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Alden J, Lambrou D, Yang J. Two-tier subclassification of the Bethesda category III (atypia of undetermined significance/follicular lesion of undetermined significance) in thyroid cytology. Diagn Cytopathol 2024; 52:156-162. [PMID: 38095097 DOI: 10.1002/dc.25261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/31/2023] [Accepted: 11/24/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND The Bethesda category III, AUS/FLUS, comprises a heterogeneous group of thyroid lesions with variable risk of malignancy (ROM). This study evaluates ROM in two subgroups of this category based on nuclear atypia and architectural atypia. METHODS Cases in Bethesda category III were reported based on nuclear atypia (AUS) and architectural atypia (FLUS). ROM was calculated by comparing the cytologic diagnosis to the follow-up histologic diagnosis. RESULTS Among the 610 Bethesda category III cases in this study, 306 (50.2%) and 304 (49.8%) cases were reported as AUS and FLUS, respectively. One hundred and eighty six of 306 AUS (60.8%) and 193 of 304 FLUS (63.5%) cases underwent surgical intervention. ROM of the cases in Bethesda category III was 12.8% if all cases were counted and 20.6% if only surgical cases were counted. When analyzing separately, ROM of AUS cases was 17.0% and 28.0% with all cases and surgical cases only, respectively. For FLUS cases, ROM was 8.6% and 13.5% with all cases and surgical cases only, respectively. CONCLUSION In Bethesda category III, ROM in the cases with nuclear atypia was significantly higher than the cases with architectural atypia. Sub-classifying the Bethesda Category III cases with nuclear atypia and architectural atypia, respectively may better stratify the ROM.
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Affiliation(s)
- Jay Alden
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Denise Lambrou
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jack Yang
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Coelho M, Capela J, Anjo SI, Pacheco J, Fernandes MS, Amendoeira I, Jones JG, Raposo L, Manadas B. Proteomics Reveals mRNA Regulation and the Action of Annexins in Thyroid Cancer. Int J Mol Sci 2023; 24:14542. [PMID: 37833989 PMCID: PMC10572572 DOI: 10.3390/ijms241914542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Differentiated thyroid cancer is the most common malignancy of the endocrine system. Although most thyroid nodules are benign, given the high incidence of thyroid nodules in the population, it is important to understand the differences between benign and malignant thyroid cancer and the molecular alterations associated with malignancy to improve detection and signal potential diagnostic, prognostic, and therapeutic targets. Proteomics analysis of benign and malignant human thyroid tissue largely revealed changes indicating modifications in RNA regulation, a common cancer characteristic. In addition, changes in the immune system and cell membrane/endocytic processes were also suggested to be involved. Annexin A1 was considered a potential malignancy biomarker and, similarly to other annexins, it was found to increase in the malignant group. Furthermore, a bioinformatics approach points to the transcription factor Sp1 as being potentially involved in most of the alterations seen in the malignant thyroid nodules.
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Affiliation(s)
- Margarida Coelho
- CNC—Center for Neurosciences and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal; (M.C.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-517 Coimbra, Portugal
- III Institute for Interdisciplinary Research, University of Coimbra (IIIUC), 3030-789 Coimbra, Portugal
- Department of Chemistry, Faculty of Sciences and Technology, University of Coimbra, 3004-535 Coimbra, Portugal
| | - João Capela
- Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal
| | - Sandra I. Anjo
- CNC—Center for Neurosciences and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal; (M.C.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-517 Coimbra, Portugal
- III Institute for Interdisciplinary Research, University of Coimbra (IIIUC), 3030-789 Coimbra, Portugal
| | - João Pacheco
- Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal
| | | | - Isabel Amendoeira
- Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal
- I3S, Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Ipatimup, Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-465 Porto, Portugal
| | - John G. Jones
- CNC—Center for Neurosciences and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal; (M.C.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-517 Coimbra, Portugal
- III Institute for Interdisciplinary Research, University of Coimbra (IIIUC), 3030-789 Coimbra, Portugal
| | - Luís Raposo
- Portuguese Society of Endocrinology, Diabetes and Metabolism, 1600-892 Lisbon, Portugal
- EPIUnit-Institute of Public Health, University of Porto, 4050-600 Porto, Portugal
| | - Bruno Manadas
- CNC—Center for Neurosciences and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal; (M.C.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-517 Coimbra, Portugal
- III Institute for Interdisciplinary Research, University of Coimbra (IIIUC), 3030-789 Coimbra, Portugal
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Ng DL, van Zante A, Griffin A, Hills NK, Ljung BM. A Large Thyroid Fine Needle Aspiration Biopsy Cohort with Long-Term Population-Based Follow-Up. Thyroid 2021; 31:1086-1095. [PMID: 33371796 PMCID: PMC9469749 DOI: 10.1089/thy.2020.0689] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Prior studies evaluating thyroid fine needle aspiration biopsies (FNABs) have limited the calculation of risk of malignancy (ROM) to cytologic specimens with corresponding histologic specimens, and clinical follow-up for those patients who do not undergo immediate surgery has been largely disregarded. Moreover, there is marked variability in how researchers have approached thyroid FNAB statistical analyses. This study addresses the urgent need for information from a large cohort of patients with long-term clinical follow-up to more accurately determine the performance of thyroid FNAB and ROM for each diagnostic category. Methods: A retrospective review of the University of California, San Francisco (UCSF), pathology database for thyroid FNABs from January 1, 1997, to December 31, 2004, was performed. Diagnoses were coded using the 2017 The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), and patients were matched to both the UCSF cancer registry and California Cancer Registry. Data were analyzed using the Kaplan-Meier method, and stratified by TBSRTC diagnostic category. Kaplan-Meier curves were used to estimate incidence rates of malignancy, stratified by FNAB category. Cox proportional hazards models were used to determine the instantaneous ROM. Results: Initial FNABs from 2207 patients were included. Median follow-up period after the first thyroid FNAB was 13.9 years (range: 10.5-18.4 years). During follow-up, there were 279 confirmed diagnoses of thyroid malignancy. Estimates derived from Kaplan-Meier curves demonstrated that the risk of having a thyroid malignancy was low for nondiagnostic and benign categories, intermediate for atypia of undetermined significance (AUS), follicular lesion of undetermined significance (FLUS), AUS/FLUS combined, and follicular neoplasm, and high for suspicious and malignant categories. A total of 52/1575 false-negative cases (3.2%) were identified. Excluding papillary microcarcinomas, the false-negative rate was 1.5% (23/1575). No patients with a false-negative diagnosis died of thyroid cancer during the follow-up period. Conclusions: Asymptomatic patients with low-risk clinical and radiologic features and initially benign or unsatisfactory biopsy are unlikely to develop thyroid malignancy and highly unlikely to die of thyroid cancer. FNAB is highly accurate in detecting malignancy. Additional studies evaluating similar large data sets after the adoption of TBSRTC and the integration of molecular testing are needed.
