Does the site of aspiration affect the efficacy of ultrasound-guided fine needle aspiration biopsy of thyroid nodules?

Abstract

Objective: To investigate whether the choice of a hypovascular or a hypervascular site of a thyroid nodule affects the efficacy of the ultrasound-guided fine needle aspiration procedure or not. Methods: Sixty solid thyroid nodules in 60 patients with hypo- and hypervascular parts were included in this prospective clinical study. Under color Doppler sonographic guidance, the fine needle aspiration was made with 22-gauge needle. Radiological and cytological features as well as the adequacy of samples were noted and compared. Results: Sonographically, 25 nodules (41.7%) were hetereogenous and calcified, 21 were hypoechoic (35%), 10 were isoechoic (16.7%) and 4 were hyperechoic (6.6%). Rate of adequate sampling when only hypervascular was used or hypovascular sites were evaluated were 81.7% and 83.3%, respectively. When both sites were evaluated together, rate of adequate sampling was found to be 91.7% in total. Presence and distribution of endothelial cells in the sample seems not to influence the diagnostic value of the procedure. Conclusion: Our results indicate that vascularity of a thyroid nodule outlined by color Doppler sonography can aid in optimizing the efficiency of fine-needle aspiration biopsy. The samples obtained from aspirates of hypo- and hypervascular sites are both complementary and assessment of these sites together yields better results in terms of diagnostic accuracy.

Keywords

• Thyroid, nodule, diagnosis, ultrasonography, fine-needle aspiration, color Doppler

Aspirasyon yerinin tiroid nodüllerinin ultrason destekli jet iğne biyopsisi verimliliği üzerindeki etkileri

Öz

Amaç: Çalışmanın amacı ultrason destekli jet iğne biyopsisinde hipovasküler ya da hipervasküler tiroid nodül tercihinin prosedür verimliliğine etkisinin incelenmesidir. Yöntem: Bu prospektif çalışmada hipovasküler ve hipervasküler tiroid nodülleri olan 60 hasta değerlendirilmiştir. Renkli Doppler sonografik yönlendirme altında 22 numara iğne ile jet iğne biyopsisi gerçekleştirmiştir. Radyolojik ve sitolojik faktörler ve numunelerin yeterliliği değerlendirilmiş ve karşılaştırılmıştır. Bulgular: Sonografik olarak 25 nodül (%41.7) heterojen ve kalsifiye, 21 nodül hipoekoik (%35), 10 nodül izoekoik (%16.7) ve 4 nodül (%6.6) hiperekoik olarak tanımlanmıştır. Yalnızca hipervasküler ve hipovasküler nodüller değerlendirildiğinde yeterli örneklem oranı %81.7 ve %83.3 olarak ölçülmüştür. Her iki grup beraber değerlendirildiğinde toplam yeterli örneklem oranı %91.7 olarak bulunmuştur. Örneklerde endotelyal hücrelerin bulunmasının ya da bu hücrelerin dağılımının prosedürün teşhis değerini etkilemediği görülmüştür. Sonuç: Elde ettiğimiz sonuçlara göre renkli Doppler sonografisi ile tiroid nodüllerinin vaskülaritesinin incelenmesinin jet iğne biyopsisinin etkinliğini optimize edebileceği görülmüştür. Hipovasküler ve hipervasküler bölgelerde yapılan biyopsiler birbirini tamamlayıcıdır ve bu verilerin birlikte kullanılması teşhis doğruluğunu arttırmaktadır.

