Curr Med Res Opin. 2022 Nov 11:1-20. doi: 10.1080/03007995.2022.2146404. Online ahead of print.
ABSTRACT
OBJECTIVE: 1) To find strategies to improve diagnostic performance of ultrasound-guided biopsy of intermediate and high suspicion thyroid nodules with macrocalcifications, 2) To find malignancy rates of nodules with macrocalcification.
MATERIALS AND METHODS: From 2018 to 2022, fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) were retrospectively evaluated. Macrocalcifications were categorized into three types: intra-nodular, rim, and entirely calcified. Diagnostic performance was compared between biopsy modes (FNAB vs. CNB) and FNAB techniques (to-and-fro vs. whirling). Multivariate logistic regression was performed to determine features associated with performance of FNAB. Malignancy rates were calculated according to macrocalcification types.
RESULTS: Total of 114 procedures (87 FNAB and 27 CNB) in 89 nodules per 86 patients (mean age, 64 years; 76 women) were performed. Overall, CNB performed better than FNAB (unsatisfactory rate: 3.7% vs. 33.3%, p = 0.005). For macrocalcification thicker than 2 mm, whirling FNAB technique demonstrated comparable unsatisfactory rate with statistical trends toward significance (to-and-fro: 69.2% vs. whirling: 27.8%, p = 0.055). Entirely calcified nodule was associated with poor performance of FNAB (adjusted odds ratio 4.46 [95%CI: 1.19 – 16.67], p = 0.027). Overall malignancy was 22.5%, and higher in intra-nodular macrocalcification than rim and entirely calcified type (68.4% vs. 21.1% vs. 10.5%, p = 0.025).
CONCLUSION: For entirely calcified type, CNB should be considered first to improve diagnosis. For other types, FNAB can be performed, and whirling technique may be an alternative technique in thicker macrocalcification. Malignancy in intermediate and high suspicion nodules with macrocalcification have non-negligible rates.
PMID:36369696 | DOI:10.1080/03007995.2022.2146404
