# Beyond Size: Integrating Ultrasonographic Features and FNAB Cytology to Predict Thyroid Malignancy—A Retrospective, Single-Center Study

## TL;DR

This study shows that combining ultrasound features and fine-needle biopsy improves accuracy in predicting thyroid cancer.

## Contribution

The study integrates ultrasonographic features and FNAB cytology to enhance thyroid malignancy prediction.

## Key findings

- Hypoechogenicity, microcalcifications, and irregular margins are strong ultrasonographic predictors of thyroid malignancy.
- FNAB has high specificity but low sensitivity, and its accuracy improves when combined with ultrasound findings.
- Integrating FNAB with structured imaging systems like ACR TI-RADS and Bethesda classification enhances diagnostic precision.

## Abstract

Background/Objectives: This study aimed to evaluate the relationship between preoperative clinical, ultrasonographic, and cytologic findings and postoperative histopathology in patients with thyroid nodules, and to determine diagnostic factors associated with malignancy. Materials and Methods: A retrospective analysis was conducted on 100 patients who underwent thyroid surgery between September 2012 and April 2014. Preoperative data—including clinical examination, thyroid function tests, and high-resolution ultrasonography—were compared with fine-needle aspiration biopsy (FNAB) results and final histopathology. Ultrasonographic features (echogenicity, calcification, vascularity, and margin) were analyzed for their association with malignancy. Statistical tests included chi-square, t-test, and correlation analysis (p < 0.05 considered significant). Results: Among 100 patients (79 females, 21 males; mean age 47.5 ± 13.9 years), 29 (29%) had benign and 71 (71%) malignant histopathology. Malignancy was significantly associated with older age (p = 0.025), smaller nodule size (p = 0.019), hypoechogenicity (p = 0.001), microcalcifications (p = 0.014), and irregular margins (p = 0.017). FNAB showed a strong correlation with final histopathology (r = 0.65, p = 0.001). The overall sensitivity and specificity of FNAB were 25.4% and 82.8%, respectively. Conclusions: Hypoechogenicity, microcalcifications, and irregular margins were the most reliable ultrasonographic predictors of malignancy. FNAB remains a highly specific but variably sensitive diagnostic tool, and its accuracy increases when interpreted in conjunction with ultrasonographic findings. Integrating cytology with structured imaging systems such as ACR TI-RADS and Bethesda classification enhances diagnostic precision in thyroid nodule evaluation.