Galectin-3 detection on large-needle aspiration biopsy improves preoperative selection of thyroid nodules: A prospective cohort study

Abstract

Background. New techniques of improving diagnostic reliability of thyroid nodules are needed. Aim and methods. This prospective cohort study includes patients with one (201) or multiple (22) palpable nodule(s). Preoperative fine-needle aspiration biopsy (FNAB), large-needle aspiration biopsy (LNAB), and galectin-3 detection on LNAB (GAL-3-LNAB) (total of 245 nodules) were compared when the FNAB finding was ‘inadequate’ or ‘indeterminate’. The sizes of the needles used for FNAB and LNAB were compared with the size of thyroid follicles. Forty nodules were surgically excised according to current recommendation.Results. GAL-3-LNAB was inadequate in 4% of nodules, compared with 34% using FNAB and 11% using LNAB (P < 0.0001). GAL-3-LNAB showed no indeterminate findings, compared with 15% using FNAB and 13% using LNAB (P < 0.0001). Among the 40 excised nodules, GAL-3-LNAB showed the highest accuracy values. The sensitivity (P = 0.011) and specificity (P < 0.000; P = 0.001) ranges were 40%–100% and 20%–40% for FNAB, 40%–100% and 50%–53.7% for LNAB, and 100% and 76.7%–80% for GAL-3-LNAB, respectively. The largest needles used for LNAB, 20 or 18 gauge, with an internal diameter of 0.6 or 0.91 mm, recorded the lowest rate of inadequate or indeterminate FNAB findings.Conclusions. GAL-3-LNAB reduced inadequate, abolished indeterminate findings, and provided specificity values higher than FNAB or LNAB in palpable thyroid nodules.