Abstract
BackgroundThyroid nodules are prevalent worldwide. Detection rates are increasing because of the use of ultrasonography. Ultrasound has become the first-choice imaging modality in evaluating nodules. The decision to perform an US-guided fine-needle aspiration (FNA) is based on a nodule’s sonographic features. Thus, it is essential to accurately risk stratify thyroid nodules so that they are appropriately referred for FNA.ObjectivesThe aim of this study was to correlate the ultrasound imaging features of thyroid nodules with FNA cytology and surgical histopathology results, and to risk stratify patients using the American Thyroid Association (ATA) classification for each imaging characteristic with the likelihood of the nodule being malignant.MethodRetrospective analysis of a thyroid ultrasound database at Chris Hani Baragwanath Academic Hospital, over the period 2015–2017. Frequencies and percentages were used to summarise the data. Univariate logistic regression analyses were used to assess the accuracy of sonographic features in predicting the histologically determined diagnosis for thyroid tumours.ResultsA total of 113 nodules underwent FNA, of which 104 were diagnostic. The best three ultrasound features that pose a higher risk for malignancy are absent halo, presence of microcalcifications and hypoechoic appearance. No single nodule feature is an absolute indicator for malignancy. There is a high agreement between ATA classification and cytopathology or histology when nodule features are grouped into clusters. Agreement between the ATA classification and cytopathology/histology was 86.7% with a kappa of 0.714. The agreement between the cytopathology FNA results and lobectomy histopathology was 98.8% with a kappa of 0.973.ConclusionThis study contributes to the paucity of data available for sub-Saharan Africa and provides reassurance that our results are consistent with international studies. The study confirms that the usage of a thyroid nodule classification system improves characterisation and increases accuracy in detecting thyroid malignancies, thus sparing many patients the morbidity of unnecessary thyroid surgery.
Highlights
BackgroundThyroid nodules are prevalent worldwide and seen in patients of all age groups
Patients were excluded from the study if the fine-needle aspiration (FNA) cytology results were non-diagnostic/unsatisfactory according to Bethesda classification or if they initially had atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) cytology and they did not return for a repeat FNA – that is, lost to follow-up
A final total of 100 thyroid nodule FNAs were included in the study of 113 patients
Summary
Thyroid nodules are prevalent worldwide and seen in patients of all age groups. Detection rates are higher than previously reported with the ever-increasing use of thyroid ultrasonography. Several large international studies report that up to 76% of women have at least one thyroid nodule and as many as 57% of routine autopsies discover incidental nodules.[1] The majority of nodules are asymptomatic and are benign in 80%–92% of cases.[2] When a thyroid nodule is discovered incidentally or clinically, there is a necessity for workup and further investigation. Detection rates are increasing because of the use of ultrasonography. The decision to perform an US-guided fine-needle aspiration (FNA) is based on a nodule’s sonographic features.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