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Affiliation(s)
- Dianna L. Ng
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Annemieke van Zante
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Ann Griffin
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA
| | - Nancy K. Hills
- Department of Epidemiology and Biostatistics, and University of California, San Francisco, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Britt-Marie Ljung
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA
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4
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Fiorentino V, Dell’ Aquila M, Musarra T, Martini M, Capodimonti S, Fadda G, Curatolo M, Traini E, Raffaelli M, Lombardi CP, Pontecorvi A, Larocca LM, Pantanowitz L, Rossi ED. The Role of Cytology in the Diagnosis of Subcentimeter Thyroid Lesions. Diagnostics (Basel) 2021; 11:diagnostics11061043. [PMID: 34204172 PMCID: PMC8230300 DOI: 10.3390/diagnostics11061043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
Thyroid nodules are common and typically detected by palpation and/or ultrasound (US). Guidelines have defined the management of large nodules, but controversy exists regarding nodules ≤ 1 cm. We evaluated a cohort of patients with subcentimeter nodules to determine their rate of malignancy (ROM). A total of 475 thyroid FNAs of lesions ≤ 1 cm with available follow-up were identified from January 2015–December 2019. For comparative analysis, we added a control series of 606 thyroid lesions larger than 1 cm from the same reference period. All aspirates were processed with liquid-based cytology and classified according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Subcentimeter nodules were stratified as 35 category I—non-diagnostic cases (ND; 7.3%), 144 category II—benign lesions (BL; 30.3%), 12 category III—atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; 2.5%), 12 category IV—follicular neoplasm/suspicious for follicular neoplasm (FN/SFN; 2.5%), 124 category V—suspicious for malignancy (SM; 26.1%), and 148 category VI—positive for malignancy (PM; 31.1%). A total of 307 cases (64.6%) underwent subsequent surgery. Only one ND and three BLs had a malignant outcome. ROM for indeterminate lesions (III + IV) was 3.2%; with 1.6% for category III and 3.2% for category IV. ROM for the malignant categories (V + VI) was 88.2%. The control cohort of lesions demonstrated a higher number of benign histological diagnoses (67.3%). We documented that 57.2% of suspected subcentimeter lesions were malignant, with a minor proportion that belonged in indeterminate categories. There were very few ND samples, suggesting that aspirates of subcentimeter lesions yield satisfactory results. Suspected US features in subcentimeter lesions should be evaluated and followed by an interdisciplinary team for appropriate patient management.
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Affiliation(s)
- Vincenzo Fiorentino
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Marco Dell’ Aquila
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Teresa Musarra
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Mariangela Curatolo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Emanuela Traini
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (E.T.); (M.R.); (C.P.L.)
| | - Marco Raffaelli
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (E.T.); (M.R.); (C.P.L.)
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (E.T.); (M.R.); (C.P.L.)
| | - Alfredo Pontecorvi
- Division of Endocrinology-Fondazione, Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy;
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
| | - Liron Pantanowitz
- Department of Pathology & Clinical Labs, University of Michigan, Ann Arbor, MI 48103, USA;
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (V.F.); (M.D.A.); (T.M.); (M.M.); (S.C.); (G.F.); (M.C.); (L.M.L.)
