International Journal of Cancer Management

Published by: Kowsar

Diagnostic Accuracy of Fine Needle Aspiration for Solitary and Multiple Thyroid Nodules in a Tertiary Care Center

Fariba Karimi 1 , *
Author Information
1 Endocrinology and Metabolism Research Center, Shiraz University, Shiraz, IR Iran
Article information
  • International Journal of Cancer Management: November 2017, 10 (11); e10589
  • Published Online: November 30, 2017
  • Article Type: Research Article
  • Received: January 17, 2017
  • Revised: May 26, 2017
  • Accepted: September 4, 2017
  • DOI: 10.5812/ijcm.10589

To Cite: Karimi F. Diagnostic Accuracy of Fine Needle Aspiration for Solitary and Multiple Thyroid Nodules in a Tertiary Care Center, Int J Cancer Manag. 2017 ; 10(11):e10589. doi: 10.5812/ijcm.10589.

Copyright © 2017, Cancer Research Center (CRC), Shahid Beheshti University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Methods
3. Results
4. Discussion
  • 1. Bomeli SR, LeBeau SO, Ferris RL. Evaluation of a thyroid nodule. Otolaryngol Clin North Am. 2010;43(2):229-38. vii. doi: 10.1016/j.otc.2010.01.002. [PubMed: 20510711].
  • 2. Wang CC, Friedman L, Kennedy GC, Wang H, Kebebew E, Steward DL, et al. A large multicenter correlation study of thyroid nodule cytopathology and histopathology. Thyroid. 2011;21(3):243-51. doi: 10.1089/thy.2010.0243. [PubMed: 21190442].
  • 3. American Thyroid Association Guidelines Taskforce on Thyroid N, Differentiated Thyroid C, Cooper DS, Doherty GM, Haugen BR, Kloos RT, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167-214. doi: 10.1089/thy.2009.0110. [PubMed: 19860577].
  • 4. Eng CY, Quraishi MS, Bradley PJ. Management of Thyroid nodules in adult patients. Head Neck Oncol. 2010;2:11. doi: 10.1186/1758-3284-2-11. [PubMed: 20444279].
  • 5. Carpi A, Di Coscio G, Iervasi G, Antonelli A, Mechanick J, Sciacchitano S, et al. Thyroid fine needle aspiration: how to improve clinicians' confidence and performance with the technique. Cancer Lett. 2008;264(2):163-71. doi: 10.1016/j.canlet.2008.02.056. [PubMed: 18384937].
  • 6. Deveci MS, Deveci G, LiVolsi VA, Baloch ZW. Fine-needle aspiration of follicular lesions of the thyroid. Diagnosis and follow-Up. Cytojournal. 2006;3:9. doi: 10.1186/1742-6413-3-9. [PubMed: 16603062].
  • 7. Pinchot SN, Al-Wagih H, Schaefer S, Sippel R, Chen H. Accuracy of fine-needle aspiration biopsy for predicting neoplasm or carcinoma in thyroid nodules 4 cm or larger. Arch Surg. 2009;144(7):649-55. doi: 10.1001/archsurg.2009.116. [PubMed: 19620545].
  • 8. Stang MT, Carty SE. Recent developments in predicting thyroid malignancy. Curr Opin Oncol. 2009;21(1):11-7. doi: 10.1097/CCO.0b013e32831db2af. [PubMed: 19125013].
  • 9. Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med. 1993;118(4):282-9. [PubMed: 8420446].
  • 10. Akgul O, Ocak S, Keskek M, Koc M, Tez M. Risk of malignancy in non-diagnostic thyroid fine-needle aspiration biopsy in multinodular goitre patients. Endocr Regul. 2011;45(1):9-12. [PubMed: 21314205].
  • 11. Dal Maso L, Bosetti C, La Vecchia C, Franceschi S. Risk factors for thyroid cancer: an epidemiological review focused on nutritional factors. Cancer Causes Control. 2009;20(1):75-86. doi: 10.1007/s10552-008-9219-5. [PubMed: 18766448].
