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Walter LB, Fernandes PM, Strieder DL, Scheinpflug AL, Zanella AB, Faccin CS, Farenzena M, Xavier LF, Zorzi BDC, Graudenz MS, Scheffel RS, Dora JM, Goemann IM, Maia AL. Age-related variation in malignant cytology rates of thyroid nodules: insights from a retrospective observational study assessing the ACR TI-RADS. Eur J Endocrinol 2023; 189:584-589. [PMID: 38033287 DOI: 10.1093/ejendo/lvad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE The influence of age on the malignant cytology rate of thyroid nodules remains uncertain. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is currently used to guide subsequent investigations of thyroid nodules, regardless of clinical variables. This study aimed to investigate the impact of age on the malignant cytology rates of thyroid nodules and the diagnostic performance of ACR TI-RADS across different age groups. DESIGN A retrospective, single-center, observational study. METHODS Patients aged ≥ 20 years with thyroid nodules, who underwent fine-needle aspiration biopsy between 2012 and 2019 were evaluated. Ultrasound images were used to obtain the TI-RADS data. Malignancy was determined based on suspicious for malignancy (Bethesda V) and malignant (Bethesda VI) cytology results or malignancy in cell block analysis. RESULTS A total of 1023 nodules from 921 patients (88.2% female) were analyzed. The median age was 58.5 (interquartile range [IQR], 41.1-66.6) years, and the median nodule size was 2.4 (IQR, 1.7-3.6) cm. Stratification by age revealed a decreasing prevalence of malignant cytology across subgroups of 20-39, 40-59, and ≥60 years (10.7%, 8.5%, and 3.7%, respectively; P = .002). After adjusting for sex, multinodularity, nodule size, and ACR TI-RADS category, we observed that each year of age reduced the OR for malignant cytology by 3.0% (95% CI: 0.7%-5.3%; P = .011). When comparing the subgroups of 20-39 and ≥60 years, the malignant cytology rate decreased by half in TI-RADS 4 (from 21.4% to 10.4%) and two-thirds in TI-RADS 5 (from 64.7% to 22.6%). CONCLUSIONS Our study demonstrated that as patient age increased, the rate of malignant cytology in thyroid nodules decreased. Moreover, age significantly influences the malignancy rates of thyroid nodules classified according to the ACR TI-RADS.
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Affiliation(s)
- Leonardo Barbi Walter
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Paula Martins Fernandes
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Débora Lunkes Strieder
- Radiology Department, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Anita Lavarda Scheinpflug
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - André Borsatto Zanella
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Carlo Sasso Faccin
- Radiology Department, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Mauricio Farenzena
- Radiology Department, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Laura Fernandes Xavier
- Department of Medicine, Medical School, Universidade do Vale do Rio dos Sinos, CEP 93022-750 São Leopoldo, RS, Brazil
| | - Bianca Dalla Costa Zorzi
- Department of Medicine, Medical School, Universidade do Vale do Rio dos Sinos, CEP 93022-750 São Leopoldo, RS, Brazil
| | - Marcia Silveira Graudenz
- Department of Pathology, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Rafael Selbach Scheffel
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
- Department of Pharmacology, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - José Miguel Dora
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
| | - Iuri Martin Goemann
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
- Department of Medicine, Medical School, Universidade do Vale do Rio dos Sinos, CEP 93022-750 São Leopoldo, RS, Brazil
| | - Ana Luiza Maia
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, CEP 90035-903 Porto Alegre, RS, Brazil
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Hess JR, Van Tassel DC, Runyan CE, Morrison Z, Walsh AM, Schafernak KT. Performance of ACR TI-RADS and the Bethesda System in Predicting Risk of Malignancy in Thyroid Nodules at a Large Children's Hospital and a Comprehensive Review of the Pediatric Literature. Cancers (Basel) 2023; 15:3975. [PMID: 37568791 PMCID: PMC10417028 DOI: 10.3390/cancers15153975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/24/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
While thyroid nodules are less common in children than in adults, they are more frequently malignant. However, pediatric data are scarce regarding the performance characteristics of imaging and cytopathology classification systems validated to predict the risk of malignancy (ROM) in adults and select those patients who require fine-needle aspiration (FNA) and possibly surgical resection. We retrospectively reviewed the electronic medical records of all patients 18 years of age or younger who underwent thyroid FNA at our institution from 1 July 2015 to 31 May 2022. Based on surgical follow-up from 74 of the 208 FNA cases, we determined the ROM for the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) ultrasound risk stratification system and The Bethesda System for Reporting Thyroid Cytopathology and added our results to those of pediatric cohorts from other institutions already published in the literature. We found the following ROMs for 1458 cases using ACR TI-RADS (TR): TR1. Benign: 2.2%, TR2. Not Suspicious: 9.3%, TR3. Mildly Suspicious: 16.6%, TR4. Moderately Suspicious: 27.0%, and TR5. Highly Suspicious 76.5%; and for 5911 cases using the Bethesda system: Bethesda I. Unsatisfactory: 16.8%, Bethesda II. Benign: 7.2%, Bethesda III: Atypia of Undetermined Significance: 29.6%, Bethesda IV. Follicular Neoplasm: 42.3%, Bethesda V. Suspicious for Malignancy: 90.8%, and Bethesda VI. Malignant: 98.8%. We conclude that ACR TI-RADS levels imply higher ROMs for the pediatric population than the corresponding suggested ROMs for adults, and, in order to avoid missing malignancies, we should consider modifying or altogether abandoning size cutoffs for recommending FNA in children and adolescents whose thyroid glands are smaller than those of adults. The Bethesda categories also imply higher ROMs for pediatric patients compared to adults.
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Affiliation(s)
- Jennifer R. Hess
- Center for Cancer and Blood Disorders, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (J.R.H.); (A.M.W.)
| | - Dane C. Van Tassel
- Department of Radiology, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA;
| | - Charles E. Runyan
- Department of Radiology, Valleywise Hospital, Phoenix, AZ 85008, USA;
| | - Zachary Morrison
- Creighton Radiology Residency, Creighton University, Phoenix, AZ 85012, USA;
| | - Alexandra M. Walsh
- Center for Cancer and Blood Disorders, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (J.R.H.); (A.M.W.)
| | - Kristian T. Schafernak
- Division of Pathology, Laboratory Medicine, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
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Puga FM, Rodrigues M, Eloy C. Usefulness of cellblock preparation in fine needle aspiration for the diagnosis of thyroid nodules. Diagn Cytopathol 2022; 50:419-423. [PMID: 35642308 DOI: 10.1002/dc.24996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Thyroid nodules are common in the general population. The current diagnostic method for nodules is the ultrasound guided fine needle aspiration (US-FNA). The aim of the study was to evaluate the usefulness of cellblock preparation in addition to routine US-FNA in the diagnosis of thyroid nodules. METHODS A retrospective study of patients with thyroid nodules submitted to US-FNA, with collection of material using both smears and cellblock preparation. Two air-dried smears were prepared for each nodule. After centrifugation, the residual aspirate in the syringe and needle was processed as a standard histology specimen (cellblock). Then a pathologist reviewed the smears and cellblock slides of each case. RESULTS A total of 12.360 thyroid nodules were submitted to US-FNA. Cellblock preparation was performed in 153 (1.2%) in addition to smears. Among the satisfactory cellblocks (80.5%, 120), 31.7% (38) provided additional morphological information in comparison with smears alone. No significant differences were found between the smear and the combined smear and cellblock evaluation concerning the number of unsatisfactory (12.1% vs. 11.4%, p = .85) and indeterminate (27.5% vs. 24.2%, p = .52) results. Overall, 10 samples (6.7%) had their diagnosis changed after cellblock evaluation, nine of them due to immunohistochemical studies. Immunohistochemistry confirmed parathyroid origin of the nodule in six cases. CONCLUSION Cellblocks did not contribute to increase cellularity of the samples or to reduce indetermined results of FNA of thyroid nodules. Immunohistochemistry was essential to characterize rare cases without follicular histogenesis. Cellblock must only be prepared when considering performing immunohistochemistry.