- Correspondence: ; Tel.: +39-06-3015-4433
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5
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Wu JH, Zeng W, Wu RG, Wang M, Ye F, Fu MY. Comparison of Ultrasonography and CT for Determining the Preoperative Benign or Malignant Nature of Thyroid Nodules: Diagnostic Performance According to Calcification. Technol Cancer Res Treat 2020; 19:1533033820948183. [PMID: 32940552 PMCID: PMC7506781 DOI: 10.1177/1533033820948183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: The present study was designed to investigate the presence or absence of
calcification and whether calcification size affect the diagnostic accuracy
of ultrasonography (US) and computed tomography (CT) in predicting the
benign or malignant nature of thyroid nodules. Material and Methods: From May 2014 to April 2019, 445 patients underwent thyroid US and neck CT
before thyroid surgery. In each case, US and CT were retrospectively
examined by radiologists. We divided the patients into 3 groups according to
the type of calcification: no calcification, microcalcification, and
macrocalcification. And macrocalcification group divided into rim
calcifications and non-rim calcifications groups. We evaluated the
diagnostic accuracy of US and CT for differentiating malignant from benign
thyroid nodules using histopathological results as a reference standard. Results: In the overall population, adding CT to US resulted in greater sensitivity,
lower specificity, and lower accuracy in the prediction of the benign or
malignant nature of nodules. In the group with no calcification, US had a
significantly greater accuracy than CT and combined US/CT. In the group with
macrocalcification, especially in rim calcifications, adding CT to US
resulted in greater sensitivity than US, and CT exhibited greater
sensitivity and accuracy than US. Conclusion: US is superior to CT for the prediction of the benign or malignant nature of
nodules in thyroid lesions according to calcification and CT is also
currently not recommended as a routine imaging tool for thyroid nodules.
However, the superior sensitivity and accuracy of CT in lesions with
macrocalcification especially in rim calcifications may enable CT to play a
complementary role in identifying benign and malignant nodules.
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Affiliation(s)
- Jian-Hui Wu
- The Department of Otolaryngology in the Zhongshan City People's Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, People's Republic of China
| | - Wei Zeng
- The Department of Otolaryngology in the Zhongshan City People's Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, People's Republic of China
| | - Ren-Guo Wu
- The Department of Radiology in the Zhongshan City People's Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, People's Republic of China
| | - Mei Wang
- The Department of Ultrasonography Image in the Zhongshan City People's Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, People's Republic of China
| | - Fei Ye
- The Department of Otolaryngology in the Zhongshan City People's Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, People's Republic of China
| | - Min-Yi Fu
- The Department of Otolaryngology in the Zhongshan City People's Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, People's Republic of China
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Zhu Y, Song Y, Xu G, Fan Z, Ren W. Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review. Diagn Pathol 2020; 15:1. [PMID: 31900180 PMCID: PMC6942345 DOI: 10.1186/s13000-019-0924-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/27/2019] [Indexed: 12/16/2022] Open
Abstract
Objective FNA is a simple, safe, cost-effective and accurate diagnostic tool for the initial screening of patients with thyroid nodules. The aims of this study were to determine the diagnostic utility of FNAC performed in our institution, assess the cytomorphologic features that contribute to diagnostic errors and propose improvement measures. Methods A total of 2781 FNACs were included in the study, and 1122 cases were compared with their histological diagnoses. We retrospectively reexamined our discordant (both false-negative and false-positive) cases and performed a systematic review of previous studies on causes of misdiagnoses. Results When DC V and DC VI were both considered cytologic-positive, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 98.3, 30.9, 94.9, 58.3 and 93.5%, respectively. If DC VI was considered cytologic-positive, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC were 98.0, 84.0, 99.4, 58.3, and 97.5% respectively. The main cause of false-negative diagnoses was sampling error (13/15, 86.7%), while interpretation error led to the majority of the false-positive diagnoses (38/47, 80.9%). Overlapping cytological features in adenomatous hyperplasia, thyroiditis and cystic lesions were the major factors contributing to interpretation errors, while the size and number of nodules may have led to false-negative diagnoses because of heterogeneity and unsampled areas. Conclusions The sensitivity and PPV of thyroid FNAC in our institution were higher than those in the published data, while the specificity and NPV were lower. Regarding the FNA category DC V, a frozen section analysis during diagnostic lobectomy is necessary. Multiple passes should be performed in various parts of a large nodule or from different nodules to reduce the risk of false-negative findings. Cytopathologists should strengthen their criteria for the identification of adenomatous hyperplasia, thyroiditis and cystic lesions to avoid false-positive diagnoses. NIFTP has little effect on diagnostic accuracy and the distribution of diagnostic errors.
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Affiliation(s)
- Yanli Zhu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Yuntao Song
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Guohui Xu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Zhihui Fan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Wenhao Ren
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
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7
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Agrafiotis AC, Sokolow Y, Ruiz-Patino M, D’Haene N, Salmon I, Corvilain B, Cappello M. Treatment of solitary thyroid nodules according to size, preoperative fine-needle aspiration cytology and frozen section: a retrospective single centre study. Acta Chir Belg 2019; 119:294-302. [PMID: 30614397 DOI: 10.1080/00015458.2018.1527566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: In order to avoid unnecessary thyroidectomies, it is important to predict the nature of thyroid nodules the more accurately possible. The size of the nodule as a predictive factor for malignancy is very controversial. Another point of debate is the accuracy of preoperative fine-needle aspiration cytology (FNAC) and frozen section (FS). The aim of our study is to correlate the nodule size with the final histological diagnosis and to estimate the accuracy of preoperative FNAC and FS. Methods: Retrospective study including 387 operated patients with ultrasound-detected solitary thyroid nodules from 01 January 2001 to 31 December 2013. The following data were collected: patient age and sex, nodule size, FNAC, FS and final histology results. Results: The odds ratio for malignancy within nodules <40 mm was 2.12 (95% CI: 1.104-4.084). The specificity of FNAC was 97.78% and the negative predictive value (NPV) was 97.78% for nodules ≥40 mm and 93.2% and 96.5% for nodules <40 mm, respectively. The observed specificity and NPV of FS ranged from 98% to 100% and from 87.4% to 98%, respectively. When combining FNAC and FS, the specificity and the NPV were 99% and 98%, respectively. Conclusions: The nodule size is not a predictive factor for thyroid cancer and therefore nodules ≥40 mm should not be routinely resected. A lege artis preparation and performance of FNAC along with an expertise on cytological interpretation can considerably diminish false-negative rate. FS can offer additional accuracy on FNAC results and should, therefore, be a part of patient treatment.
