Francesca Ng MBBS, Presenter: Nothing to Disclose

Sashin Kaneria MRCP, FRCR, Abstract Co-Author: Nothing to Disclose

Mohammad Haroon Qarib BSc, MSc, Abstract Co-Author: Nothing to Disclose

Ravi K. Lingam MRCP FRCR, Abstract Co-Author: Nothing to Disclose

To prospectively assess the diagnostic performance of ultrasound with colour doppler in selecting neoplastic nodules for fine needle aspiration cytology.

127 patients that were referred for thyroid ultrasound/FNA examination were prospectively and independently assessed by two experienced observers with regards to well established thyroid nodular characteristics for neoplasia. The presence of microcalcification, ill-defined contour or central/mixed doppler vascular flow pattern or a combination of any of these characteristics was used to select the nodules that required Fine Needle Aspiration (FNA) Cytology. Sonographic prediction/selection for FNA was compared to the final diagnosis (histological diagnosis for all neoplastic nodules and histology or cytology with at least 6 months follow up for all non-neoplastic nodules).

4 patients were excluded from our study because they were not adequately diagnosed and lost to follow-up. There were 25 neoplastic and 98 non-neoplastic nodules in our series. . There is a statistically significant association between  colour flow, contours and presence of microcalcification with the diagnosis with p values less than 0.001. There was no significant difference in the incidence of neoplastic and non-neoplastic nodules between solitary nodules and multinodular glands or between palpable or non-palpable nodules. The non-neoplastic nodules were larger than neoplastic nodules but with borderline statistical significance (Mann-Whitney test, p=0.06). All neoplastic nodules were correctly selected  for FNA cytology using ultrasound features, with a sensitivity of 100% (95% CI 86-100). Only 74 out of 98  (76%) non-neoplastic nodules were correctly not selected for FNA cytology using ultrasound features . There was very good interobserver agreement (k>0.9).

Ultrasound with colour doppler accurately selected all (100%) neoplastic nodules for FNA cytological analysis using established thyroid nodular characteristics for malignancy. However, due to its lower specificity (76% (95% CI 57-76%)) it also selected 24% of non-neoplastic nodules for FNA . This is work in progress with an aim of acquiring an additional 40 patients for data analysis by Aug 2010.

This study supports the need for using ultrasound with colour doppler to select suspicious/neoplastic  thyroid nodules for cytological analysis to maximise benefit and minimise cost.

Ng, F, Kaneria, S, Qarib, M, Lingam, R, Can Ultrasound Accurately Select Neoplastic Nodules for Fine Needle Aspiration (FNA) Cytology?  .  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9003922.html