Anahtar Kelimeler

• Tiroid, nodül, tanı, ultrason, ince iğne aspirasyonu, renkli Doppler

References

1. Kamenov ZA, Karamfilova VN, Chavrakov GN. Ultrasound- guided fine-needle aspiration biopsy in unselected consecutive patients with thyroid nodules. ISRN Endocrinol 2011;2011: 284837.
2. Rausch P, Nowels K, Jeffrey RB Jr. Ultrasonographically guided thyroid biopsy: a review with emphasis on technique. J Ultrasound Med 2001;20:79–85.
3. Kim MJ, Kim EK, Park SI, et al. US-guided fine-needle aspiration of thyroid nodules: indications, techniques, results. Radiographics 2008;28:1869–86.
4. Kim DW, Lee EJ, Lee JH. Role of ultrasound diagnosis in assess- ing and managing thyroid nodules with inadequate cytology. AJR Am J Roentgenol 2011;197:1213–9.
5. Degirmenci B, Haktanir A, Albayrak R, et al. Sonographically guided fine-needle biopsy of thyroid nodules: the effects of nodule characteristics, sampling technique, and needle size on the ade- quacy of cytological material. Clin Radiol 2007;62:798–803.
6. Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid 1998;8: 15–21.
7. Frates MC, Benson CB, Charboneau JW, et al.; Society of Radiologists in Ultrasound. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 2005;237:794–800.
8. Söderström N, Telenius-Berg M, Akerman M. Diagnosis of medullary carcinoma of the thyroid by fine needle aspiration biop- sy. Acta Med Scand 1975;197:71–6.

9. Berge T, Söderström N. Fine-needle cytologic biopsy in diseases of the salivary glands. Acta Pathol Microbiol Scand 1963;58:1–9.
10. Lopes Cardozo P. The significance of fine needle aspiration cytol- ogy for the diagnosis and treatment of malignant lymphomas. Folia Haematol Int Mag Klin Morphol Blutforsch 1980;107: 601–20.
11. Moon HJ, Kwak JY, Kim MJ, Son EJ, Kim EK. Can vascularity at power Doppler US help predict thyroid malignancy? Radiology 2010;255:260–9.
12. Newman JS, Bree RL, Rubin JM. Prostate cancer: diagnosis with color Doppler sonography with histologic correlation of each biopsy site. Radiology 1995;195:86–90.
13. Kim EK, Park CS, Chung WY, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 2002;178:687–91.
14. Papini E, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 2002;87:1941–6.
15. Sohn YM, Yoon JH, Moon HJ, Kim EK, Kwak JY. Mixed echoic thyroid nodules on ultrasound: approach to management. Yonsei Med J 2012;53:812–9.
16. Hoang JK, , Lee WK, Lee M, Johnson D, Farrell S. US Features of thyroid malignancy: pearls and pitfalls. Radiographics 2007;27:847–60.
17. Tangpricha V, Chen BJ, Swan NC, Sweeney AT, de las Morenas A, Safer JD. Twenty-one-gauge needles provide more cellular samples than twenty-five-gauge needles in fine-needle aspiration biopsy of the thyroid but may not provide increased diagnostic accuracy. Thyroid 2001;11:973–6.
18. Hanbidge AE, Arenson AM, Shaw PA, Szalai JP, Hamilton PA, Leonhardt C. Needle size and sample adequacy in ultrasound- guided biopsy of thyroid nodules. Can Assoc Radiol J 1995;46: 199–201.
19. Ravetto C, Colombo L, Dottorini ME. Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients. Cancer 2000;90:357–63.
20. Suen KC. Fine-needle aspiration biopsy of the thyroid. CMAJ 2002;167:491–5.
21. Gharib H, Papini E, Valcavi R, et al.; AACE/AME Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 2006;12:63–102. Erratum in Endocr Pract 2008;14:802–3.
22. O’Malley ME, Weir MM, Hahn PF, Misdraji J, Wood BJ, Mueller PR. US-guided fine-needle aspiration biopsy of thyroid nodules: adequacy of cytologic material and procedure time with and without immediate cytologic analysis. Radiology 2002;222: 383–7.
23. Ahn SS, Kim EK, Kang DR, Lim SK, Kwak JY, Kim MJ. Biopsy of thyroid nodules: comparison of three sets of guidelines. AJR Am J Roentgenol 2010;194:31–7.
24. Cooper DS, Doherty GM, Haugen BR, et al.; American Thyroid Association Guidelines Taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006;16:109–42.
25. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY
26. NC-ND0) Licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) which permits unrestricted noncommercial use, distribution, and reproduc
27. tion in any medium, provided the original work is properly cited.
28. Please cite this article as: Çakmakcı E, Tokgöz Özal S, Kolçak Türko¤lu Ö, Uçan B, Kaygusuz U, Dinç T, Ece D. Does the site of aspiration affect
29. the efficacy of ultrasound-guided fine needle aspiration biopsy of thyroid nodules? ENT Updates 2015;5(1):13–18.