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Original article
DOI: 10.1016/j.endien.2018.12.007
Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination: Diagnostic efficacy, prevalence, and factors predicting for Bethesda category I results
Punción-aspiración con aguja fina ecoguiada de nódulos tiroideos con valoración citológica in situ: eficacia diagnóstica, prevalencia y factores predictores de los resultados de categoría Bethesda I
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Luis García Pascuala,
Corresponding author
23566LGP@comb.cat

Corresponding author.
, Maria Lluïsa Surrallesb, Xavier Morliusb, Clarisa González Mínguezb, Guillem Viscasillasc, Xavier Laoc
a Servicio de Endocrinología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
b Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
c Servicio de Otorrinolaringología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
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Tables (4)
Table 1. Results of the 279 cytological evaluations performed by fine needle aspiration with ultrasound control and on-site cytological examination of the extracted material, distributed into half-year periods for the second year of our experience with the technique.
Table 2. Histopathological diagnosis in patients operated on according to the prior cytological result.
Table 3. Results of the variables studied in the total study subjects and a comparison of patients with Bethesda category I nodules with the other Bethesda cytological categories.
Table 4. Binary logistic regression findings referring to the prediction of Bethesda category I cytological results in thyroid nodules.
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Abstract
Background and objective

Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination may decrease the number of Bethesda category I cytologies. The study objective was to evaluate our second-year experience with this procedure to analyze diagnostic efficacy, prevalence, and factors predicting for Bethesda category I results.

Patients and method

A retrospective study was conducted of 279 nodules from 233 patients. Ultrasound-guided fine needle aspiration was performed according to the 2015 criteria of the American Thyroid Association. A specimen of each aspiration was air-fixed on site before Diff-Quik staining and microscopic examination to assess its suitability; otherwise, nodule aspiration was repeated up to 5 times. Diagnostic efficacy was assessed based on sensitivity and specificity on the cytological categories Bethesda II and Bethesda VI.

Results

Diagnostic sensitivity and specificity were both 100%, 5.4% Bethesda category I results were obtained, and variables independently associated were age (4.7% increase per year of life) and nodule volume (2.3% increase per each 1ml of volume).

Conclusions

Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination allows for a high diagnostic efficacy and has been shown to be a highly relevant procedure because it has a very low rate of cytological results of Bethesda category I, whose risk has been higher in older subjects and with larger nodules.

Keywords:
Fine-needle aspiration cytology
Thyroid nodule
Bethesda
Cytology
Resumen
Antecedentes y objetivo

El procedimiento de punción-aspiración con aguja fina ecoguiada de nódulos tiroideos con examen citológico in situ del material extraído puede reducir el número de citologías obtenidas de categoría Bethesda I. El objetivo del estudio ha sido evaluar nuestra experiencia del segundo año en dicha técnica para analizar la eficacia diagnóstica, la prevalencia y los factores predictores de los resultados de categoría Bethesda I.

Pacientes y método

Estudio retrospectivo sobre 279 nódulos en 233 pacientes. La punción-aspiración se realizó según los criterios de 2015 de la American Thyroid Association. Una muestra de cada punción se fijó al aire y se procesó in situ mediante tinción con Diff-Quik y examen microscópico para valorar su idoneidad; en caso contrario, se repitió la punción hasta un total de 5veces. La eficacia diagnóstica se valoró en base a la sensibilidad y a la especificidad sobre las categorías citológicas Bethesda II y Bethesda VI.

Resultados

La sensibilidad y la especificidad diagnóstica fueron del 100% en ambos casos. Obtuvimos un 5,4% de resultados de categoría Bethesda I y las variables independientemente asociadas fueron la edad (incremento del 4,7% por cada año de vida) y el volumen del nódulo (incremento del 2,3% por cada 1ml de volumen).

Conclusiones

La punción-aspiración ecoguiada con aguja fina y examen citológico in situ del material extraído permite obtener una elevada eficacia diagnóstica y demuestra ser un procedimiento de gran validez por conseguir una tasa muy baja de resultados citológicos de categoría Bethesda I, cuyo riesgo ha sido superior en sujetos de mayor edad y en nódulos de mayor tamaño.

Palabras clave:
Punción-aspiración con aguja fina
Nódulo tiroideo
Bethesda
Citología

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