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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
The most important diagnostic test to differentiate thyroid nodules from each other is fine needle aspiration (FNA).
Other Diagnostic Studies
Fine needle aspiration
- The most important diagnostic test to differentiate thyroid nodules from each other is fine needle aspiration (FNA).
- Autonomously functioning ( hot) thyroid nodule is usually not an indication for fine-needle aspiration biopsy.
As FNA is considered as an aggressive procedure, the American Thyroid Association developed the following criteria for FNA indication:
- Nodules ≥ 1 cm with intermediate or high suspicion US pattern
- Nodules ≥ 1.5 cm with low suspicion US pattern
- Nodules ≥ 2 cm with very low suspicion US pattern (e.g., spongiform). Observation an alternate option
- For nodules that do not meet the above criteria, FNA is not required, including nodules < 1 cm (with some exceptions) and purely cystic nodules.[1]
- Criteria for US-guided FNA:
- A higher likelihood of either a nondiagnostic cytology (>25–50% cystic component)
- A higher likelihood of sampling error
- Difficult to palpate nodules
- Posteriorly located nodules
- FNA biopsy has a mean sensitivity higher than 80% and mean specificity higher than 90%.
- The accuracy of FNAB in diagnosing thyroid conditions is influenced by pathologist's experience and the technical skill of the physician performing the biopsy.
- Thyroid FNAB diagnostic categories and the respective risk of malignancy associated include:
- Benign - < 1%
- Atypia of undetermined significance (AUS) - 5-10%
- Follicular neoplasm - 20-30%
- Suspicious for malignancy - 50-75%
- Malignant - 100%
References
- ↑ Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016). "2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer". Thyroid. 26 (1): 1–133. doi:10.1089/thy.2015.0020. PMC 4739132. PMID 26462967.