe continuous and categorical variables. -test and Chi-square tests were used to compare statistics.
Three hundred and forty-five patients were included in the study. The majority were female (86.7%) and older than 40 years. Half had a benign histology; the other 50% were malignant. The majority (49.3%) had indeterminate thyroid cytology. The proportion of indeterminate or non-diagnostic FNAC was the same (58%) in nodules ≥4 cm and <4 cm. The proportion of true FNAC was similar between different nodule size categories. It was 35% in ≥4 cm, and 34.3% in <4 cm nodules.
The study found that the diagnostic performance of FNAC in thyroid nodules did not significantly differ based on nodule size, with similar rates of indeterminate or non-diagnostic results across different size categories. The proportion of true positive FNAC results also remained consistent regardless of nodule size.
甲状腺结节在医疗实践中很常见。细针穿刺抽吸活检（FNAC）用于排除恶性结节，但与较小的甲状腺结节相比，很少有研究质疑FNAC在较大甲状腺结节中的准确性。因此，我们旨在比较基于结节大小的FNAC诊断性能，以及较大的结节大小是否会增加获得不确定或非诊断性结果的可能性。
纳入2016年至2022年接受甲状腺活检和手术的成年甲状腺结节患者。我们评估了与结节大小相关的良性、恶性、不确定和非诊断性FNAC的比例。然后，我们将细胞学分为真阳性（恶性FNAC和组织学）和真阴性（良性FNAC和组织学），并检查不同甲状腺结节临界值是否会影响真FNAC的比例。该研究使用均值和频率来描述连续变量和分类变量。使用t检验和卡方检验来比较统计数据。
该研究纳入了345名患者。大多数为女性（86.7%），年龄超过40岁。一半患者组织学为良性；另一半为恶性。大多数（49.3%）患者甲状腺细胞学检查结果不确定。直径≥4 cm和<4 cm的结节中，不确定或非诊断性FNAC的比例相同（58%）。不同结节大小类别之间真FNAC的比例相似。直径≥4 cm的结节中为35%，直径<4 cm的结节中为34.3%。
该研究发现，FNAC在甲状腺结节中的诊断性能不会因结节大小而有显著差异，不同大小类别的不确定或非诊断性结果发生率相似。无论结节大小如何，真阳性FNAC结果的比例也保持一致。