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Affiliation(s)
- Francisca Marques Puga
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Miguel Rodrigues
- Serviço de Anatomia Patológica, Hospital Distrital de Santarém, Santarém, Portugal
| | - Catarina Eloy
- Laboratório de Anatomia Patológica, Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Instituto de Investigação e Inovação em Saúde (i3S), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Goemann IM, Paixão F, Migliavacca A, Guimarães JR, Scheffel RS, Maia AL. Intraoperative frozen section performance for thyroid cancer diagnosis. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:50-57. [PMID: 35263048 PMCID: PMC9991033 DOI: 10.20945/2359-3997000000445] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective A primary medical relevance of thyroid nodules consists of excluding thyroid cancer, present in approximately 5% of all thyroid nodules. Fine-needle aspiration biopsy (FNAB) has a paramount role in distinguishing benign from malignant thyroid nodules due to its availability and diagnostic performance. Nevertheless, intraoperative frozen section (iFS) is still advocated as a valuable tool for surgery planning, especially for indeterminate nodules. Methods To compare the FNAB and iFS performances in thyroid cancer diagnosis among nodules in Bethesda Categories (BC) I to VI. The performance of FNAB and iFS tests were calculated using final histopathology results as the gold standard. Results In total, 316 patients were included in the analysis. Both FNAB and iFS data were available for 272 patients (86.1%). The overall malignancy rate was 30.4%% (n = 96). The FNAB sensitivity, specificity, and accuracy for benign (BC II) and malignant (BC V and VI) were 89.5%, 97.1%, and 94.1%, respectively. For all nodules evaluated, the iFS sensitivity, specificity, and accuracy were 80.9%, 100%, and 94.9%, respectively. For indeterminate nodules and follicular lesions (BC III and IV), the iFS sensitivity, specificity, and accuracy were 25%, 100%, and 88.7%, respectively. For BC I nodules, iFS had 95.2% of accuracy. Conclusion Our results do not support routine iFS for indeterminate nodules or follicular neoplasms (BC III and IV) due to its low sensitivity. In these categories, iFS is not sufficiently accurate to guide the intraoperative management of thyroidectomies. iFS for BC I nodules could be an option and should be specifically investigated.
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Affiliation(s)
- Iuri Martin Goemann
- Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.,Faculdade de Medicina, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil
| | - Francisco Paixão
- Divisão de Cirurgia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Alceu Migliavacca
- Divisão de Cirurgia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - José Ricardo Guimarães
- Divisão de Cirurgia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Rafael Selbach Scheffel
- Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.,Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Ana Luiza Maia
- Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil,
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Thedinger W, Raman E, Dhingra JK. Comparative Study of ACR TI-RADS and ATA 2015 for Ultrasound Risk Stratification of Thyroid Nodules. Otolaryngol Head Neck Surg 2021; 167:35-40. [PMID: 34905442 DOI: 10.1177/01945998211064607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To study the adoption rate of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) scoring system over a 3-year period in a community setting and compare its performance with that of the American Thyroid Association 2015 (ATA 2015) ultrasound risk scoring system. STUDY DESIGN Case series with prospective data collection and retrospective chart review. SETTING Large community-based practice with multiple satellite offices and a dedicated thyroid ultrasound clinic. METHODS All patients referred to the thyroid clinic between January 2018 and December 2020 for ultrasound-guided fine-needle biopsy were assigned an ATA 2015 risk score in a prospective manner immediately prior to biopsy. ACR TI-RADS scores were recorded through retrospective chart review of the radiologist report. Performance of the 2 systems was compared with cytology as the gold standard. RESULTS A total of 949 nodules underwent biopsy, of which 236 had available data for both scoring systems. There was a 33.8% increase in adoption of the ACR TI-RADS over the 3-year study period. The ATA 2015 guidelines yielded sensitivity and specificity of 81.6% and 54.5%, respectively, as opposed to 73.7% and 27.0% for the ACR TI-RADS. CONCLUSION In our community, there has been a gradual increase in adoption of the ACR TI-RADS, although the ATA 2015 risk scoring system has performed better.
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Affiliation(s)
| | | | - Jagdish K Dhingra
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Tufts University, Boston, Massachusetts, USA.,ENT Specialists, Inc, Brockton, Massachusetts, USA
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Interobserver Variability of Ultrasound Features Based on American College of Radiology Thyroid Imaging Reporting and Data System Lexicon in American College of Radiology Thyroid Imaging Reporting and Data System System: A Single-Center Study With Radiologists and Radiology Residents. Ultrasound Q 2021; 37:324-328. [PMID: 34855708 DOI: 10.1097/ruq.0000000000000512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The aim of this study is to evaluate the variability of selecting the ultrasound features used in American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and in assigning the ACR-TIRADS level in a single center among radiologists and radiology residents. The study cohort consisted of 108 thyroid nodules in 102 patients who had definite cytology results after thyroid fine needle aspiration biopsy (Bethesda category II, VI) or surgery. Seven observers including 3 radiologists and 4 radiology residents evaluated the nodules according to 5 ultrasound feature categories. The evaluation process was performed after a joint meeting session, in which the "white papers" of the ACR-TIRADS committee were discussed regarding the thyroid ultrasound reporting lexicon, and final TIRADS system. Variability of ultrasound features and assigning ACR-TIRADS level was measured using Fleiss kappa statistics. Agreement for ultrasound features was "substantial" to "almost perfect" among all observers, with composition (κ = 0.86), macrocalcification (κ = 0.89) and peripheral calcification (κ = 0.92) at the highest level of agreement. The level of agreement for large comet tail artifacts and punctate echogenic foci was "moderate" in residents, whereas in radiologists, that level was "substantial." The agreement for assigning ACR-TIRADS level was moderate in resident as well as in radiologist subgroup. Agreement of thyroid ultrasound features was "substantial to almost perfect" among all observers. Although the level of agreement among resident group decreased to "moderate" level, ACR-TIRADS is a useful system in thyroid nodule management.
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 236] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
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Fine-needle aspiration biopsy of thyroid nodules: Is routine ultrasound-guidance necessary? Surgery 2018; 164:789-794. [DOI: 10.1016/j.surg.2018.04.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/13/2018] [Accepted: 04/30/2018] [Indexed: 12/26/2022]
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Fine Needle Aspiration Cytology for Neck Masses in Childhood. An Illustrative Approach. Diagnostics (Basel) 2018; 8:diagnostics8020028. [PMID: 29690556 PMCID: PMC6023333 DOI: 10.3390/diagnostics8020028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/16/2018] [Accepted: 04/19/2018] [Indexed: 02/06/2023] Open
Abstract
The primary indication of fine-needle aspiration cytology of the head and neck region is a thyroid nodule or a mass located in the cervical area or the head. Although a thyroid nodule may raise the suspicion of malignancy, less than one in 20 cases results in a carcinoma. In addition, the list of differential diagnoses is quite different according to the age of the patient. A number of benign lesions, such as branchial cysts, sialadenosis, and sialoadenitis are often seen in childhood and youth. The malignant lesions that are on the top of the list of a pediatric mass of the head and neck (H&N) region include rhabdomyosarcoma, neuroblastoma, and papillary carcinoma of the thyroid gland. This critical review of the diagnostic features of a pediatric mass of the H&N region is accompanied by panels of several cytology features that may be of help to the cytopathologist and clinician.
