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Diagnostic adequacy of thyroid fine needle aspiration biopsy: a comparative analysis by age and gender

Year 2025, Volume: 8 Issue: 5, 754 - 758, 16.09.2025
https://doi.org/10.32322/jhsm.1706182

Abstract

Aims: To evaluate the diagnostic success of thyroid fine needle aspiration biopsy (FNAB) across different age and gender groups, and to investigate the effect of aging and sex-related variables on biopsy adequacy.
Methods: This retrospective study included 486 patients who underwent thyroid FNAB between 2022 and 2024. Patients were stratified into two age groups (<65 and ≥65 years) and analyzed by gender. Diagnostic outcomes were classified as diagnostic (benign, malignant, atypia) or non-diagnostic. Statistical analyses, including Fisher’s exact and chi-square tests, were applied to determine the significance of differences.
Results: The overall diagnostic yield was 81.7%. Patients under 65 years had a significantly higher diagnostic success rate (86.4%) compared to those aged 65 and older (65.5%, p<0.01). Among older patients, diagnostic adequacy was notably lower in males (53.1%) than females (70.5%). The distribution of pathological diagnoses also varied: the atypia rate was higher in the ≥65 group (8.33%), whereas malignancy was slightly more prevalent in younger patients. Gender alone did not significantly influence diagnostic outcomes (p>0.05), but advanced age was associated with reduced adequacy, potentially due to structural tissue changes or technical limitations.
Conclusion: The diagnostic performance of thyroid FNAB diminishes significantly with age, especially in elderly male patients. Gender does not appear to be an independent determinant. These findings highlight the need for optimized biopsy strategies in older populations to enhance diagnostic yield.

Ethical Statement

Ethical Approval The study was conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Ethics committee approval was obtained from [Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, 2025-05/74]. Informed Consent: Because the study was designed retrospectively, no written informed consent form was obtained from patients Funding The authors received no specific funding for this work. Conflict of Interest The authors declare no conflict of interest related to this study.

References

  • Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules-2016 update. Endocr Pract. 2016;22(5):622-639. doi:10.4158/EP161208.GL
  • Haugen BR, Alexander EK, Bible KC, et al. 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. 2016;26(1):1-133. doi:10.1089/thy.2015.0020
  • Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med. 1993;328(8):553-559. doi:10.1056/NEJM199302253280807
  • Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest. 2009;39(8):699-706. doi:10. 1111/j.1365-2362.2009.02162.x
  • Poma AM, Macerola E, Basolo A, et al. Fine-needle aspiration cytology and histological types of thyroid cancer in the elderly: evaluation of 9070 patients from a single referral centre. Cancers (Basel). 2021;13:4. doi:10.3390/cancers13040907
  • Kwong N, Medici M, Angell TE, et al. The influence of patient age on thyroid nodule formation, multinodularity, and thyroid cancer risk. J Clin Endocrinol Metab. 2015;100(12):4434-4440. doi:10.1210/jc.2015-3100
  • Ospina NS, Papaleontiou M. Thyroid Nodule evaluation and management in older adults: a review of practical considerations for clinical endocrinologists. Endocr Pract. 2021;27(3):261-268. doi:10.1016/ j.eprac.2021.02.003
  • Cibas ES, Ali SZ, Conference NCITFSotS. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132(5):658-665. doi:10.1309/AJCPPHLWMI3JV4LA
  • Baloch ZW, LiVolsi VA, Asa SL, et al. Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol. 2008;36(6):425-437. doi: 10.1002/dc.20830
  • Frates MC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2005;237(3):794-800. doi:10.1148/radiol.2373050220
  • Belfiore A, Giuffrida D, La Rosa GL, et al. High frequency of cancer in cold thyroid nodules occurring at young age. Acta Endocrinol (Copenh). 1989;121(2):197-202. doi:10.1530/acta.0.1210197
  • Yoon JH, Lee HS, Kim EK, Moon HJ, Kwak JY. Malignancy risk stratification of thyroid nodules: comparison between the thyroid imaging reporting and data system and the 2014 American Thyroid Association management guidelines. Radiology. 2016;278(3):917-924. doi:10.1148/radiol.2015150056
  • Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda system for reporting thyroid cytopathology: a meta-analysis. Acta Cytol. 2012;56(4):333-339. doi:10.1159/000339959
  • Trimboli P, Giovanella L. Reliability of core needle biopsy as a second-line procedure in thyroid nodules with an indeterminate fine-needle aspiration report: a systematic review and meta-analysis. Ultrasonography. 2018;37(2):121-128. doi:10.14366/usg.17066
  • Rossi ED, Bizzarro T, Martini M, et al. The role of fine-needle aspiration in the thyroid nodules of elderly patients. Oncotarget. 2016;7(11):11850-11859. doi:10.18632/oncotarget.7643
  • Jeong EJ, Chung SR, Baek JH, Choi YJ, Kim JK, Lee JH. A comparison of ultrasound-guided fine needle aspiration versus core needle biopsy for thyroid nodules: pain, tolerability, and complications. Endocrinol Metab (Seoul). 2018;33(1):114-120. doi:10.3803/EnM.2018.33.1.114
  • Shin JH. Strategies for safe and effective core needle biopsy of thyroid nodules with macrocalcification. Int J Thyroidol. 2023;16(2):195-199.
  • Aysan E, Guler B, Kiran T, Idiz UO. Core needle biopsy in the diagnosis of thyroid nodules. Am Surg. 2023;89(12):5170-5174. doi:10.1177/00031348221142570
  • Atmış VEÖ, B. Comparison of the results of thyroidectomy and second fine-needle aspiration biopsy of the old age group with the previous Bethesda III group: is the second biopsy necessary. Erciyes Med J. 2020; 42(1):25-29. doi:10.14744/etd.2019.80378
  • Yim Y, Baek JH. Core needle biopsy in the management of thyroid nodules with an indeterminate fine-needle aspiration report. Gland Surg. 2019;8(Suppl 2):S77-S85. doi:10.21037/gs.2018.09.07

