JRM
Journal of Radiology in Medicine

Journal of Radiology in Medicine is an international journal that published original research and articles in all areas of radiology. Its publishes original research articles, review articles, case reports, editorial commentaries, letters to the editor, educational articles, and conference/meeting announcements.

eISSN: 3023-6487
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Original Article
Management of thyroid nodules initially classified as benign: ultrasonographic features as a criterion for repetition of fine-needle aspiration
Abstract
Aims: Nodular thyroid disease is highly prevalent in the adult population. The primary objective in the management of thyroid nodules is to distinguish malignant lesions from benign ones. Following ultrasound-guided fine-needle aspiration (FNA), malignancy is detected in only 3% to 12% of cases. However, in clinical practice, false-negative rates ranging from 1.3% to 11.5% in nodules classified as benign can introduce uncertainty into the management process. Early identification of distinct ultrasonographic features associated with malignancy may not only reduce unnecessary repeat FNA procedures but also help prevent diagnostic delays caused by false-negative results.
Methods: A retrospective review was performed of 513 nodules that underwent repeat fine-needle aspiration biopsies within 6 to 12 months over a 5-year period. Ultrasound features (number and size of nodules, growth in nodule size, echotexture, echogenicity, presence of microcalcifications, cervical lymphadenopathy, and lymphadenopathy progression) were compared with cytology results to determine which sonographic findings warrant repeat biopsy and which support clinical follow-up.
Results: Repeat FNA was performed on 513 thyroid nodules initially classified as benign, with malignancy detected in 15 cases (2.9%). Ultrasound features significantly associated with increased malignancy risk included microcalcifications, hypoechoic solitary nodules, enlarging hypoechoic solitary nodules, accompanying lymphadenopathy, and progressive lymphadenopathy. In contrast, nodule number, size, growth, and echotexture alone were not significant predictors of malignancy. Ultrasound characteristics such as cystic composition, isoechogenicity, and hyperechogenicity were more commonly observed in benign nodules.
Conclusion: This study recommends repeat FNA for hypoechoic solitary nodules, enlarging hypoechoic solitary nodules, nodules with microcalcifications, and those associated with lymphadenopathy. In contrast, repeat FNA is not advised for cystic nodules or solid nodules without hypoechogenicity.

Keywords : Thyroid, nodules, fine-needle aspiration, benign, malignant nodules

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Article available in :
Volume 2, Issue 4, 2025
Page : 59-63
https://doi.org/10.51271/JRM-0036
Article Information
Received : 23 Haz 2025
Accepted : 01 Ağu 2025
Published : 15 Eki 2025
Corresponding Author :

Alev Dolu: Department of Radiology, Acıbadem Maslak Hospital, İstanbul, Turkiye

[email protected]
Citation : Dolu A, Özkale Yavuz Ö, Özyer EU. Management of thyroid nodules initially classified as benign: ultrasonographic features as a criterion for repetition of fine-needle aspiration. J Radiol Med. 2025;2(4):59-63.

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