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Affiliation(s)
| | - Youri Sokolow
- Department of Thoracic Surgery, Erasme University Hospital, Brussels, Belgium
| | - Maria Ruiz-Patino
- Department of Thoracic Surgery, Erasme University Hospital, Brussels, Belgium
| | - Nicky D’Haene
- Department of Pathology, Erasme University Hospital, Brussels, Belgium
| | - Isabelle Salmon
- Department of Pathology, Erasme University Hospital, Brussels, Belgium
| | - Bernard Corvilain
- Department of Endocrinology, Erasme University Hospital, Brussels, Belgium
| | - Matteo Cappello
- Department of Thoracic Surgery, Erasme University Hospital, Brussels, Belgium
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8
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Hosokawa S, Takebayashi S, Sasaki Y, Nakamura Y, Shinmura K, Takahashi G, Mineta H. Clinical analysis of false-negative fine needle aspiration cytology of head and neck cancers. Postgrad Med 2018; 131:151-155. [DOI: 10.1080/00325481.2019.1559431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Seiji Hosokawa
- Department of Otorhinolaryngology/Head & Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Satoru Takebayashi
- Department of Otorhinolaryngology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Yutaka Sasaki
- Department of Otorhinolaryngology, Numazu City Hospital, Numazu, Japan
| | - Yuuki Nakamura
- Department of Otorhinolaryngology, Numazu City Hospital, Numazu, Japan
| | - Kazuya Shinmura
- Department of Tumor Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Goro Takahashi
- Department of Otorhinolaryngology/Head & Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Yamahoshi ENT Clinic, Hamamatsu, Japan
| | - Hiroyuki Mineta
- Department of Otorhinolaryngology/Head & Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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9
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Abi-Raad R, Prasad M, Baldassari R, Schofield K, Callender GG, Chhieng D, Adeniran AJ. The Value of Negative Diagnosis in Thyroid Fine-Needle Aspiration: a Retrospective Study with Histologic Follow-Up. Endocr Pathol 2018; 29:269-275. [PMID: 29949024 DOI: 10.1007/s12022-018-9536-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The Bethesda System for reporting thyroid cytopathology (BSRTC) predicts an incidence of malignancy of less than 5% in thyroid nodules with a benign diagnosis on fine-needle aspiration (FNA). However, recent series have suggested that the true rate of malignancy might be significantly higher in this category of patients. We reviewed our experience by performing a retrospective analysis of patients with benign thyroid FNA results who underwent thyroidectomy between 2008 and 2013 at a large academic center. Information including demographics, ultrasound features, FNA diagnosis, and surgical follow-up information were recorded. Slides were reviewed on cytology-histology discrepant cases, and it was determined whether the discrepancy was due to sampling or interpretation error. A total of 802 FNA cases with a benign diagnosis and surgical follow-up were identified. FNA diagnoses included 738 cases of benign goiter and 64 cases of lymphocytic thyroiditis. On subsequent surgical resection, 144 cases were found to be neoplastic, including 117 malignant cases. False negative, defined as interpretation error and inadequate biopsy of the nodule harboring malignancy, was 6%. When cases of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) were excluded from the analysis, false-negative rate was 5%. When microPTC cases were excluded, false-negative rate was 3% and was slightly less than 3% when both microPTC and NIFTP cases were excluded from the analysis. Retrospective review of neoplastic cases showed that 57% were due to sampling error and 43% were due to interpretation error. Interpretation error was more likely to occur in follicular patterned neoplasms (75%), while sampling error was more common in non-follicular variants of papillary thyroid carcinoma (non-FVPTC) (61%). With the exclusion of microPTC, interpretation errors were still more likely to occur in follicular neoplasms (79%) but there was no significant difference in sampling error between non-FVPTC (37%) and follicular patterned neoplasms (42%). Tumor size was larger in cases with interpretation error (mean = 2.3 cm) compared to cases with sampling error (mean = 1.4 cm). This study shows that the false-negative rate of thyroid FNA at our institution is not significantly above the rate suggested by the BSRTC. Interpretation errors were more likely to occur in follicular patterned neoplasms, while non-FVPTC was more frequently found in false negative cases due to inadequate sampling.
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Affiliation(s)
- Rita Abi-Raad
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, CB510A, New Haven, CT, 06520, USA
| | - Manju Prasad
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, CB510A, New Haven, CT, 06520, USA
| | - Rebecca Baldassari
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, CB510A, New Haven, CT, 06520, USA
| | - Kevin Schofield
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, CB510A, New Haven, CT, 06520, USA
| | - Glenda G Callender
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - David Chhieng
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Adebowale J Adeniran
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, CB510A, New Haven, CT, 06520, USA.