Tiroid ince iğne aspirasyon biyopsisinin tanısal yeterliliği: yaş ve cinsiyete göre karşılaştırmalı analiz

Year 2025, Volume: 8 Issue: 5, 754 - 758, 16.09.2025
https://doi.org/10.32322/jhsm.1706182

Abstract

Amaç:
Tiroid ince iğne aspirasyon biyopsisinin (FNAB) farklı yaş ve cinsiyet gruplarında tanısal başarısını değerlendirmek ve yaşlanma ve cinsiyete bağlı değişkenlerin biyopsi yeterliliği üzerindeki etkisini araştırmak.
Yöntemler:
Bu retrospektif çalışmaya 2022-2024 yılları arasında tiroid FNAB'si yapılan 486 hasta dahil edildi. Hastalar iki yaş grubuna (<65 ve ≥65 yaş) ayrıldı ve cinsiyete göre analiz edildi. Tanısal sonuçlar tanısal (iyi huylu, kötü huylu, atipi) veya tanısal olmayan olarak sınıflandırıldı. Farklılıkların anlamlılığını belirlemek için Fisher's Exact ve ki-kare testleri de dahil olmak üzere istatistiksel analizler uygulandı.
Sonuçlar:
Genel tanı verimi %81,7 idi. 65 yaş altı hastaların tanısal başarı oranı (%86,4) 65 yaş ve üzeri hastalara kıyasla önemli ölçüde daha yüksekti (%65,5, p<0,01). Yaşlı hastalarda tanısal yeterlilik erkeklerde (%53,1) kadınlardan (%70,5) belirgin şekilde daha düşüktü. Patolojik tanıların dağılımı da çeşitlilik gösteriyordu: atipi oranı ≥65 grubunda daha yüksekti (%8,33), buna karşın malignite genç hastalarda biraz daha yaygındı. Cinsiyet tek başına tanısal sonuçları önemli ölçüde etkilemedi (p>0,05), ancak ileri yaş, potansiyel olarak yapısal doku değişiklikleri veya teknik kısıtlamalar nedeniyle azalmış yeterlilikle ilişkilendirildi.
Sonuç:
Tiroid FNAB'nin tanısal performansı yaşla birlikte önemli ölçüde azalır, özellikle yaşlı erkek hastalarda. Cinsiyet bağımsız bir belirleyici gibi görünmüyor. Bu bulgular, tanısal verimi artırmak için yaşlı popülasyonlarda optimize edilmiş biyopsi stratejilerine olan ihtiyacı vurgulamaktadır.

