Correlation of Findings from Iodine 123 Scan and Ultrasonography in the Recommendation for Thyroid Fine-Needle Aspiration Biopsy

Objective To assess the impact of correlating findings from iodine I 123 (123I) radionuclide scans and thyroid ultrasonography on the decision to perform fine-needle aspiration (FNA) biopsy of thyroid nodules. Methods Iodine 123 scans and sonographic images of adult patients who had both examinations performed within 6 months of each other at our institution were retrospectively reviewed. The presence of 1 or more nodules satisfying imaging-specific criteria for recommending FNA biopsy was recorded. Iodine 123 scan and sonographic images were then directly compared to determine how frequently the FNA recommendation would be affected by discordant findings. Results The study included 97 adult patients, with a total of 291 thyroid lobes (right thyroid lobe, left thyroid lobe, and isthmus). Recommendations for FNA biopsy were concordant in 231 of 291 lobes (79.4%), with both modalities recommending FNA biopsy in 55 lobes and not recommending FNA biopsy in 176 lobes. A discordant recommendation occurred in 60 of 291 lobes (20.6%). Using only ultrasonography findings, a recommendation for FNA biopsy was not indicated for 11 of the 291 lobes (3.8%) with functioning nodules. Using only 123I findings, a recommendation for FNA biopsy was not indicated for 23 of the 291 lobes (7.9%); 13 had nodules, but none that fulfilled sonographic criteria, and 10 had no identifiable nodule on ultrasonography. Iodine 123 scan did not identify 26 lobes with nodules (8.9%) for which FNA biopsy was recommended based on ultrasonography findings. Conclusion Recommendations for FNA biopsy should not be based on the presence of hypofunctioning regions on 123I scan without sonographic confirmation. (Endocr Pract. 2011;17:699-706)