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10
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Cytopathologic Features in Papillary Thyroid Cancer Arising From Benign Nodular Disease. Int Surg 2017. [DOI: 10.9738/intsurg-d-15-00223.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The presence of papillary thyroid carcinoma (PTC) arising from benign nodular disease (PTCAB) is a rare condition. Our study evaluates the clinicopathologic features of PTCAB. PTCAB is extremely rare, and its characteristics have not been well described. From April 2007 through March 2014, 323 patients with PTC were treated at Kangdong Sacred Heart Hospital. During this period, 10 cases of PTCAB were found. We also randomly selected 15 cases each of benign and papillary thyroid microcarcinoma (PTMC) for controls. We reviewed the medical records and the cytomorphologic features of fine-needle aspiration cytology and postoperative specimens. There was a significant difference in the rates of capsular invasion (P = 0.003) and lymphovascular invasion (P = 0.040) between the PTCAB and PTMC groups. Hashimoto's thyroiditis was more prevalent in the PTCAB group (62.5%, P = 0.026). The PTCAB group had a more even and variable distribution from category II to VI by the Bethesda Systems for Reporting Thyroid Cytopathology (P < 0.001). The most common cytomorphologic features of PTCAB were nuclear grooves (90%), pale chromatin (90%), and follicles (60%). Moderate to high cellularity and anisonucleosis were absent in 90% and 80%, respectively, of PTCAB cases. The only cytomorphologic feature significantly different between PTCAB and PTMC group was cellularity. Clinical characteristics were similar between PTCAB and PTMC. PTCAB has an overlapping pattern of cytomorphologic features between benign nodules and PTMC. However, most PTCAB cases contained a nuclear groove, pale chromatin, numerous follicles, and low cellularity, and these features help to establish a new diagnostic point for PTCAB.
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11
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Raguin T, Schneegans O, Rodier JF, Volkmar PP, Sauleau E, Debry C, Debonnecaze G, Ghnassia JP, Dupret-Bories A. Value of fine-needle aspiration in evaluating large thyroid nodules. Head Neck 2016; 39:32-36. [PMID: 27299703 DOI: 10.1002/hed.24524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The American Thyroid Association (ATA) recommends using ultrasound-guided fine-needle aspiration (FNA) in order to evaluate supracentimetric and suspect thyroid nodules. The purpose of this study was to evaluate the effective use of FNA before surgery for nodules over 3 cm in diameter. METHODS In this retrospective study, we analyzed the results of ultrasound-guided FNA and postoperative histological analysis in 843 nodules >3 cm. RESULTS The FNA was informative in 42.6%. The correlation with the final histological analysis was 94.8% for benign nodules and 71.0% for malignant nodules. The FNA had a positive predictive value of 71%, a specificity of 97%, a sensitivity of 56%, and a 4.7% rate of false-negative results. CONCLUSION Because there is a nonnegligible FNA risk of error, notably allowing the evolution of a cancer in 1 of 20 cases, the FNA data should not delay surgical intervention for potentially suspect nodules >3 cm in diameter. © 2016 Wiley Periodicals, Inc. Head Neck 39: 32-36, 2017.
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Affiliation(s)
- Thibaut Raguin
- Service ORL et Chirurgie Cervico-faciale, CHU de Strasbourg, Strasbourg Cedex, France
| | | | - Jean-François Rodier
- Service de Chirurgie Viscérale et Thyroïdienne, Clinique Saint-Anne, Strasbourg, France
| | | | - Eric Sauleau
- Service de Santé Publique, CHU de Strasbourg, France
| | - Christian Debry
- Service ORL et Chirurgie Cervico-faciale, CHU de Strasbourg, Strasbourg Cedex, France
| | - Guillaume Debonnecaze
- Service d'Otorhinolaryngologie et Chirurgie Cervico-faciale, CHU de Toulouse, Toulouse, France
| | | | - Agnès Dupret-Bories
- Service d'Otorhinolaryngologie et Chirurgie Cervico-faciale, Institut Universitaire du Cancer, Toulouse, France
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12
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Chai YJ, Suh H, Yi JW, Yu HW, Lee JH, Kim SJ, Won JK, Lee KE. Factors associated with the sensitivity of fine-needle aspiration cytology for the diagnosis of follicular variant papillary thyroid carcinoma. Head Neck 2015; 38 Suppl 1:E1467-71. [PMID: 26580475 DOI: 10.1002/hed.24261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the factors associated with diagnostic accuracy of preoperative fine-needle aspiration (FNA) for follicular variant papillary thyroid carcinoma (FVPTC). METHODS The patients with FVPTC who underwent thyroidectomy were divided into 2 groups: "group A" (Bethesda category II, III, or IV) versus "group B" (category V or VI). RESULTS A total of 225 patients (117 in group A and 108 in group B) were included. Group B was associated with older age, malignant ultrasonographic features, smaller tumor size, extrathyroidal extension, higher stage, and B-type Raf (BRAF)(V600E) mutation compared with group A. In multivariable analysis, malignant ultrasonographic features and tumor size ≤3.0 cm were independent predictive factors for group B. CONCLUSION FVPTCs >3.0 cm are unlikely to be diagnosed as category V or VI. Clinicians should keep FVPTC in mind and consider diagnostic lobectomy for the nodules regardless of FNA or ultrasonographic findings. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1467-E1471, 2016.