  • 12. Pellegriti G, De Vathaire F, Scollo C, Attard M, Giordano C, Arena S, et al. Papillary thyroid cancer incidence in the volcanic area of Sicily. J Natl Cancer Inst. 2009;101(22):1575-83. doi: 10.1093/jnci/djp354. [PubMed: 19893009].
  • 13. Dijkstra B, Prichard RS, Lee A, Kelly LM, Smyth PP, Crotty T, et al. Changing patterns of thyroid carcinoma. Ir J Med Sci. 2007;176(2):87-90. doi: 10.1007/s11845-007-0041-y. [PubMed: 17486294].
  • 14. Feldt-Rasmussen U. Iodine and cancer. Thyroid. 2001;11(5):483-6. doi: 10.1089/105072501300176435. [PubMed: 11396706].
  • 15. Belfiore A, La Rosa GL, La Porta GA, Giuffrida D, Milazzo G, Lupo L, et al. Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity. Am J Med. 1992;93(4):363-9. [PubMed: 1415299].
  • 16. Al-azawi D, Mann GB, Judson RT, Miller JA. Endocrine surgeon-performed US guided thyroid FNAC is accurate and efficient. World J Surg. 2012;36(8):1947-52. doi: 10.1007/s00268-012-1592-2. [PubMed: 22526037].
  • 17. Choi SH, Han KH, Yoon JH, Moon HJ, Son EJ, Youk JH, et al. Factors affecting inadequate sampling of ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf). 2011;74(6):776-82. doi: 10.1111/j.1365-2265.2011.04011.x. [PubMed: 21521280].
  • 18. Stojadinovic A, Peoples GE, Libutti SK, Henry LR, Eberhardt J, Howard RS, et al. Development of a clinical decision model for thyroid nodules. BMC Surg. 2009;9:12. doi: 10.1186/1471-2482-9-12. [PubMed: 19664278].
  • 19. McCann DJ, Su TP. Haloperidol competitively inhibits the binding of (+)-[3H]SKF-10,047 to sigma sites. Eur J Pharmacol. 1990;180(2-3):361-4. [PubMed: 2163868].
  • 20. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab. 2006;91(9):3411-7. doi: 10.1210/jc.2006-0690. [PubMed: 16835280].
  • 21. Rosen JE, Stone MD. Contemporary diagnostic approach to the thyroid nodule. J Surg Oncol. 2006;94(8):649-61. doi: 10.1002/jso.20701. [PubMed: 17131409].
  • 22. Walsh RM, Watkinson JC, Franklyn J. The management of the solitary thyroid nodule: a review. Clin Otolaryngol Allied Sci. 1999;24(5):388-97. [PubMed: 10542917].
  • 23. Nakbjavani M, Esteghamati AR, Khalafpour M. A study of 558 cases of cold thyroid nodules, 1991-1999; Comparison to a decade earlier. Int J Endocrinol Metab. 2004;2(2).
  • 24. Coorough N, Hudak K, Jaume JC, Buehler D, Selvaggi S, Rivas J, et al. Nondiagnostic fine-needle aspirations of the thyroid: is the risk of malignancy higher?. J Surg Res. 2013;184(2):746-50. doi: 10.1016/j.jss.2013.02.018. [PubMed: 23490138].
  • 25. Kaliszewski K, Diakowska D, Wojtczak B, Strutynska-Karpinska M, Domoslawski P, Sutkowski K, et al. Fine-Needle Aspiration Biopsy as a Preoperative Procedure in Patients with Malignancy in Solitary and Multiple Thyroid Nodules. PLoS One. 2016;11(1). e0146883. doi: 10.1371/journal.pone.0146883. [PubMed: 26784518].
  • 26. Yoon JH, Kwak JY, Moon HJ, Kim MJ, Kim EK. The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy and the sonographic differences between benign and malignant thyroid nodules 3 cm or larger. Thyroid. 2011;21(9):993-1000. doi: 10.1089/thy.2010.0458. [PubMed: 21834673].
