| Objectives:Thyroid nodules are a common clinical endocrine disease.The discovery of ultrasound screening rate is as high as 20%-76% and 5–15% are malignant.Therefore,early diagnosis and treatment have become increasingly important in curing malignant thyroid carcinoma.Now,thyroid biopsy has been routinely recommend as the gold standard for diagnosis of thyroid cancer and Fine needle aspiration(FNA)used as the most widely method.On the basis of the ultrasound-guided,the Fine Needle Aspiration Cytology(FNAC)and Fine Needle Non-aspiration Cytology(FNNAC)were developed.Ultrasound-guided FNAC and FNNAC are the two primary approaches to applying clinic,however,which one is superior is controversial.Thus,by comparing cytology and pathology of FNAC and FNNAC,this prospective trial provided reference for clinicians to select an appropriate biopsy method.To compare the sampling efficiency and diagnostic performance of ultrasound(US)-guided fine-needle aspiration cytology(FNAC)and fine-needle non-aspiration cytology(FNNAC)for thyroid nodules.The Ethics Committee of hospital monitored,reviewed and approved the study protocol.The study conformed to the standards of the Declaration of Helsinki.In this test,according to sample size estimation,at least 650 participants were needed for this trial.All patients who agreed to be randomly assigned to the FNAC group or FNNAC group gave written informed consent before enrollment.Patients were enrolled on the basis of the inclusion criteria as following: with one or more suspicious US findings and results of laboratory tests including blood routine examination and coagulation profile were eligible.At last,629 thyroid nodules in 629 cases were randomly subjected to FNAC(n=313)or FNNAC(n=316)from Sep 2014 to Feb 2015.All FNA cytology cwere classified according to the Bethesda system and the American Thyroid Association(ATA)has published the latest guideline regarding the evaluation and management of thyroid nodules.Diagnostic performance was calculated in reference to the histological findings or follow-up results.Data were compared using independent samples t-test,Mc Nemar test or chi-squared test.Materials and Methods:Results:629 patients(152 men,477 women)with 629 thyroid nodules were enrolled in the study.Pathological results were obtained in 173 nodules and benign nodules at FNA with more than six months' follow-up were found in 65 nodules.Tumor size for FNAC ranges from 3.0 to 51.0 mm(mean ± SD;10.2 ± 6.9 mm);whereas FNNAC(2.0-43.0 mm;11.9 ± 7.7 mm).Non-diagnostic results were found in 7.59%(24/316)of FNNAC procedures and 7.59%(25/313)of FNAC(P > 0.05).Determinate and indeterminate results were found in 50.63%(160/316)and 41.77%(132/316)of FNNAC procedures,whereas 58.15%(182/313)and 33.87%(106/313)of FNAC(P< 0.05).In order to obtain determinate cytological results,FNAC might be more suitable than FNNAC for diagnosis of nodules with hypovascularity(51.38% vs.41.78%,P < 0.05)and macrocalcifications(9.72% vs.6.50%,P < 0.05).No US and Color-Doppler US characteristics,such as the presence of hypervascularity(P > 0.05),microcalcifications(P > 0.05),internal component(P > 0.05),or size(P > 0.05),were significantly different to obtain determinate cytological results between the FNAC and FNNAC groups.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy of FNAC and FNNAC were as follows: 96.67% vs.100%,89.74% vs.96.5%,87.88% vs.96.97%,97.22% vs.100%,92.75% vs.98.36%,respectively(all P > 0.05).Conclusions:Both FNAC and FNNAC are effective for diagnosis of thyroid nodules.However,FNAC is more effective than FNNAC to acquire determinate cytological results for nodules which US present hypovascularity and macrocalcifications. |
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