Πέμπτη 6 Φεβρουαρίου 2020

Ultrasound‐guided Fine Needle Aspiration or Core Needle Biopsy for diagnosing follicular thyroid carcinoma?

Ultrasound‐guided Fine Needle Aspiration or Core Needle Biopsy for diagnosing follicular thyroid carcinoma?:

Abstract

Objective

We evaluated the preoperative diagnostic values of ultrasound (US), fine needle aspiration (FNA), and core needle biopsy (CNB) leading to surgery in patients with FTC.

Methods

From October 1994 to July 2016, 298 FTC patients who had preoperative US images and underwent US‐guided FNA or CNB and surgery were included in this study. We evaluated the results of preoperative FNA or CNB based on the Bethesda system and the US findings according to the Korean thyroid imaging reporting and data system (K‐TIRADS).

Results

Predominant US features of FTC showed solid, hypo or isoechogenicity, oval smooth margin, and halo with no calcification. Based on K‐TIRADS, 140 (47.0%) FTC patients were categorized as low suspicion, 133 (44.63%) as intermediate suspicion, and 25 (8.4%) as high suspicion at US. Considering only FNA cytology (n = 230), 6.9% were revealed as Bethesda class I, 16.1% as class II, 37.0% as class III, 29.1% as class IV, and 10.9% as class V. Considering the 68 cases with CNB results, 2.9% were revealed as class I, 4.4% as class II, 20.6% as class III, and 72.1% as class IV. Despite multiple FNAs, 16.7% of the 84 FTC patients still obtained Bethesda class I or class II. CNB results in FTC patients had a significantly higher rate of Bethesda class IV compared to the FNA results (P < 0.001). FTCs with distant metastasis exhibited a significantly higher rate of Bethesda classes IV and V compared to those without distant metastasis (P = 0.004).

Conclusion

Surgery for FTC is deferred only with preoperative US and FNA. CNB in FTC patients can lead to surgery better than FNA. Therefore, if the US feature is characteristic and a serially growing large nodule is suspected, the first attempt of CNB may be helpful in selecting a surgical candidate.

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