  • 27. Pacini F. Thyroid microcarcinoma. Best Pract Res Clin Endocrinol Metab. 2012;26(3):381-9. doi: 10.1016/j.beem.2011.10.006. [PubMed: 22632373].
  • 28. Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol. 2013;2013:965212. doi: 10.1155/2013/965212. [PubMed: 23737785].
  • 29. Alevizaki M, Papageorgiou G, Rentziou G, Saltiki K, Marafelia P, Loukari E, et al. Increasing prevalence of papillary thyroid carcinoma in recent years in Greece: the majority are incidental. Thyroid. 2009;19(7):749-54. doi: 10.1089/thy.2008.0421. [PubMed: 19534620].
  • 30. Elisei R, Molinaro E, Agate L, Bottici V, Masserini L, Ceccarelli C, et al. Are the clinical and pathological features of differentiated thyroid carcinoma really changed over the last 35 years? Study on 4187 patients from a single Italian institution to answer this question. J Clin Endocrinol Metab. 2010;95(4):1516-27. doi: 10.1210/jc.2009-1536. [PubMed: 20156922].
  • 31. Burman KD. Micropapillary thyroid cancer: should we aspirate all nodules regardless of size?. J Clin Endocrinol Metab. 2006;91(6):2043-6. doi: 10.1210/jc.2006-0799. [PubMed: 16757534].
  • 32. Lee J, Rhee Y, Lee S, Ahn CW, Cha BS, Kim KR, et al. Frequent, aggressive behaviors of thyroid microcarcinomas in korean patients. Endocr J. 2006;53(5):627-32. [PubMed: 16896263].
  • 33. Malandrino P, Pellegriti G, Attard M, Violi MA, Giordano C, Sciacca L, et al. Papillary thyroid microcarcinomas: a comparative study of the characteristics and risk factors at presentation in two cancer registries. J Clin Endocrinol Metab. 2013;98(4):1427-34. doi: 10.1210/jc.2012-3728. [PubMed: 23482606].
  • 34. Vlassopoulou V, Vryonidou A, Paschou SA, Ioannidis D, Koletti A, Klonaris N, et al. No considerable changes in papillary thyroid microcarcinoma characteristics over a 30-year time period. BMC Res Notes. 2016;9:252. doi: 10.1186/s13104-016-2018-2. [PubMed: 27129971].
  • 35. Roti E, Rossi R, Trasforini G, Bertelli F, Ambrosio MR, Busutti L, et al. Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. J Clin Endocrinol Metab. 2006;91(6):2171-8. doi: 10.1210/jc.2005-2372. [PubMed: 16478817].
  • 36. Choi YJ, Park YL, Koh JH. Prevalence of thyroid cancer at a medical screening center: pathological features of screen-detected thyroid carcinomas. Yonsei Med J. 2008;49(5):748-56. doi: 10.3349/ymj.2008.49.5.748. [PubMed: 18972595].
  • 37. Pellegriti G, Scollo C, Lumera G, Regalbuto C, Vigneri R, Belfiore A. Clinical behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: study of 299 cases. J Clin Endocrinol Metab. 2004;89(8):3713-20. doi: 10.1210/jc.2003-031982. [PubMed: 15292295].
  • 38. Kuo EJ, Goffredo P, Sosa JA, Roman SA. Aggressive variants of papillary thyroid microcarcinoma are associated with extrathyroidal spread and lymph-node metastases: a population-level analysis. Thyroid. 2013;23(10):1305-11. doi: 10.1089/thy.2012.0563. [PubMed: 23600998].
  • 39. Ghossein R, Ganly I, Biagini A, Robenshtok E, Rivera M, Tuttle RM. Prognostic factors in papillary microcarcinoma with emphasis on histologic subtyping: a clinicopathologic study of 148 cases. Thyroid. 2014;24(2):245-53. doi: 10.1089/thy.2012.0645. [PubMed: 23745671].
  • 40. Buffet C, Golmard JL, Hoang C, Tresallet C, Du Pasquier Fediaevsky L, Fierrard H, et al. Scoring system for predicting recurrences in patients with papillary thyroid microcarcinoma. Eur J Endocrinol. 2012;167(2):267-75. doi: 10.1530/EJE-12-0105. [PubMed: 22648965].