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Contributory Factors to Hemorrhage After Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules with an Emphasis on Patients Taking Antithrombotic or Anticoagulant Medications. IRANIAN JOURNAL OF RADIOLOGY 2018. [DOI: 10.5812/iranjradiol.57231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Zhou H, Baloch ZW, Nayar R, Bizzarro T, Fadda G, Adhikari-Guragain D, Hatem J, Larocca LM, Samolczyk J, Slade J, Rossi ED. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): Implications for the risk of malignancy (ROM) in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Cancer Cytopathol 2017; 126:20-26. [DOI: 10.1002/cncy.21926] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/17/2017] [Accepted: 08/29/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Haijun Zhou
- Department of Pathology; Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital; Chicago Illinois
| | - Zubair W. Baloch
- Department of Pathology; Hospital of University of Pennsylvania; Philadelphia Pennsylvania
| | - Ritu Nayar
- Department of Pathology; Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital; Chicago Illinois
| | - Tommaso Bizzarro
- Department of Anatomic Pathology and Histology, “A. Gemelli” University Polyclinic Foundation; University Rome; Italy
| | - Guido Fadda
- Department of Anatomic Pathology and Histology, “A. Gemelli” University Polyclinic Foundation; University Rome; Italy
| | | | - Joseph Hatem
- Department of Pathology; Hospital of University of Pennsylvania; Philadelphia Pennsylvania
| | - Luigi M. Larocca
- Department of Anatomic Pathology and Histology, “A. Gemelli” University Polyclinic Foundation; University Rome; Italy
| | - Julia Samolczyk
- Department of Pathology; Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital; Chicago Illinois
| | - Jamie Slade
- Department of Pathology; Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital; Chicago Illinois
| | - Esther Diana Rossi
- Department of Anatomic Pathology and Histology, “A. Gemelli” University Polyclinic Foundation; University Rome; Italy
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Gill AS, Amdur R, Joshi AS. Importance of FNA Technique for Decreasing Non-diagnostic Rates in Thyroid Nodules. Head Neck Pathol 2017; 12:160-165. [PMID: 28819755 PMCID: PMC5953868 DOI: 10.1007/s12105-017-0844-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/31/2017] [Indexed: 01/26/2023]
Abstract
To identify potential interventions that may lower the high non-diagnostic rates associated with ultrasound guided (US) fine needle aspiration (FNA) biopsy of the thyroid nodule. A case series of 164 thyroid nodule US-guided FNA was identified retrospectively. The following variables were analyzed in regards to diagnostic and non-diagnostic sampling: patient age, gender, size of nodule, biopsy technique (capillary vs. aspiration), needle gauge (23 vs. 25), and physician experience. The FNA diagnosis, and final pathology, when applicable, was recorded for each sample using the Bethesda criteria. Data was analyzed using the Fisher's exact test or the chi square test. After multivariate logistic regression, capillary action was independently associated with lower non-diagnostic rates (p = 0.01), while increasing patient age was associated with higher non-diagnostic rates (p = 0.018). Physician experience (p = 0.014) was not independently associated with lower non-diagnostic rates. Nodules that were "cystic >50%" were significantly more likely to yield a non-diagnostic result (p < 0.0001). After taking into account confounding variables, including physician experience, our data reveals a statistically significant decrease in non-diagnostic rates with the use of capillary action vs. aspiration technique in US-guided FNA. A major focus in healthcare today is providing cost-effective and minimally invasive care to the patient. In the setting of a rising incidence of thyroid disease, we believe our study demonstrates the need for a prospective analysis of the relationship between technique and non-diagnostic rates.
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Affiliation(s)
- Amarbir S Gill
- Division of Otolaryngology - Head and Neck Surgery, The University of California, Davis, 2521 Stockton Blvd. #7200, Sacramento, CA, 95817, USA.
| | - Richard Amdur
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University, Washington, DC, USA
| | - Arjun S Joshi
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University, Washington, DC, USA
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Cristo APD, Goldstein HF, Faccin CS, Maia AL, Graudenz MS. Increasing diagnostic effectiveness of thyroid nodule evaluation by implementation of cell block preparation in routine US-FNA analysis. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 60:367-73. [PMID: 27533613 PMCID: PMC10118724 DOI: 10.1590/2359-3997000000180] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/09/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Ultrasound-guided fine-needle aspiration (US-FNA) biopsy has proven to be an accurate and efficient tool in thyroid nodule evaluation. We evaluated whether cell block adds to the diagnostic accuracy of US-FNA. SUBJECTS AND METHODS Three hundred twenty-eight consecutive patients underwent US-FNA, cytology and cell block evaluation. Six slides were prepared for each patient and stained by Papanicolaou and Giemsa techniques. The residual hemorrhagic aspirate in the syringe and needle was fixed in 10% formalin and paraffin-embedded (cell block). The histological sections were examined as a complementary diagnostic tool to US-FNA. RESULTS The study population comprised 89% females and the mean age was 57.4 ± 13.7 years. The mean nodule size was 2.3 ± 1.2 cm. US-FNA cytological results were as follows: Bethesda I, 17.1% (n = 56); Bethesda II, 61.6% (n = 202); Bethesda III, 9.5% (n = 31); Bethesda IV, 5.8% (n = 19); Bethesda V, 2.4% (n = 8), and Bethesda VI, 3.6% (n = 12). Cell blocks were obtained in 100% of cases and were considered diagnostic in 89.6%. Combined cytological and cell block (cyto-cell block) results were as follows: unsatisfactory, 4.3% (n = 14); benign, 72.6% (n = 238); indeterminate, 11.3% (n = 37); follicular lesion, 5.8% (n = 19); suspicious for malignancy, 2.4% (n = 8), and malignant, 3.6% (n = 12). The sensitivity and specificity for cyto-cell block was 100% and 90%, respectively, and the accuracy was 94%. Cyto-cell block analysis reduced the rate of unsatisfactory samples (p < 0.001). CONCLUSIONS The cyto-cell block interpretation improved the efficiency of US-FNA. This simple, fast and low-cost technique should be used as an adjunctive test in thyroid nodule evaluation. Arch Endocrinol Metab. 2016;60(4):367-73.
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Affiliation(s)
- Ana Patrícia de Cristo
- Programa de Pós-Graduação em Medicina: Endocrinologia, Universidade Federal do Rio Grande do Sul (UFRGS); Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brasil
| | - Heloísa Folgierini Goldstein
- Serviço de Patologia, Hospital de Clínicas de Porto Alegre (HCPA); Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Carlo Sasso Faccin
- Serviço de Radiologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brasil
| | - Ana Luiza Maia
- Unidade de Tireoide, Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Marcia Silveira Graudenz
- Serviço de Patologia, Hospital de Clínicas de Porto Alegre (HCPA); Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
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Liu X, Zhu L, Wang Z, Cui D, Chen H, Duan Y, Shen M, Lu H, Zhang Z, Chen J, Alexander EK, Yang T, Wang X. Evolutionary features of thyroid cancer in patients with thyroidectomies from 2008 to 2013 in China. Sci Rep 2016; 6:28414. [PMID: 27328631 PMCID: PMC4916471 DOI: 10.1038/srep28414] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/31/2016] [Indexed: 01/21/2023] Open
Abstract
To evaluate the characteristics of thyroid carcinoma over time, we carried out a retrospective study to illustrate the evolutionary features of thyroid carcinoma. All records of thyroidectomies from the First Affiliated Hospital of Nanjing Medical University from 2008 to 2013 were obtained focusing on pathological diagnosis, size, local lymph node metastasis (LNM) of the tumors. The thyroid cancer detection rate increased from 24.6% to 41.5% significantly (P < 0.05). Papillary thyroid carcinoma (PTC) remained to be the most common type counting 86.4% of all thyroid carcinomas. In all 1,704 PTCs, microPTC (mPTC) with maximum diameter less than or equal to 10 mm has become the dominant form taking up 56.5% of all PTCs in 2013 while only 43.1% in 2008. The mean maximum tumor size has decreased from 17.8 mm to 12.2 mm significantly (P < 0.05). However, the average age, female dominance, and local LNM remained similarly in the past six years. Logistic regression test showed that the determinants for local LNM were age, gender and tumor size. mPTC has become the most common form of thyroid carcinoma detected during thyroidectomies in China while other features of thyroid carcinoma remained similarly in the recent years.