References

  • Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules-2016 update. Endocr Pract. 2016;22(5):622-639. doi:10.4158/EP161208.GL
  • Haugen BR, Alexander EK, Bible KC, et al. 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. 2016;26(1):1-133. doi:10.1089/thy.2015.0020
  • Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med. 1993;328(8):553-559. doi:10.1056/NEJM199302253280807
  • Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest. 2009;39(8):699-706. doi:10. 1111/j.1365-2362.2009.02162.x
  • Poma AM, Macerola E, Basolo A, et al. Fine-needle aspiration cytology and histological types of thyroid cancer in the elderly: evaluation of 9070 patients from a single referral centre. Cancers (Basel). 2021;13:4. doi:10.3390/cancers13040907
  • Kwong N, Medici M, Angell TE, et al. The influence of patient age on thyroid nodule formation, multinodularity, and thyroid cancer risk. J Clin Endocrinol Metab. 2015;100(12):4434-4440. doi:10.1210/jc.2015-3100
  • Ospina NS, Papaleontiou M. Thyroid Nodule evaluation and management in older adults: a review of practical considerations for clinical endocrinologists. Endocr Pract. 2021;27(3):261-268. doi:10.1016/ j.eprac.2021.02.003
  • Cibas ES, Ali SZ, Conference NCITFSotS. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132(5):658-665. doi:10.1309/AJCPPHLWMI3JV4LA
  • Baloch ZW, LiVolsi VA, Asa SL, et al. Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol. 2008;36(6):425-437. doi: 10.1002/dc.20830
  • Frates MC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2005;237(3):794-800. doi:10.1148/radiol.2373050220
  • Belfiore A, Giuffrida D, La Rosa GL, et al. High frequency of cancer in cold thyroid nodules occurring at young age. Acta Endocrinol (Copenh). 1989;121(2):197-202. doi:10.1530/acta.0.1210197
  • Yoon JH, Lee HS, Kim EK, Moon HJ, Kwak JY. Malignancy risk stratification of thyroid nodules: comparison between the thyroid imaging reporting and data system and the 2014 American Thyroid Association management guidelines. Radiology. 2016;278(3):917-924. doi:10.1148/radiol.2015150056
  • Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda system for reporting thyroid cytopathology: a meta-analysis. Acta Cytol. 2012;56(4):333-339. doi:10.1159/000339959
  • Trimboli P, Giovanella L. Reliability of core needle biopsy as a second-line procedure in thyroid nodules with an indeterminate fine-needle aspiration report: a systematic review and meta-analysis. Ultrasonography. 2018;37(2):121-128. doi:10.14366/usg.17066
  • Rossi ED, Bizzarro T, Martini M, et al. The role of fine-needle aspiration in the thyroid nodules of elderly patients. Oncotarget. 2016;7(11):11850-11859. doi:10.18632/oncotarget.7643
  • Jeong EJ, Chung SR, Baek JH, Choi YJ, Kim JK, Lee JH. A comparison of ultrasound-guided fine needle aspiration versus core needle biopsy for thyroid nodules: pain, tolerability, and complications. Endocrinol Metab (Seoul). 2018;33(1):114-120. doi:10.3803/EnM.2018.33.1.114
  • Shin JH. Strategies for safe and effective core needle biopsy of thyroid nodules with macrocalcification. Int J Thyroidol. 2023;16(2):195-199.
  • Aysan E, Guler B, Kiran T, Idiz UO. Core needle biopsy in the diagnosis of thyroid nodules. Am Surg. 2023;89(12):5170-5174. doi:10.1177/00031348221142570
  • Atmış VEÖ, B. Comparison of the results of thyroidectomy and second fine-needle aspiration biopsy of the old age group with the previous Bethesda III group: is the second biopsy necessary. Erciyes Med J. 2020; 42(1):25-29. doi:10.14744/etd.2019.80378
  • Yim Y, Baek JH. Core needle biopsy in the management of thyroid nodules with an indeterminate fine-needle aspiration report. Gland Surg. 2019;8(Suppl 2):S77-S85. doi:10.21037/gs.2018.09.07
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Details

Primary Language English
Subjects Radiology and Organ Imaging
Journal Section Original Article
Authors

Erkan Bilgin 0000-0002-2054-1571

Ahmet Bayrak This is me 0000-0002-2150-8650

Publication Date September 16, 2025
Submission Date May 28, 2025
Acceptance Date July 16, 2025
Published in Issue Year 2025 Volume: 8 Issue: 5

Cite

AMA Bilgin E, Bayrak A. Diagnostic adequacy of thyroid fine needle aspiration biopsy: a comparative analysis by age and gender. J Health Sci Med / JHSM. September 2025;8(5):754-758. doi:10.32322/jhsm.1706182

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