Thyroid nodules with discordant results of ultrasonographic and fine-needle aspiration findings

Min Joo Kim; Ka Hee Yi

doi:10.5124/jkma.2018.61.4.225

J Korean Med Assoc > Volume 61(4); 2018 > Article

Kim and Yi: Thyroid nodules with discordant results of ultrasonographic and fine-needle aspiration findings

Focused Issue of This Month

Recent Diagnosis and Treatment of Thyroid Disease

Journal of the Korean Medical Association 2018; 61(4): 225-231.

Published online: April 12, 2018

DOI: http://dx.doi.org/10.5124/jkma.2018.61.4.225

Thyroid nodules with discordant results of ultrasonographic and fine-needle aspiration findings

Min Joo Kim, MD¹

, Ka Hee Yi, MD²

¹Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.

²Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.

Corresponding author: Ka Hee Yi. khyi@snu.ac.kr

Received March 08, 2018 Accepted March 22, 2018

Korean Medical Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

As the detection of thyroid nodules increases, it is important to differentiate whether thyroid nodules are malignant or not. Ultrasonography-guided fine-needle aspiration cytology is the standard method to diagnose thyroid nodules. Ultrasonographic findings of thyroid nodules can predict the risk of malignancy, and fine-needle aspiration allows the examination of cytopathology of thyroid nodules. However, both are not perfect, with a certain degree of false negative or false positive results. Therefore, we can face thyroid nodules with discordant results of ultrasonographic and fine-needle aspiration findings. In the case of benign features on ultrasonography with malignant cytology, follicular thyroid cancer, follicular variant papillary thyroid cancer, cystic or degenerative changes of thyroid cancer, and thyroiditis are candidates for diagnosis. In contrast, for the nodules with ultrasonographic features of highly suspicious of malignancy but benign cytology, we can consider the possibility of thyroiditis, changes of benign nodule, and cystic changes of thyroid cancer. These various conditions may result in discordant results of ultrasonographic features and fine-needle aspiration cytology, which need special attention not to miss the diagnosis of malignant nodules.

Biopsy, fine-needle; Thyroid nodule; Ultrasonography

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Figure 1

Thyroid nodules with discordant results of ultrasonography and fine-needle aspiration (FNA). (A,B) Thyroid nodule showed low suspicion features (Korean Thyroid Imaging Reporting and Data System 3) in ultrasonography, but FNA cytology (×400) was malignant (Bethesda category VI). The final pathology was follicular variant papillary thyroid carcinoma. (C,D) Thyroid nodule showed intermediate suspicion features (Korean Thyroid Imaging Reporting and Data System 4) in ultrasonography, but FNA cytology (×400) was benign (Bethesda category II).

Table 1

Malignant risk of thyroid nodules according to Korean Thyroid Imaging Reporting and Data System

Reproduced from Shin JH, et al. Korean J Radiol 2016;17:370-395, according to the Creative Commons license [2].

US, ultrasonography.

^a)Microcalcification, nonparallel orientation (taller-than-wide), spiculated/microlobulated margin.

Table 2

Malignant risk of thyroid nodules according to the Bethesda System Thyroid Cytopathology

Adapted from Cibas ES, et al. Am J Clin Pathol 2009;132:658-665 [8].