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Affiliation(s)
- Xiaoyun Liu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lijun Zhu
- Department of Children's Health care, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, China
| | - Zhixiao Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dai Cui
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huanhuan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Duan
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meiping Shen
- Department of Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Lu
- Department of Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhihong Zhang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiawei Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Erik K Alexander
- Thyroid Unit, Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Brigham &Women's Hospital and Harvard Medical School, Boston, USA
| | - Tao Yang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaodong Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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15
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Uchida T, Himuro M, Komiya K, Goto H, Takeno K, Honda A, Sato J, Kawano Y, Suzuki R, Watada H. Evanescent Hyperechoic Changes After Fine-Needle Aspiration Biopsy of the Thyroid in a Series With a Low Overall Prevalence of Complications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:599-604. [PMID: 26892822 DOI: 10.7863/ultra.15.06017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/07/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the frequency of and risk factors for fine-needle aspiration biopsy (FNAB)-related complications in Japanese patients with thyroid nodules evaluated by standard FNAB techniques. METHODS Six hundred fifty-three consecutive Japanese patients with 742 nodules who had undergone FNAB were enrolled. Nodule characteristics were evaluated, and thyroid volumes were measured. Fine-needle aspiration biopsy-related complications were identified on the basis of sonographic findings and patients' conditions after undergoing FNAB. Comparisons of patients' backgrounds and nodule characteristics were made between those with and without complications. RESULTS The prevalence rates for FNAB-related complications, including acute transient thyroid swelling after FNAB and appearance of anechoic lesions, were 0.13% and 0.94%. In this study, we could not identify risk factors for FNAB-related complications. The sudden appearance of bright hyperechoic foci within the thyroid immediately after biopsy was reported as an FNAB-related unfamiliar appearance in 5 cases. Experimental FNA using resected porcine thyroid tissue suggested that the etiology of the hyperechoic appearance may be artificial air bubbles or reversed flow of aspirated fluid. CONCLUSIONS Fine-needle aspiration biopsy-related complications are rare if preventive measures are performed and are not specific to Japanese patients with thyroid nodules. The sudden appearance of bright hyperechoic foci may be cause by contamination from air or fluid.
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Affiliation(s)
- Toyoyoshi Uchida
- Department of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan.
| | - Miwa Himuro
- Department of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Koji Komiya
- Department of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Hiromasa Goto
- Department of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Kageumi Takeno
- Department of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Akira Honda
- Department of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Junko Sato
- Department of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yui Kawano
- Department of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Ruriko Suzuki
- Department of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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16
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Bobanga ID, McHenry CR. Evaluation and management of thyroid nodules with atypia/follicular lesion of undetermined significance on fine-needle aspiration. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015. [DOI: 10.2217/ije.15.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Since the introduction of the Bethesda System for Reporting Thyroid Cytopathology in 2008, the management of thyroid nodules has become more standardized, with clearly defined algorithms based on risk of malignancy for each of the six cytologic categories. However, the management of a thyroid nodule with a fine-needle aspiration biopsy classified as Bethesda III, or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), remains controversial due to the cytologic heterogeneity and the variability in the reported rates of malignancy. In this review, the history and rationale for the new Bethesda III category is examined, the reported incidence and risk of malignancy from published studies is reviewed and recommendations for management of patients with a thyroid nodule and AUS/FLUS are provided. Recent advances in molecular analysis and their role in the evaluation of patients with AUS/FLUS are also discussed.
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Affiliation(s)
- Iuliana D Bobanga
- Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Christopher R McHenry
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44109, USA
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17
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Simms A, Jacob RP, Cohen C, Siddiqui MT. TROP-2 expression in papillary thyroid carcinoma. Diagn Cytopathol 2015; 44:26-31. [DOI: 10.1002/dc.23382] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/21/2015] [Accepted: 09/24/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Anthony Simms
- Department of Pathology and Laboratory Medicine; Emory University Hospital; Atlanta Georgia
| | - Reuben P. Jacob
- Department of Pathology and Laboratory Medicine; Emory University Hospital; Atlanta Georgia
| | - Cynthia Cohen
- Department of Pathology and Laboratory Medicine; Emory University Hospital; Atlanta Georgia
| | - Momin T. Siddiqui
- Department of Pathology and Laboratory Medicine; Emory University Hospital; Atlanta Georgia
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18
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Faquin WC, Wong LQ, Afrogheh AH, Ali SZ, Bishop JA, Bongiovanni M, Pusztaszeri MP, VandenBussche CJ, Gourmaud J, Vaickus LJ, Baloch ZW. Impact of reclassifying noninvasive follicular variant of papillary thyroid carcinoma on the risk of malignancy in The Bethesda System for Reporting Thyroid Cytopathology. Cancer Cytopathol 2015; 124:181-7. [PMID: 26457584 DOI: 10.1002/cncy.21631] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 09/02/2015] [Accepted: 09/09/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent discussions have focused on redefining noninvasive follicular variant of papillary thyroid carcinoma (NI-FVPTC) as a neoplasm rather than a carcinoma. This study assesses the potential impact of such a reclassification on the implied risk of malignancy (ROM) for the diagnostic categories of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). METHODS The study consisted of consecutive fine-needle aspiration biopsy (FNAB) cases collected between January 1, 2013 and June 30, 2014 from 5 academic institutions. Demographic information, cytology diagnoses, and surgical pathology follow-up were recorded. The ROM was calculated with and without NI-FVPTC and was presented as a range: all cases (ie, overall risk of malignancy [OROM]) versus those with surgical follow-up only. RESULTS The FNAB cohort consisted of 6943 thyroid nodules representing 5179 women and 1409 men with an average age of 54 years (range, 9-94 years). The combined average ROM and OROM for the diagnostic categories of TBSRTC were as follows: nondiagnostic, 4.4% to 25.3%; benign, 0.9% to 9.3%; atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 12.1% to 31.2%; follicular neoplasm (FN), 21.8% to 33.2%; suspicious for malignancy (SM), 62.1% to 82.6%; and malignant, 75.9% to 99.1%. The impact of reclassifying NI-FVPTC on the ROM and OROM was most pronounced and statistically significant in the 3 indeterminate categories: the AUS/FLUS category had a decrease of 5.2% to 13.6%, the FN category had a decrease of 9.9% to 15.1%, and the SM category had a decrease of 17.6% to 23.4% (P < .05), whereas the benign and malignant categories had decreases of 0.3% to 3.5% and 2.5% to 3.3%, respectfully. The trend of the effect on the ROM and OROM was similar for all 5 institutions. CONCLUSIONS The results from this multi-institutional cohort indicate that the reclassification of NI-FVPTC will have a significant impact on the ROM for the 3 indeterminate categories of TBSRTC.
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Affiliation(s)
| | - Lawrence Q Wong
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Syed Z Ali
- Johns Hopkins Hospital, Baltimore, Maryland
| | | | | | | | | | - Jolanta Gourmaud
- Institute of Pathology, University Hospital, Lausanne, Switzerland
| | | | - Zubair W Baloch
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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19
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Fazeli R, Schneider EB, Ali SZ, Zeiger MA, Olson MT. Diagnostic Frequency Ratios Are Insufficient to Measure Laboratory Precision with The Bethesda System for Reporting Thyroid Cytopathology. Acta Cytol 2015; 59:225-32. [PMID: 26022342 DOI: 10.1159/000379738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/04/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Diagnostic frequency ratios such as the atypia of undetermined significance (AUS):malignant ratio are touted to be useful for laboratory precision benchmarking. We therefore sought to examine their reproducibility and usefulness at a tertiary hospital. METHODS We reviewed thyroid fine-needle aspirates (FNA) submitted to our institution from outside laboratories and evaluated the ability of diagnostic frequency ratios to capture the complexity of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Specifically, we evaluated the ability of the AUS:malignant ratio to describe the frequencies of the other TBSRTC diagnoses. RESULTS A total of 2,784 cases from 19 laboratories were included. The use of the AUS category varied the most. There was insufficient reflection of the non-AUS nonmalignant TBSRTC diagnostic frequencies in our analysis, and these results do not appear to arise from observer variability in the outside laboratories. CONCLUSION Diagnostic frequency ratios are not reproducible in our experience and fail to describe the other TBSRTC categories. As such, they are unlikely to prove sufficient for benchmarking laboratory precision with TBSRTC.
