Hurtado LLM, Arellano MS, Martínez DC, Torres-Acosta EM, Zaldívar RFR, Duarte-Torres RM, Pulido CA

Language: Spanish
References: 14
Page: 14-18
PDF size: 50.49 Kb.

ABSTRACT

Introduction: Fine-needle aspiration biopsy (FNAB) of the thyroid is a fundamental tool for the diagnosis of the nonfunctioning thyroid nodule, however, it has its limitations when it is nondiagnostic.
Objective: To assess the diverse diagnostic tools, paralleling FNAB, such as clinical findings, ultrasound (US), Tc-99-methoxy-isobuthyl-isonitrile (MIBI) gammagram, and transoperative study by freezing (TOS), to shed light on the approach to be taken when faced with a nonfunctioning thyroid nodule resulting in an indeterminate FNAB.
Material and methods: Prospective, longitudinal, analytical, blind study of 24 nonfunctioning thyroid nodules, with nondiagnostic FNAB from a total of 92 consecutive patients. Studied variables were: age, gender, number and repetitive result of FNAB, clinical diagnosis of malignancy, ultrasound malignancy di agnosis, malignancy diagnosis through Tc-99-MIBI gammagraphy, and malignancy diagnosis through TOS. All patients were subjected to surgery. Variables were analyzed by determining sensitivity, specificity, accuracy, positive predictive value, negative predictive value, prevalence and positive and negative odds ratio for each alternate diagnostic method compared with the final histopathological result.
Results: From the 24 nondiagnostic biopsies, five FNAB were inadequate and 19 indeterminate. Twenty-two corresponded to women and two to men, with an average age of 38 years, range 16 to 62 (SD ± 12.9), mode 42 and median 39. Six (25%) corresponded to cancer. Clinical study and ultrasound revealed no important impact for the therapeutic decision. Tc-99-MIBI gammagraphy provided a 100% negative predictive value with a negative odds ratio of 0, TOS revealed a positive predictive value of 100% and positive odds ratio of 0.
Conclusion: The only studies parallel to FNAB with diagnostic value were the 99-Tc-MIBI gammagraphy and TOS, reliable for the diagnostic and therapeutic management of the nonfunctioning thyroid nodule with nondiagnostic FNAB.

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