Mehmet Ilker TURAN, Nedim AKGUL
Çukurova Anestezi ve Cerrahi Bilimler Dergisi - 2026;9(1):81-86
Aim: Ultrasound -guided fine -needle aspiration biopsy (US -FNAB) is the cornerstone of thyroid nodule evaluation. Although traditionally performed by radiologists, the increasing involvement of endocrine surgeons in this procedure necessitates assessment of its effectiveness. This study aims to evaluate the diagnostic adequacy of US-FNAB performed by a single endocrine surgeon and to identify ultrasonographic risk factors associated with non-diagnostic cytology and malignancy. Methods: Data from 607 US -FNAB procedures performed by a single surgeon and histopathology of 161 nodules from 138 thyroidectomies were retrospectively reviewed. Nodule characteristics (composition, location, echogenicity, shape, margins, echogenic foci) were correlated with Bethesda cytology categories and final histopathology. Statistical analyses were performed to identify factors associated with non -diagnostic results and malignancy. Results: The non -diagnostic cytology rate was 8.73%. Anterior location was associated with reduced risk of non -diagnostic cytology (p=0.019), while peripheral calcification significantly increased this risk (p=0.0039). Malignancy rates were consistent with Bethesda categories, ranging from 13.69% (Bethesda 2) to 100% (Bethesda 6). Marked hypoechogenicity (43.08%, p<0.001), taller -than-wide shape (35.29%, p<0.001), irregular margins (33.75%, p<0.001), and punctate calcifications (25.26%, p<0.001) were strong predictors of malignancy. Inferior location was associated with lower malignancy risk (p=0.029). Conclusions: US-FNAB performed by an experienced endocrine surgeon demonstrates high diagnostic adequacy. Anterior location reduces the risk of non -diagnostic cytology, while inferior location lowers malignancy risk. Peripheral calcification increases non -diagnostic risk, whereas marked hypoechogenicity, taller -than-wide shape, irregular margins, and punctate calcifications elevate malignancy risk. These findings support the important and complementary role of endocrine surgeons in thyroid nodule management.
