{
  "abstract": "BackgroundPapillary thyroid microcarcinoma (PTMC, [≤]1 cm) is increasingly diagnosed, and a subset behaves aggressively. Preoperative ultrasound (US) and fine-needle aspiration (FNA) accuracy in this size range, particularly with multinodular disease, is poorly defined outside East Asian screening cohorts.\n\nMaterials and MethodsWe retrospectively analyzed 180 consecutive PTMC cases (2017- 2026) with preoperative US and FNA and compared them with 191 benign thyroidectomy controls. ROC analysis identified an optimal size cutoff. We compared sensitivity, specificity, PPV, NPV, and accuracy across tumor-size subgroups, before/after 2023, and with/without dominant nodules (DNs) [≥]2 cm.\n\nResultsROC analysis identified 5 mm as the optimal cutoff (AUC 0.80). FNA sensitivity was 44.4% overall, falling to 14.1% for tumors <5 mm versus 61.2% for [≥]5 mm, with specificity uniformly high (94.8%). US showed a similar pattern (sensitivity 23.4% vs. 64.7%) but lower specificity (69.6%), driven largely by calcification and Hashimotos-related hypoechogenicity. Combined FNA+US improved sensitivity to 59.4%. DNs [≥]2 cm markedly reduced FNA true-positive rates (67.9% vs. 10.8%; OR 17.4). Excluding DN cases raised FNA sensitivity to 67%, NPV to 84.2%, and accuracy to 85.2%. Post-2023 experience significantly improved all metrics (sensitivity 34.4% to 54.4%).\n\nConclusionFNA and US sensitivity for PTMC decline sharply below 5 mm and in multinodular glands with dominant nodules, while specificity/PPV remain high. A 5 mm threshold, operator experience, and selective avoidance of FNA in dominant-nodule-bearing multinodular goiters (favoring direct surgical referral) can meaningfully improve diagnostic performance and guide management.",
  "abstract_shown": true,
  "affiliations": [
    "Security Force Hospital, Riyadh, Saudi Arabia."
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "I. EL HAG"
    },
    {
      "name": "M. T. Al Shammary"
    },
    {
      "name": "R. Tallab"
    },
    {
      "name": "S. Patil"
    },
    {
      "name": "A. Alghamdi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/84hp51ybqm5ey.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.06.26364827",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.06.26364827v1.full",
  "id": "84hp51ybqm5ey",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.06.26364827v1",
  "language": null,
  "licence": "CC0-1.0",
  "licence_label": "CC0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/publicdomain/zero/1.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "oncology"
    ],
    [
      "openalex",
      "2712|Thyroid Cancer Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7220964268",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.06.26364827v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-06",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/84hp51ybqm5ey.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:29Z",
      "native_id": "10.64898/2026.10.06.26364827",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.06.26364827v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:oncology",
      "subfield": "oncology"
    }
  ],
  "title": "US-Guided Fine-Needle Aspiration of Papillary Thyroid Microcarcinoma in Non-Screening Settings: Diagnostic Errors and Mitigation Strategies",
  "title_text": "US-Guided Fine-Needle Aspiration of Papillary Thyroid Microcarcinoma in Non-Screening Settings: Diagnostic Errors and Mitigation Strategies",
  "type": "preprint",
  "updated_at": "2026-10-30T12:20:29Z",
  "url": "https://research.draconitic.com/paper/84hp51ybqm5ey",
  "venue": "medRxiv",
  "versions": []
}