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Affiliation(s)
- Young Jun Chai
- Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunsuk Suh
- Department of Surgery, Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jin Wook Yi
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Hyeong Won Yu
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Joon-Hyop Lee
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Su-Jin Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Jae-Kyung Won
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Pathology, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Kyu Eun Lee
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea
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13
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Elsharkawy SL, AbdEl-Aal WE, Esmal RS, Ali HH, Mahfouz SM, El-Habashi A. Preoperative Evaluation of Thyroid Epithelial Lesions by DNA Ploidy and Galectin-3 Expression in FNAC. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: This study aimed to investigate the value of DNA ploidy and galectins-3 immunostain in the preoperative evaluation of thyroid epithelial lesions.MATERIAL AND METHODS: Sixty patients presenting with thyroid enlargement were included in this study and referred by clinicians for FNA. Routine cytological evaluation was done on PAP  stained slides according to the WHO criteria and at least three slides were prepared for routine cytological examinations. The nuclear DNA analysis was performed at the Pathology Department, National Research Center using the Leica Qwin 500 Image Analyzer (LEICA Imaging Systems Ltd, Cambridge, England). Galectin-3 expression was investigated in all tissues using streptavidin-biotin technique.RESULTS: Conventional Fine needle aspiration cytology (FNAC) of 60 cases could diagnose malignancy with a sensitivity of 60%, negative predictive value (NPV) 71.4%, and overall diagnostic accuracy of 80%. The aneuploidy was significantly associated with malignancy, with sensitivity 90.9%, specificity 83.3% and accuracy 88.3%. On using galectin-3 immunocytochemichal stain on cell blocks prepared from FNA the values were improved, sensitivity 93.3% specificity 86.7% and overall accuracy 90% and it was noticed that galectin-3 over expression was significantly associated with malignancy.CONCLUSIONS: From the results of this study we can consider that DNA ploidy and Galectin-3 could refine the FNA results and increase its sensitivity as a screening test from sensitivity(60%) to reach sensitivity (93.3%), thus decreasing the false negative cases. From this study, it is concluded that the application of ancillary techniques as galectin-3 immunocytochemical markers may become a reliable indicator for surgical intervention, DNA ploidy measurements on the other hand may be of value in galectin-3 negative cases to determine the behavior of the lesion in such cases & refine the preoperative assessment by out ruling false negative cases.
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14
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Abstract
PURPOSE OF REVIEW To summarize the latest developments in the use of molecular diagnostic testing in cytologically indeterminate thyroid nodules. RECENT FINDINGS The majority of nodules with fine needle aspiration biopsy (FNAB) results that are classified as indeterminate (i.e., atypia of undetermined significance/lesion of undetermined significance, follicular neoplasm, and suspicious for malignancy) are histologically benign. Improvements in diagnostic discrimination can potentially be achieved with immunocytochemical analysis for candidate protein markers such as galectin-3, or analysis of differential microRNA expression patterns although larger prospective validation studies are still needed. After large-scale gene expression analysis, a marker panel was selected with the goal of optimizing the negative predictive value, and in indeterminate nodules, the panel may be helpful in lowering but not eliminating the risk of cancer. Another panel composed of gene mutations and rearrangements associated with thyroid cancer can improve the specificity and positive predictive value of preoperative FNAB, and better identify cytologically indeterminate nodules with a high risk of cancer. SUMMARY Molecular diagnostic testing improves preoperative risk stratification for nodules that have indeterminate FNAB results. Although currently available tests do not yet have the sensitivity to reliably exclude malignancy altogether, improvements in specificity can be used to guide the extent of initial surgery and clinical management.
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15
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Proietti A, Borrelli N, Giannini R, Romani R, Di Coscio G, Quilici F, Rago T, Miccoli P, Vitti P, Basolo F. Molecular characterization of 54 cases of false-negative fine-needle aspiration among 1347 papillary thyroid carcinomas. Cancer Cytopathol 2014; 122:751-9. [PMID: 24913568 DOI: 10.1002/cncy.21454] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/12/2014] [Accepted: 05/27/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) has been widely accepted as the most crucial step in the preoperative assessment of thyroid nodules, but the false-negative rates are generally reported to be between 3.6% and 10.2%. To lower the overall incidence of this false-negative testing, new reporting systems encourage the molecular testing of thyroid nodules. However, to the authors' knowledge, the role of molecular testing in false-negative FNA has not yet been evaluated. METHODS In total, 1347 consecutive papillary thyroid carcinomas (PTCs) with both cytological and histological diagnoses were collected from the same center. A blinded revision of the false-negative cases was performed. An analysis of the BRAF and Ras genes in the false-negative cases was then performed. RESULTS The false-negative rate at the time of primary FNA diagnosis was 4.8% (65 of 1347 cases). False-negative cases were 15 follicular variant PTCs, 2 classical variant, and 1 solid variant that lacked peculiar PTC cytomorphological features. Adequate cellular material for molecular analysis was available only in 54 of the 65 false-negative cases. Mutations were found in 6 cases (11%), and Ras alterations were present in 16 cases (29.6%). The addition of molecular analysis decreased the false-negative rate to 0.4% (5 of 1347 cases). CONCLUSIONS The results of the current study confirm the feasibility of BRAF and Ras analysis in routine FNA. However, when the false-negative FNA rate is low, the cost-benefit analysis of the detection of BRAF and Ras mutations should be carefully evaluated. Consequently, the authors suggest that preoperative molecular assessment could be helpful for benign nodules, but only in the presence of clinical suspicion of malignancy.