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Affiliation(s)
- Roghayeh Fazeli
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md., USA
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20
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Bellevicine C, Vigliar E, Malapelle U, Pisapia P, Conzo G, Biondi B, Vetrani A, Troncone G. Cytopathologists can reliably perform ultrasound-guided thyroid fine needle aspiration: a 1-year audit on 3715 consecutive cases. Cytopathology 2015; 27:115-21. [PMID: 25810099 DOI: 10.1111/cyt.12243] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE In our Pathology Department, fine needle aspiration (FNA) of palpable thyroid nodules is performed by cytopathologists who ensure correct sample management and rapid on-site evaluation (ROSE). Conversely, ultrasound (US)-guided FNAs have traditionally been carried out by endocrinologists and radiologists in outside clinics, where the presence of a cytopathologist is not always feasible. To overcome this limitation, cytopathologists have started to perform US-guided FNAs themselves. This study retrospectively evaluates 1 year of this novel practice. METHODS A total of 2225 US-guided FNAs were performed in our clinic by cytopathologists, whereas 1490 aspirates were taken by a group of non-cytopathologists. Among these, 756 FNAs were taken by a single experienced endocrinologist. The distribution of the Bethesda classification categories was evaluated in each of these groups. RESULTS FNAs performed by cytopathologists were more often diagnostic and better prepared than those taken by non-cytopathologists, including those taken by the experienced endocrinologist (P < 0.01). The latter operator yielded a higher rate of suspicious and malignant FNAs, reflecting a more appropriate clinical triage of worrisome nodules. CONCLUSION Although the endocrinologist's evaluation is crucial to select clinically relevant thyroid nodules, cytopathologists can reliably perform US guidance in addition to their traditional expertise in sampling, specimen preparation and ROSE.
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Affiliation(s)
- C Bellevicine
- Department of Public Health, Pathology Division, University of Naples Federico II, Naples, Italy
| | - E Vigliar
- Department of Public Health, Pathology Division, University of Naples Federico II, Naples, Italy
| | - U Malapelle
- Department of Public Health, Pathology Division, University of Naples Federico II, Naples, Italy
| | - P Pisapia
- Department of Public Health, Pathology Division, University of Naples Federico II, Naples, Italy
| | - G Conzo
- Department of Anesthesiologic, Surgical and Emergency Sciences, VII Division of General and Endocrine Surgery, Second University of Naples, Naples, Italy
| | - B Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - A Vetrani
- Department of Public Health, Pathology Division, University of Naples Federico II, Naples, Italy
| | - G Troncone
- Department of Public Health, Pathology Division, University of Naples Federico II, Naples, Italy
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21
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Lee YH, Baek JH, Jung SL, Kwak JY, Kim JH, Shin JH. Ultrasound-guided fine needle aspiration of thyroid nodules: a consensus statement by the korean society of thyroid radiology. Korean J Radiol 2015; 16:391-401. [PMID: 25741201 PMCID: PMC4347275 DOI: 10.3348/kjr.2015.16.2.391] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/15/2014] [Indexed: 12/11/2022] Open
Abstract
Ultrasound (US)-guided fine needle aspiration (US-FNA) has played a crucial role in managing patients with thyroid nodules, owing to its safety and accuracy. However, even with US guidance, nondiagnostic sampling and infrequent complications still occur after FNA. Accordingly, the Task Force on US-FNA of the Korean Society of Thyroid Radiology has provided consensus recommendations for the US-FNA technique and related issues to improve diagnostic yield. These detailed procedures are based on a comprehensive analysis of the current literature and from the consensus of experts.
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Affiliation(s)
- Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan 425-707, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - So Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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22
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Lale SA, Morgenstern NN, Chiara S, Wasserman P. Fine needle aspiration of thyroid nodules in the pediatric population: A 12-year cyto-histological correlation experience at north shore-long island jewish health system. Diagn Cytopathol 2015; 43:598-604. [DOI: 10.1002/dc.23265] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/28/2014] [Accepted: 01/31/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Seema A. Lale
- Department of Pathology; Mercy Hospital; Independence Kansas
| | | | - Sugrue Chiara
- Department of Pathology; Long Island Jewish Medical Cente; Lake Success New York
| | - Patricia Wasserman
- Department of Pathology; Columbia University Medical Center; New York New York
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Thyroid cytopathology reporting by the bethesda system: a two-year prospective study in an academic institution. PATHOLOGY RESEARCH INTERNATIONAL 2015; 2015:240505. [PMID: 25688327 PMCID: PMC4320899 DOI: 10.1155/2015/240505] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 12/16/2014] [Accepted: 12/24/2014] [Indexed: 12/30/2022]
Abstract
Background. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has attempted to standardize reporting and cytological criteria in aspiration smears. Aims. The objective of this study was to analyze the thyroid cytology smears by TBSRTC, to determine the distribution of diagnostic categories and subcategories, to analyze cytological features, and to correlate the cytopathology with histopathology, wherever surgery was done. Materials and Methods. This was a prospective study of 225 fine needle aspirations (FNA) of thyroid nodules. All fine needle aspiration cytology (FNAC) diagnoses were classified according to the features given in the monograph of TBSRTC into nondiagnostic/unsatisfactory (ND/UNS), benign, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm/suspicious of a follicular neoplasm (FN/SFN), suspicious for malignancy (SFM), and malignant. Cytohistological correlation was done, when surgical material was available. Results. The distribution of various categories from 225 evaluated thyroid nodules was as follows: 7.2% ND/UNS, 80.0% benign, 4.9% AUS/FLUS, 2.2% FN, 3.5% SFM, and 2.2% malignant. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Conclusions. TBSRTC is an excellent reporting system for thyroid FNA. It also provides clear management guidelines to clinicians to go for follow-up FNA or surgery and also the extent of surgery.
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Resident experience increases diagnostic rate of thyroid fine-needle aspiration biopsies. Acad Radiol 2014; 21:1490-4. [PMID: 25088838 DOI: 10.1016/j.acra.2014.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 06/17/2014] [Accepted: 06/19/2014] [Indexed: 01/21/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to determine whether the diagnostic yield of thyroid fine-needle aspirations (FNAs) changes over the course of residency training. MATERIALS AND METHODS We identified 5418 ultrasound-guided thyroid nodule FNAs performed in our radiology department from 2004 through 2012. For each FNA, we recorded if the FNA was performed by a resident and if so the name of the resident and supervising attending radiologist. For each resident, we determined the level of training based on their graduation year from our residency program and the date of the FNA as well as prior surgical training and if they completed subsequent interventional radiology fellowship. Pathology reports were reviewed, and FNAs were classified as diagnostic or nondiagnostic (ND). Generalized mixed models were used to assess ND rate with postgraduate years, including residents with and without prior surgical training or if they subsequently completed an interventional radiology fellowship. RESULTS Of the 5418 thyroid FNAs, 3164 (58.4%) were performed by a radiology resident under the direct supervision of an attending physician. There was a significant decrease in ND rate as postgraduate years increased (P < .05). A significant decrease in ND rate was found as postgraduate years increased for residents without prior surgical training (P = .0007) or subsequent training in interventional radiology (P = .0014); however, no significant decrease was found for residents with surgical training (P = .37) or completing an interventional radiology fellowship (P = .08). In addition, no significant difference was found for ND rate between postgraduate year 4 (PGY4) and PGY5 (P > .05). CONCLUSIONS ND thyroid FNA rates progressively decrease with training level, suggesting that early and continued participation in procedures throughout residency improves outcomes. This is particularly true for residents without prior surgical training or subsequent interventional radiology fellowship.
