Comparison of the diagnostic value of fine needle aspiration and ultrasound in thyroid pathology

Abstract

Fine needle aspiration (FNA) biopsy has been a powerful tool in the preoperative diagnosis of thyroid nodules for more than 60 years. The Bethesda scale standardizes the results of cytology and is a tool for interaction between the laboratory and the clinician. At the same time, there is a stratification of ultrasound signs of thyroid lesions according to the TI-RADS scale. In this regard, it became necessary to determine the diagnostic value of ultrasound signs of thyroid lesions, stratified by TI-RADS, in comparison with the results of a biopsy, classified by the Bethesda scale.AIM: a comparative assessment of the results of FNA and ultrasound in determining indications for the surgical treatment of thyroid nodules.MATERIALS AND METHODS: for 2018–2021 in the surgical department of the SCC №2 of the Petrovsky National Research Centre of Surgery, 859 FNA were performed. For comparative analysis, 141 patients who underwent surgery for thyroid nodules were selected. All patients at the preoperative stage underwent FNA with stratification of the results according to the Bethesda scale and ultrasound of the thyroid gland with stratification according to the EU-TI-RADS scale.RESULTS: FNA showed high diagnostic accuracy and sensitivity, preoperative thyroid ultrasound had high specificity, but low sensitivity. The high diagnostic value of FNA was confirmed by statistical analysis of the obtained data (OR 31.29 95% CI 2.20–4.69, RR 13.28 95% CI 1.46–3.71). When analyzing preoperative ultrasound, it was not possible to obtain reliable statistical results (OR 2.99 95% CI 0.34-1.85, RR 1.97 95% CI 0.23-1.12).CONCLUSION: Ultrasound of the thyroid gland cannot replace FNA in thyroid nodules. Biopsy remains the main diagnostic method for nodular goiter. The main objective of TI-RADS-stratified ultrasound is to select patients for subsequent FNA.