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Affiliation(s)
- Agnese Proietti
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Pathological Anatomy, University of Pisa, Pisa, Italy
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16
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Słowińska-Klencka D, Woźniak-Oseła E, Popowicz B, Sporny S, Klencki M. Repeat FNA Significantly Lowers Number of False Negative Results in Patients with Benign Nodular Thyroid Disease and Features of Chronic Thyroiditis. Int J Endocrinol 2014; 2014:967381. [PMID: 24812559 PMCID: PMC4000634 DOI: 10.1155/2014/967381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 03/22/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose. The aim of the study was to compare the risk of thyroid malignancy and efficacy of repeat FNA in patients with thyroid nodules diagnosed cytologically as benign lesion (BL) with features of chronic thyroiditis (BL-CT) and BL without CT features (BL-nCT). Methods. The analysis included 917 patients with BL-CT and 7046 with BL-nCT in the first FNA. Repeat biopsy was carried out in 787 patients of BL-CT and 5147 of BL-nCT; 218 patients of BL-CT and 2462 of BL-nCT were operated; in 88 cases of BL-CT and 563 of BL-nCT both ways of follow-up were available. Results. Outcome of repeat cytology implied surgery more frequently in patients with BL-CT than with BL-nCT-3.2% versus 1.9%, P < 0.05. Incidence of cancer (including incidentalomas) was higher in patients with BL-CT operated after one benign cytology than in patients with two benign FNA outcomes: 10.8% versus 1.6%, P < 0.05. In patients with BL-nCT that difference was not significant: 3.2% versus 2.6%. Conclusions. Patients with thyroid nodules diagnosed as BL with CT features have higher risk of malignancy than patients with BL without CT features. Repeat biopsy significantly lowers percentage of FN results in patients with BL-CT in the first FNA.
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Affiliation(s)
- Dorota Słowińska-Klencka
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Sterlinga Street No 5, 91-425 Lodz, Poland
- *Dorota Słowińska-Klencka:
| | - Ewa Woźniak-Oseła
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Sterlinga Street No 5, 91-425 Lodz, Poland
| | - Bożena Popowicz
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Sterlinga Street No 5, 91-425 Lodz, Poland
| | - Stanisław Sporny
- Department of Dental Pathomorphology, Chair of Pathomorphology, Medical University of Lodz, Pomorska Street No. 251, 92-213 Lodz, Poland
| | - Mariusz Klencki
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Sterlinga Street No 5, 91-425 Lodz, Poland
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17
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Wharry LI, McCoy KL, Stang MT, Armstrong MJ, LeBeau SO, Tublin ME, Sholosh B, Silbermann A, Ohori NP, Nikiforov YE, Hodak SP, Carty SE, Yip L. Thyroid Nodules (≥4 cm): Can Ultrasound and Cytology Reliably Exclude Cancer? World J Surg 2013; 38:614-21. [PMID: 24081539 DOI: 10.1007/s00268-013-2261-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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18
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Agcaoglu O, Aksakal N, Ozcinar B, Sarici IS, Ercan G, Kucukyilmaz M, Yanar F, Ozemir IA, Kilic B, Caglayan K, Yilmazbayhan D, Salmaslioglu A, Issever H, Ozarmagan S, Erbil Y. Factors that affect the false-negative outcomes of fine-needle aspiration biopsy in thyroid nodules. Int J Endocrinol 2013; 2013:126084. [PMID: 23935616 PMCID: PMC3712239 DOI: 10.1155/2013/126084] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 05/16/2013] [Accepted: 05/26/2013] [Indexed: 11/18/2022] Open
Abstract
Background. The purpose of this study was to assess the factors that affect the false-negative outcomes of fine-needle aspiration biopsies (FNABs) in thyroid nodules. Methods. Thyroid nodules that underwent FNAB and surgery between August 2005 and January 2012 were analyzed. FNABs were taken from the suspicious nodules regardless of nodule size. Results. Nodules were analyzed in 2 different groups: Group 1 was the false-negatives (n = 81) and Group 2 was the remaining true-positives, true-negatives, and false-positives (n = 649). A cytopathologist attended in 559 (77%) of FNAB procedures. There was a positive correlation between the nodule size and false-negative rates, and the absence of an interpreting cytopathologist for the examination of the FNAB procedure was the most significant parameter with a 76-fold increased risk of false-negative results. Conclusion. The contribution of cytopathologists extends the time of the procedure, and this could be a difficult practice in centres with high patient turnovers. We currently request the contribution of a cytopathologist for selected patients whom should be followed up without surgery.
