Current Guidelines for Fine Needle Aspiration of Thyroid Nodules

Jeonghun Lee; Euy Young Soh

doi:10.16956/kjes.2015.15.1.1

Journal List > Korean J Endocr Surg > v.15(1) > 1060137

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee and Soh: Current Guidelines for Fine Needle Aspiration of Thyroid Nodules

Review Article

Korean J Endocrine Surg 2015;15(1):1-5.

Published online: 10 December 2015

DOI: https://doi.org/10.16956/kjes.2015.15.1.1

Current Guidelines for Fine Needle Aspiration of Thyroid Nodules

Jeonghun Lee, Euy Young Soh

Department of Surgery, Ajou University School of Medicine, Suwon, Korea

Correspondence: Euy Young Soh Department of Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon 440-380, Korea Tel: ＋82-31-219-5200 Fax: ＋82-31-219-5755 e-mail: sohey@ajou.ac.kr

Received 19 February 2015 Revised 2 March 2015 Accepted 19 March 2015

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

Thyroid cancer is a hot issue in Korea because there is debate on screening and diagnosis of thyroid cancer. Therefore, we reviewed the guidelines for the management of thyroid nodules of other countries. Western countries accepted the criteria of fine needle aspiration including the tumor size of thyroid nodules, although ultrasonographic morphologic characteristics are more important to diagnose the thyroid cancer than tumor size. This recommendation is based on good prognosis of papillary thyroid microcarcinoma. However, small subset of papillary thyroid microcarcinoma has aggressive behavior, which we cannot discern from those with benign behavior before operation. Therefore, further researches are necessary to resolve these problems and improve the management of papillary thyroid cancer avoiding overtreatment and mismanagement.

Keywords: Thyroid nodule, Thyroid cancer, Fine needle aspiration

References

1. Baskin HJ. Thyroid ultrasound-just do it. Thyroid. 2004; 14:91–2.

2. Park K YH, Nam EJ. Cancer Facts & Figures 2014, Seoul. Ministry of Health and Welfare;2014.

3. Howlader NA, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, et al. SEER Stat Fact Sheets: Thyroid Cancer. National Cancer Institute. 2014.

4. Tuttle M, Haddad R, Ball DW, Byrd D, Dickson P, Duh DY, et al. NCCN Clinical Practice Guidelines in Oncology. Thyroid cancer. 2014.

5. Kamran SC, Marqusee E, Kim MI, Frates MC, Ritner J, Peters H, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab. 2013; 98:564–70.

6. Shrestha M, Crothers BA, Burch HB. The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-needle aspiration: a 10-year study from a single institution. Thyroid. 2012; 22:1251–6.

7. Kim DW, Lee EJ, Kim SH, Kim TH, Lee SH, Kim DH, et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules: comparison in efficacy according to nodule size. Thyroid. 2009; 19:27–31.

8. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19:1167–214.

9. Moon WJ, Baek JH, Jung SL, Kim DW, Kim EK, Kim JY, et al. Korean Society of Thyroid Radiology (KSThR); Korean Society of Radiology. Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean J Radiol. 2011; 12:1–14.

10. Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrad G, et al. Guidelines for the management of thyroid cancer. 2014.

11. Suzuki S, Fukunari N, Kameyama K, Miyakawa M, Tanaka K, Hibi Y. Treatment of Thyroid Tumor. Tokyo Heidelberg New York Dordrecht London: Springer;2013.

12. Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, et al. AACE/AME/ETA Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. Endocr Pract. 2010; 16:468–75.

Table 1.

NCCN guidelines, version 2. thyroid carcinom (2014)

Ultrasonographic features	Threshold for FNA
Solid nodule
With suspicious US features	≥1.0 cm
Without suspicious US features	≥1.5 cm
Mixed cystic-solid nodule
With suspicious US features	≥1.5∼2.0 cm
Without suspicious US features	≥2.0 cm
Spongiform nodule	≥2.0 cm
Simple cyst	Not indicated
Suspicious cervical lymph node	FNA node±FNA thyroid nodule

Table 2.

FNA recommendation by American Thyroid Association (2009)

Ultrasonographic features T	Threshold for FNA
High-risk history
Nodule with suspicious US features	＞0.5 cm
Nodule without suspicious US features	＞0.5 cm
Abnormal cervical lymph nodes	All
Microcalicifications present in nodule	≥1 cm
Solid nodule
With hypoechic	≥1.0 cm
Without iso- or hyperechoic	≥1∼1.5 cm
Mixed cystic-solid nodule
With suspicious US features	≥1.5∼2.0 cm
Without suspicious US features	≥2.0 cm
Spongiform nodule	≥2.0 cm
Simple cyst	Not indicated

Table 3.

The management of thyroid cancer, British Thyroid Association (2014)

BTA		Consider biopsy
Grade	US features	Consider biopsy
U5 malignancy	1. Solid, hypo-, lobulated/irregualr, microcalicification (PTC)	YES
	2. Solid, hypo-, lobulated/irregular, globular calcification (MTC)
	3. Intra-nodular vascularity
	4. Taller than wide
	5. lymphadenopathy
U4 Suspicious	1. Solid, hypo-echoid	YES
	2. Solid, very hypo-
	3. Disrupted peripheral calcification, hypoechoic
	4. Lobulated margin
U3 Indeterminate/equivocal	1. Homogenous, iso-/hyper, solid, halo (follicular lesion)	YES
	2. Hypo-, equivocal echogenic foci, cystic change
	3. Mixed central vascularity
U2 Benign	1. Halo, hyper-/iso-	No
	2. Cystic chagne+/− ring down sign (colloid)	(yes, if high risk history)
	3. Micro-cystic/spongioform
	4. Peripheral egg shell calcification
	5. Peripheral vascularity
U1 Normal		No

Table 4.

American Association of Clinical Endocrinologists (AACE), Associazione Medici Endocrinologi (AME), and European Thyroid Association (ETA) (2010)

	FNA guideline
Nodule(s)	＞1 cm	Solid and hypoechoic
	Any size	Extracapsular growth or metastatic cervical lymph nodes
	Any size	History of neck irradiation in childhood or adolescence
		PTC, MTC, or MEN 2 in first-degree relatives
		Increased calcitonin levels in the absence of interfering factors
	＜1 cm	Coexistence of 2 or more suspicious US findings
	No	Hot nodules in scintigraphy
MNG	Selected on the basis of previously described criteria
	Not biopsy hot areas
	Biopsy both LN and nodule in presence of suspicious cervical LN
Solid-cystic	Sample the solid compoenent of the lesion by UGFNA biopsy
Solid-cystic	Submit both FNA biopsy specimen and drained fluid for cytologic examination
Incidentaloma	Should be managed according to previously described criteria
	US evaluation before consideration for UGFNA biopsy
	Hot nodule on PET should be undergo US evaluation plus UGFNA biopsy

UGFNA = Ultrasound-guided fine needle aspiration; MNG = multinodular goiter; PTC = papillary thyroid cancer; MTC = medullary thyroid cancer; MEN 2 = multiple endocrine neoplasia type 2.

TOOLS

Similar articles