  • 41. Yu XM, Wan Y, Sippel RS, Chen H. Should all papillary thyroid microcarcinomas be aggressively treated? An analysis of 18,445 cases. Ann Surg. 2011;254(4):653-60. doi: 10.1097/SLA.0b013e318230036d. [PubMed: 21876434].
  • 42. Noguchi S, Yamashita H, Uchino S, Watanabe S. Papillary microcarcinoma. World J Surg. 2008;32(5):747-53. doi: 10.1007/s00268-007-9453-0. [PubMed: 18264828].
  • 43. Williams BA, Bullock MJ, Trites JR, Taylor SM, Hart RD. Rates of thyroid malignancy by FNA diagnostic category. J Otolaryngol Head Neck Surg. 2013;42:61. doi: 10.1186/1916-0216-42-61. [PubMed: 24359603].
  • 44. McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH. The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery. 2007;142(6):837-44. discussion 844 e1-3. doi: 10.1016/j.surg.2007.08.012. [PubMed: 18063065].
  • 45. Rios A, Rodriguez JM, Galindo PJ, Montoya M, Tebar FJ, Sola J, et al. Utility of fine-needle aspiration for diagnosis of carcinoma associated with multinodular goitre. Clin Endocrinol (Oxf). 2004;61(6):732-7. doi: 10.1111/j.1365-2265.2004.02157.x. [PubMed: 15579188].
  • 46. Kulstad R. Do All Thyroid Nodules >4 Cm Need to Be Removed? An Evaluation of Thyroid Fine-Needle Aspiration Biopsy in Large Thyroid Nodules. Endocrine Pract. 2016;22(7):791-8. doi: 10.4158/ep151150.or.
  • 47. Delshad H, Amouzegar A, Mirmiran P, Mehran L, Azizi F. Eighteen years of continuously sustained elimination of iodine deficiency in the Islamic Republic of Iran: the vitality of periodic monitoring. Thyroid. 2012;22(4):415-21. doi: 10.1089/thy.2011.0156. [PubMed: 22409203].
  • 48. Mostafavi H. Determination of prevalence of malignancy in cold solitary thyroid nodules and assessment of efficacy of fine needle aspiration in their evaluation. Med J Tabriz Univ Med Sci. 2006:101-5.
  • 49. Tee YY, Lowe AJ, Brand CA, Judson RT. Fine-needle aspiration may miss a third of all malignancy in palpable thyroid nodules: a comprehensive literature review. Ann Surg. 2007;246(5):714-20. doi: 10.1097/SLA.0b013e3180f61adc. [PubMed: 17968160].
  • 50. Yeh MW, Demircan O, Ituarte P, Clark OH. False-negative fine-needle aspiration cytology results delay treatment and adversely affect outcome in patients with thyroid carcinoma. Thyroid. 2004;14(3):207-15. doi: 10.1089/105072504773297885. [PubMed: 15072703].
  • 51. Carrillo JF, Frias-Mendivil M, Ochoa-Carrillo FJ, Ibarra M. Accuracy of fine-needle aspiration biopsy of the thyroid combined with an evaluation of clinical and radiologic factors. Otolaryngol Head Neck Surg. 2000;122(6):917-21. doi: 10.1016/S0194-59980070025-8. [PubMed: 10828810].
  • 52. Albuja-Cruz MB, Goldfarb M, Gondek SS, Allan BJ, Lew JI. Reliability of fine-needle aspiration for thyroid nodules greater than or equal to 4 cm. J Surg Res. 2013;181(1):6-10. doi: 10.1016/j.jss.2012.06.030.
  • 53. Porterfield JR, Grant CS, Dean DS, Thompson GB, Farley DR, Richards ML, et al. Reliability of benign fine needle aspiration cytology of large thyroid nodules. Surgery. 2008;144(6):963-9. doi: 10.1016/j.surg.2008.09.006.
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