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Affiliation(s)
- Orhan Agcaoglu
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Nihat Aksakal
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Beyza Ozcinar
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
- *Beyza Ozcinar:
| | - Inanc S. Sarici
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Gulcin Ercan
- General Surgery Clinic, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Meltem Kucukyilmaz
- General Surgery Clinic, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Fatih Yanar
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Ibrahim A. Ozemir
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Berkay Kilic
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Kasim Caglayan
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Dilek Yilmazbayhan
- Department of Pathology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Artur Salmaslioglu
- Department of Radiology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Halim Issever
- Department of Public Health, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Selcuk Ozarmagan
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Yesim Erbil
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
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19
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Jean-Gilles J, Fischer AH, Luu MH, Owens CL. Clinical and pathologic features and clinical impact of false negative thyroid fine-needle aspirations. Cancer Cytopathol 2012; 120:326-33. [DOI: 10.1002/cncy.21196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 02/20/2012] [Accepted: 02/21/2012] [Indexed: 01/21/2023]
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20
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Yu XM, Patel PN, Chen H, Sippel RS. False-negative fine-needle aspiration of thyroid nodules cannot be attributed to sampling error alone. Am J Surg 2012; 203:331-4; discussion 334. [DOI: 10.1016/j.amjsurg.2011.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/18/2011] [Accepted: 09/18/2011] [Indexed: 10/14/2022]
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21
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García-Pascual L, Balsells M, Fabbi M, Pozo CD, Valverde MT, Casalots J, González-González JM, Veloso E, Anglada-Barceló J. Prognostic factors and follow-up of patients with differentiated thyroid carcinoma with false negative or nondiagnostic FNAC before surgery. Comparison with a control group. Endocrine 2011; 40:423-31. [PMID: 21541652 DOI: 10.1007/s12020-011-9479-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 04/25/2011] [Indexed: 04/17/2023]
Abstract
Since the clinical implementation of fine needle aspiration cytology (FNAC) to diagnose thyroid carcinoma, few patients remain misdiagnosed and little is known about their clinical outcomes. An observational retrospective study was carried out to analyse prognostic factors and follow-up of patients with differentiated thyroid carcinoma (DTC) not disclosed by FNAC before surgery, compared to a control group. From October 2003 to July 2010, 308 patients underwent surgery as treatment for nodular goitre and 53 had DTC. Cases were 12 subjects with DTC and benign (n = 7) or nondiagnostic (n = 5) FNAC. Controls were 39 subjects with DTC and suspicious (n = 19) or malignant (n = 20) FNAC. Prognostic factors, recurrence and survival rates were compared. Cases had longer time from FNAC to surgery than the control group (86.8 ± 74.1 vs. 16.4 ± 23.8 weeks; P < 0.001), higher prevalence of follicular carcinoma (33.3 vs. 2.6%; P = 0.009), and of two-time total thyroidectomy (75 vs. 30.8%; P = 0.016). Average follow-up was 42.7 ± 25.3 months (2-86 months). There were no deaths. Disease-free survival for cases was 66.9 ± 5.8 months, and for controls 78.7 ± 3.9 months (P: ns). In patients with DTC, the result of the FNAC performed before surgery was not an independent predictor of recurrences or mortality in the first 7 years of follow-up. Thus, false negative or nondiagnostic FNAC in a patient with DTC does not seem to be a primary prognostic factor, but it may reveal other adverse prognostic factors such as longer time to therapy and higher prevalence of follicular carcinoma that may influence long-term outcomes.
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Affiliation(s)
- Luis García-Pascual
- Endocrinology Service, Hospital Universitari Mútua de Terrassa, Plaza Dr. Robert, 5, 08221, Terrassa, Barcelona, Spain.
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The false-negative rate of fine-needle aspiration cytology for diagnosing thyroid carcinoma in thyroid nodules. Langenbecks Arch Surg 2009; 395:127-32. [PMID: 19296123 DOI: 10.1007/s00423-009-0470-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 01/30/2009] [Indexed: 10/21/2022]
Abstract
PURPOSE Our aim was to define the false-negative rate of fine-needle aspiration cytology (FNAC) for diagnosing thyroid carcinoma in thyroid nodules <4 cm versus > or =4 cm. MATERIALS AND METHODS Six hundred sixty-two patients with thyroid nodules who underwent FNAC and surgery at our institution were analyzed. The association of predictive factors with thyroid carcinoma was evaluated. The sensitivity, specificity, and the false-negative rate of FNAC were calculated. RESULTS The incidence of thyroid carcinoma was significantly higher in nodules > or =4 cm (24%) compared with nodules <4 cm (12%). The false-negative rates of FNAC were 2% in all nodules and 1.3% and 4.3% in nodules <4 cm and > or =4 cm (p = 0.9), respectively. Sensitivity and specificity of FNAC were 90% and 79%, respectively. CONCLUSIONS The false-negative rate of FNAC is low for thyroid nodules <4 cm and for nodules > or =4 cm.
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Abstract
PURPOSE OF REVIEW To provide an update on potential predictors of thyroid malignancy and how their use may alter clinical management. RECENT FINDINGS As thyroid nodules become more prevalent clinicians are increasingly impelled to identify the optimal predictor(s) of thyroid malignancy, with the goal of guiding management based on assessed risk. The gold standard evaluation for thyroid nodules is ultrasound-guided fine-needle aspiration biopsy. Fine-needle aspiration biopsy is not perfect and adjuncts which complement its predictive value are being investigated from several innovative perspectives. These include large tumor size (> or =4 cm), which appears to be an independent predictor of thyroid malignancy; 18F-fluorodeoxyglucose positron emission tomography, which appears to facilitate exclusion of malignancy in cytologically indeterminate thyroid nodules; and peripheral blood and fine-needle aspiration biopsy analysis of molecular markers, which may help to identify malignant thyroid nodules with greater specificity. SUMMARY Fine-needle aspiration biopsy of large thyroid nodules has a high false-negative rate and should be considered for diagnostic lobectomy. Nodule size appears to be an independent factor predicting malignancy and indeterminate lesions at least 4 cm should be considered for initial total thyroidectomy. Nuclear imaging may aid exclusion of malignancy in thyroid nodules and molecular markers have great promise in predicting thyroid malignancy with higher specificity.
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