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Anderson TJT, Atalay MK, Grand DJ, Baird GL, Cronan JJ, Beland MD. Management of Nodules with Initially Nondiagnostic Results of Thyroid Fine-Needle Aspiration: Can We Avoid Repeat Biopsy? Radiology 2014; 272:777-84. [DOI: 10.1148/radiol.14132134] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Addati T, Achille G, Centrone M, Petroni S, Popescu O, Russo S, Grammatica L, Simone G. TROP-2 expression in papillary thyroid cancer: a preliminary cyto-histological study. Cytopathology 2014; 26:303-11. [DOI: 10.1111/cyt.12196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 12/30/2022]
Affiliation(s)
- T. Addati
- Anatomic Pathology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
| | - G. Achille
- Otorhinolaryngology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
| | - M. Centrone
- Anatomic Pathology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
| | - S. Petroni
- Anatomic Pathology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
| | - O. Popescu
- Anatomic Pathology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
| | - S. Russo
- Otorhinolaryngology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
| | - L. Grammatica
- Otorhinolaryngology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
| | - G. Simone
- Anatomic Pathology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
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Liu XY, Zhu LJ, Cui D, Wang ZX, Chen HH, Duan Y, Shen MP, Zhang ZH, Wang XD, Chen JW, Alexander EK, Yang T. Annual financial impact of thyroidectomies for nodular thyroid disease in China. Asian Pac J Cancer Prev 2014; 15:5921-6. [PMID: 25081723 DOI: 10.7314/apjcp.2014.15.14.5921] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A large proportion of patients with thyroid nodules in China undergo thyroidectomy in order to get confirmatory histology diagnosis. The financial impact of this modality remains to be investigated. To evaluate rationality of performing thyroidectomy without a routine FNA preoperatively from the economic perspective, we conducted a retrospective, observational study of all archival thyroidectomies with records of cost per stay (CPS), cost per day (CPD) and length of stay (LOS) from 2008 to 2013 in the First Affiliated Hospital of Nanjing Medical University. We compared all the parameters between cancer and non-cancer thyroidectomies. We recruited 6, 140 thyroidectomies with valid records of CPS, CPD and LOS in this period. The CPS of cancer thyroidectomy was significantly higher than non-cancer thyroidectomy. The percentage of cancer thyroidectomy increased from 26.5% to 41.6%. The percentage of annual cost of cancer thyroidectomies rose from 30.2% to 45.2%. The LOS for cancer and non-cancer thyroidectomy decreased while the CPD increased in the past six years. The estimated national cost in 2012 for all thyroidectomies would be USD 1.86 billion with USD 1.09 billion for non-cancer thyroidectomies. We have witnessed great improvement in the healthcare for patients with thyroid nodules in China. However, given limited healthcare resources, currently thyroid FNA for more precise preoperative diagnosis may help to curb the rapidly increasing demand in healthcare costs in the future for nodular thyroid disease in China.
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Affiliation(s)
- Xiao-Yun Liu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China E-mail :
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Preliminary Results of Ex Vivo Multispectral Photoacoustic Imaging in the Management of Thyroid Cancer. AJR Am J Roentgenol 2014; 202:W552-8. [PMID: 24848849 DOI: 10.2214/ajr.13.11433] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Choi JS, Nam CM, Kim EK, Moon HJ, Han KH, Kwak JY. Evaluation of serum thyroid-stimulating hormone as indicator for fine-needle aspiration in patients with thyroid nodules. Head Neck 2014; 37:498-504. [PMID: 24435826 DOI: 10.1002/hed.23616] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, it has been reported that the risk of thyroid malignancy increases with increasing concentrations of serum thyroid-stimulating hormone (TSH). The purpose of this study was to determine whether or not serum TSH can be a predictor for thyroid malignancy when considering the relevant ultrasound features and clinical risk factors. METHODS This retrospective study included 1200 euthyroid patients with 1269 thyroid nodules who underwent ultrasound-guided fine-needle aspiration (FNA) biopsy between January and June 2009. Serum TSH, ultrasound feature, and clinical parameters were compared according to final diagnosis. Subgroup analyses were performed according to nodule size. RESULTS Serum TSH did not show a positive association with malignancy for all nodules and the micronodule subgroup in multivariate analysis, although they showed significant association with thyroid malignancy for the macronodule subgroup. For all nodules and the 2 subgroups, suspicious ultrasound features and younger age were significantly associated with malignancy in univariate and multivariate analyses. CONCLUSION Our study suggests that TSH alone is not as useful as ultrasound features in deciding whether or not to perform FNA in patients with micronodules.
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Affiliation(s)
- Ji Soo Choi
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea; Department of Radiology, Samsung Medical Center, Seoul, Korea
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Conti de Freitas LC, Phelan E, Liu L, Gardecki J, Namati E, Warger WC, Tearney GJ, Randolph GW. Optical coherence tomography imaging during thyroid and parathyroid surgery: a novel system of tissue identification and differentiation to obviate tissue resection and frozen section. Head Neck 2013; 36:1329-34. [PMID: 23956009 DOI: 10.1002/hed.23452] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/13/2013] [Accepted: 08/12/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Optical coherence tomography (OCT) allows tissue histologic-like evaluation, but without tissue fixation or staining. We investigated OCT images from tissues obtained at thyroid and parathyroid surgeries to provide a preliminary assessment as to whether these images contain sufficient information for recognition and differentiation of normal neck tissues. METHODS Normal tissues were obtained from patients undergoing surgical treatment. Two new-generation OCT systems, including optical frequency domain imaging (OFDI) and μOCT, were compared to representative hematoxylin-eosin histology. RESULTS Thyroid, fat, muscle, lymph nodes, and parathyroid tissues were evaluated. Histologic-like microscopic characteristics sufficient for tissue type identification was realized using both systems for all tissue types examined. CONCLUSION This pilot study demonstrated that new-generation OCT systems are capable of recognizing and differentiating neck tissues encountered during thyroid and parathyroid surgeries. Further advances in OCT miniaturization and development of sterile intraoperative probe formats may allow OCT to offer an intraoperative "optical biopsy" without fixation, staining, or tissue resection.
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Affiliation(s)
- Luiz C Conti de Freitas
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Wellman Center of Photomedicine and Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts; Division of Head and Neck Surgery, Department of Ophthalmology, Otolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Harvey AM, Mody DR, Amrikachi M. Thyroid Fine-Needle Aspiration Reporting Rates and Outcomes Before and After Bethesda Implementation Within a Combined Academic and Community Hospital System. Arch Pathol Lab Med 2013; 137:1664-8. [DOI: 10.5858/arpa.2012-0366-oa] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—The current study compares data from our hospital system before and after the 2008 implementation of the Bethesda System for Reporting Thyroid Cytology (BSRTC).
Objective.—To show the effects the BSRTC has had on the reporting rates and outcomes for thyroid lesions.
Design.—A search for thyroid fine-needle aspiration biopsies (FNABs) was performed for 2002–2005 (before BSRTC) and 2009–2011 (after BSRTC). Diagnostic outcomes were reviewed for cases with available follow-up.
Results.—For 2002–2005, cytology reports for 3302 thyroid FNABs were reviewed, and 309 (9.4%) were classified as suspicious. For 2009–2011, cytology reports for 3432 thyroid FNABs were reviewed; 72 (2.1%) were classified as “atypia of undetermined significance or follicular lesion of undetermined significance” (AUS/FLUS), and 142 (4.1%) were classified as suspicious. Follow-up material was available for 31 AUS/FLUS cases (43.0%), and 6 of these cases (19%) were malignant. Follow-up material was available for 60 cases (42.3%) classified as suspicious, and 23 of these cases (38%) were malignant.
Conclusions.—The AUS/FLUS rate of 2.1% at our institution is at the lower range of the <7% recommended by the BSRTC, and our rate of 19% for risk of malignancy for AUS/FLUS is slightly above the BSRTC recommendation of 5% to 15%. Implementation of the BSRTC did not significantly affect our institution's reporting rates, most likely because an essentially similar classification system was employed before implementation of the BSRTC.
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Affiliation(s)
- Aaron M. Harvey
- From the Department of Pathology and Genomic Medicine, The Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas
- Dr Harvey is now with the Department of Pathology, Christus Health System, Corpus Christi, Texas
| | - Dina R. Mody
- From the Department of Pathology and Genomic Medicine, The Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas
- Dr Harvey is now with the Department of Pathology, Christus Health System, Corpus Christi, Texas
| | - Mojgan Amrikachi
- From the Department of Pathology and Genomic Medicine, The Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas
- Dr Harvey is now with the Department of Pathology, Christus Health System, Corpus Christi, Texas
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Smith-Bindman R, Lebda P, Feldstein VA, Sellami D, Goldstein RB, Brasic N, Jin C, Kornak J. Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study. JAMA Intern Med 2013; 173:1788-96. [PMID: 23978950 PMCID: PMC3936789 DOI: 10.1001/jamainternmed.2013.9245] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE There is wide variation in the management of thyroid nodules identified on ultrasound imaging. OBJECTIVE To quantify the risk of thyroid cancer associated with thyroid nodules based on ultrasound imaging characteristics. METHODS Retrospective case-control study of patients who underwent thyroid ultrasound imaging from January 1, 2000, through March 30, 2005. Thyroid cancers were identified through linkage with the California Cancer Registry. RESULTS A total of 8806 patients underwent 11,618 thyroid ultrasound examinations during the study period, including 105 subsequently diagnosed as having thyroid cancer. Thyroid nodules were common in patients diagnosed as having cancer (96.9%) and patients not diagnosed as having thyroid cancer (56.4%). Three ultrasound nodule characteristics--microcalcifications (odds ratio [OR], 8.1; 95% CI, 3.8-17.3), size greater than 2 cm (OR, 3.6; 95% CI, 1.7-7.6), and an entirely solid composition (OR, 4.0; 95% CI, 1.7-9.2)--were the only findings associated with the risk of thyroid cancer. If 1 characteristic is used as an indication for biopsy, most cases of thyroid cancer would be detected (sensitivity, 0.88; 95% CI, 0.80-0.94), with a high false-positive rate (0.44; 95% CI, 0.43-0.45) and a low positive likelihood ratio (2.0; 95% CI, 1.8-2.2), and 56 biopsies will be performed per cancer diagnosed. If 2 characteristics were required for biopsy, the sensitivity and false-positive rates would be lower (sensitivity, 0.52; 95% CI, 0.42-0.62; false-positive rate, 0.07; 95% CI, 0.07-0.08), the positive likelihood ratio would be higher (7.1; 95% CI, 6.2-8.2), and only 16 biopsies will be performed per cancer diagnosed. Compared with performing biopsy of all thyroid nodules larger than 5 mm, adoption of this more stringent rule requiring 2 abnormal nodule characteristics to prompt biopsy would reduce unnecessary biopsies by 90% while maintaining a low risk of cancer (5 per 1000 patients for whom biopsy is deferred). CONCLUSIONS AND RELEVANCE Thyroid ultrasound imaging could be used to identify patients who have a low risk of cancer for whom biopsy could be deferred. On the basis of these results, these findings should be validated in a large prospective cohort.
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Affiliation(s)
- Rebecca Smith-Bindman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco2Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco3Department of Epidemiology and Biostatistics, University of California, San Francisco
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Rosen JE, Suh H, Giordano NJ, Aamar OM, Rodriguez-Diaz E, Bigio II, Lee SL. Preoperative discrimination of benign from malignant disease in thyroid nodules with indeterminate cytology using elastic light-scattering spectroscopy. IEEE Trans Biomed Eng 2013; 61:2336-40. [PMID: 23771305 DOI: 10.1109/tbme.2013.2267452] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Thyroid nodules are common and often require fine needle aspiration biopsy (FNAB) to determine the presence of malignancy to direct therapy. Unfortunately, approximately 15-30% of thyroid nodules evaluated by FNAB are not clearly benign or malignant by cytology alone. These patients require surgery for the purpose of diagnosis alone; most of these nodules ultimately prove to be benign. Elastic light scattering spectroscopy (ESS) that measures the spectral differences between benign and malignant thyroid nodules has shown promise in improving preoperative determination of benign status of thyroid nodules. We describe the results of a large, prospective, blinded study validating the ESS algorithm in patients with thyroid nodules. An ESS system was used to acquire spectra from human thyroid tissue. Spectroscopic results were compared to the histopathology of the biopsy samples. Sensitivity and specificity of the ESS system in the differentiation of benign from malignant thyroid nodules are 74% and 90% respectively, with a negative predictive value of 97%. These data suggest that ESS has the potential for use in real time diagnosis of thyroid nodules as an adjunct to FNAB cytology.
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Mufti ST, Molah R. The bethesda system for reporting thyroid cytopathology: a five-year retrospective review of one center experience. Int J Health Sci (Qassim) 2013; 6:159-73. [PMID: 23579269 DOI: 10.12816/0005991] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED Fine-needle aspiration (FNA) of the thyroid gland is a widely accepted and accurate method for triaging patients with thyroid nodules. Thyroid FNA suffers from a reporting confusion due to multiplicity of category terminologies. To address this, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was recently introduced for unifying the terminology and morphologic criteria along with the corresponding risk of malignancy. OBJECTIVE The aim of this study was to report the diagnostic utility of TBSRTC at our institution and report the malignancy risk for FNA of thyroid lesions among Saudi patients using this system at KAUH (King Abdulaziz University Hospital), Jeddah, Saudi Arabia. MATERIALS AND METHODS A retrospective study identifying 250 thyroid FNAs performed among Saudi patients between Jan 2005-Dec 2010 was undertaken. Cytology specimen data was collected through a computerized search of our cytopathology archives. RESULTS Among the 250 thyroid FNAs, 84 were followed by surgical resection. The overall surgical yield of malignancy was 23.8%. The malignancy rate for the 6 categories was as follows: non diagnostic: 20%, benign: 3.1%, atypia of undetermined significance: 50%, suspicious for follicular neoplasm: 20%, suspicious for malignancy: 80%, malignant: 100%. CONCLUSION Retrospective classification of FNAs of thyroid lesions among Saudi patients using TBSRTC at KAAUH, Jeddah, Saudi Arabia, validates the diagnostic reproducibility of this system and yields similar results for risk of malignancy as reported by others. However the associated rates found for non diagnostic (20%) raise the possibility of malignancy risk in this category and validate the past observations that sample inadequacy is a common cause of false negative thyroid FNAs.
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Affiliation(s)
- Shagufta Tahir Mufti
- Associate Professor, Department of Anatomic Pathology, Faculty of Medicine, King Abdulaziz University and Hospital, P.O. Box 80215, Jeddah 21589, Saudi Arabia, , Mobile no: 00966545250730
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Eze OP, Cai G, Baloch ZW, Khan A, Virk R, Hammers LW, Udelsman R, Roman SA, Sosa JA, Carling T, Chhieng D, Theoharis CG, Prasad ML. Vanishing thyroid tumors: a diagnostic dilemma after ultrasonography-guided fine-needle aspiration. Thyroid 2013; 23:194-200. [PMID: 22928739 PMCID: PMC6463999 DOI: 10.1089/thy.2012.0157] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) is the most accurate and cost-effective method for evaluating thyroid nodules. However, FNA-induced secondary changes completely replacing thyroid tumors (vanishing tumors) may create a novel problem. In this study, we highlight the diagnostic and management issues associated with the unintended consequences of ultrasonography (US)-guided FNA. METHODS Fourteen thyroid glands (11 women and 3 men, ages 33-64 years) with vanishing tumors were prospectively identified between 2009 and 2012 upon surgical resection. Cytology and histopathology slides were reviewed, and second opinions were obtained when necessary. RESULTS The cytology of the 14 vanishing tumors was suspicious/positive for papillary thyroid carcinoma (PTC) in 5, indeterminate (atypia of unknown significance) in 5, benign in 2, follicular neoplasm in 1, and nondiagnostic in 1 nodule. Upon thyroidectomy, the vanishing tumors ranged in size from 0.4 to 3.5 cm (median 0.7 cm). Microscopically, the nodules showed cystic degeneration, organizing hemorrhage, granulation tissue, fibrosis, and microcalcifications. In seven tumors, a few residual malignant cells (PTC in five) or residual benign follicles (hemorrhagic cyst in two) at the periphery of the vanishing tumors helped with the final diagnosis. The remaining seven tumors were completely replaced by FNA-induced secondary changes, and had the cytology diagnosis of benign in one, follicular neoplasm in one, and suspicious/positive for PTC in five. Of the latter five, two showed additional separate foci of PTC, while three vanishing tumors (0.5, 1.2, and 1.6 cm) had no residual malignant cells and no additional carcinoma leading to a final diagnosis of negative for malignancy. CONCLUSIONS US-guided FNA may lead to complete obliteration of thyroid nodules, rendering final diagnosis upon thyroidectomy difficult or impossible. In these unusual circumstances, the possibility that the surgical pathology may be nonrepresentative should be considered if the cytologic features on FNA are sufficient by themselves to support a definitive diagnosis of PTC.
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Affiliation(s)
- Ogechukwu P. Eze
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Guoping Cai
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Zubair W. Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashraf Khan
- Department of Pathology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Renu Virk
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Robert Udelsman
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Sanziana A. Roman
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Julie A. Sosa
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Tobias Carling
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - David Chhieng
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Manju L. Prasad
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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Langer JE, Baloch ZW, McGrath C, Loevner LA, Mandel SJ. Thyroid nodule fine-needle aspiration. Semin Ultrasound CT MR 2012; 33:158-65. [PMID: 22410364 DOI: 10.1053/j.sult.2011.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Thyroid nodules are a common clinical problem and are noted much more commonly on imaging examinations than are apparent by palpation. Fine-needle aspiration biopsy (FNA), which yields a cytology specimen for analysis, is the standard test to determine whether surgical removal of a detected nodule is recommended. This article will review the current guidelines for recommending FNA of thyroid nodules, the technique and risk of the procedure, and the implications for patient care based on FNA results. FNA has an essential role in the evaluation of patients with thyroid nodules to reduce the rate of unnecessary thyroid surgery for patients with benign nodules and triage patients with thyroid cancer to appropriate surgery. Before the routine use of FNA, approximately 14% of resected thyroid nodules were malignant, whereas with the current widespread use of thyroid nodule FNA, >50% of resected thyroid nodules are malignant. Historically, thyroid nodules were identified by physical examination of the neck, with a prevalence of approximately 5%-10% of adults in the United States, and these patients underwent palpation-guided FNA in the physician's office. In recent years, the increased use of sonography to examine the thyroid as well as cross-sectional imaging of the neck by computed tomography and magnetic resonance imaging has resulted in the detection of many nonpalpable nodules. In older adults, thyroid nodules may be detected in >67% of people screened by sonography. Fortunately, the vast majority of nodules are benign, but when they are discovered, an assessment regarding the need to exclude malignancy using FNA must be performed.
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Affiliation(s)
- Jill E Langer
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Hryhorczuk AL, Stephens T, Bude RO, Rubin JM, Bailey JE, Higgins EJ, Fox GA, Klein KA. Prevalence of malignancy in thyroid nodules with an initial nondiagnostic result after ultrasound guided fine needle aspiration. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:561-567. [PMID: 22341051 DOI: 10.1016/j.ultrasmedbio.2011.12.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 12/12/2011] [Accepted: 12/29/2011] [Indexed: 05/31/2023]
Abstract
The objective of this study was to determine the rate of malignancy in thyroid nodules with an initial nondiagnostic fine needle aspiration. From October 2001 to April 2007, biopsies were performed on 1344 thyroid nodules in our practice. Biopsies were performed on nodules using 25-27 gauge needles, ultrasound guidance and multiple passes using both suction and capillary action. We retrospectively reviewed the results of these biopsies as well as any further management of nodules that received nondiagnostic results (IRB HUM00006459). Following initial biopsy, 295/1344 (21.9%) of nodules received nondiagnostic pathologic results. Of this population, 39 nodules (13.1%) were lost to follow-up. Of the remaining 256 nodules that received a repeat FNA, surgical excision, or greater than 24 months of clinical and imaging follow-up, only five cancers were detected, representing only 2% of the population that received an initial nondiagnostic biopsy result. All of these cancers were papillary neoplasms. When rigorous, ultrasound-guided, fine needle aspiration of thyroid nodules is performed, a nondiagnostic histopathologic result should not be interpreted as suspicious for thyroid cancer. Given the low rate of malignancy in this population (2%), we suggest that clinical and imaging follow-up of these nodules, opposed to repeat sampling, is warranted.
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Kerr L, Vidigal MEL, Rozenkwit D. Pode a gestação influenciar a evolução de nódulo tireoidiano maligno? Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000100016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os autores descrevem um nódulo tireoidiano com padrões ultrassonográfico e citopatológico benignos que diminuiu mais de 50% em três anos e se modificou durante a gestação, constatando-se que era carcinoma papilífero. Conclui-se que a gestação pode aumentar o risco de malignização ou acelerar o crescimento de nódulo tireoidiano maligno preexistente, corroborando dados da literatura.
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Affiliation(s)
- Lucy Kerr
- Instituto Kerr de Ensino e Pesquisa; Sonimage, Brasil
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Kitano M, Rahbari R, Patterson EE, Xiong Y, Prasad NB, Wang Y, Zeiger MA, Kebebew E. Expression profiling of difficult-to-diagnose thyroid histologic subtypes shows distinct expression profiles and identify candidate diagnostic microRNAs. Ann Surg Oncol 2011; 18:3443-52. [PMID: 21553140 PMCID: PMC3474204 DOI: 10.1245/s10434-011-1766-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND The incidence of thyroid cancer is increasing worldwide. The findings of up to 30% of thyroid fine-needle aspiration biopsies (FNAB) are inconclusive, primarily as a result of several thyroid histologic subtypes with overlapping cytologic features. MicroRNAs (miRNAs) are small noncoding RNAs and have been implicated in carcinogenesis. We hypothesized that there are miRNAs that are differentially expressed between benign and malignant thyroid tumors that are difficult to distinguish by FNAB. METHODS The expression of 1263 human miRNAs was profiled in 47 tumor samples representing difficult to diagnose histologic subtypes of thyroid neoplasm (21 benign, 26 malignant). Differentially expressed miRNAs were validated by quantitative real-time reverse transcriptase-polymerase chain reaction. The area under the receiver operating characteristic curve (AUC) was used to determine the diagnostic accuracy of differentially expressed miRNAs. RESULTS Supervised hierarchical cluster analysis demonstrated grouping of 2 histologies (papillary and follicular thyroid carcinoma). A total of 34 miRNAs were differentially expressed in malignant compared to benign thyroid neoplasms (P<0.05). A total of 25 of the 34 nonproprietary miRNAs were selected for validation, and 15 of the 25 miRNAs were differentially expressed between benign and malignant samples with P-value<0.05. Seven miRNAs had AUC values of >0.7. miR-7 and miR-126 had the highest diagnostic accuracy with AUCs values of 0.81 and 0.77, respectively. CONCLUSION To our knowledge, this is the first study to evaluate the diagnostic accuracy of miRNAs in thyroid histologies that are difficult to distinguish as benign or malignant by FNAB. miR-126 and miR-7 had high diagnostic accuracy and could be helpful adjuncts to thyroid FNAB.
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Affiliation(s)
- Mio Kitano
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - Reza Rahbari
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - Erin E. Patterson
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - Yin Xiong
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - Nijaguna B. Prasad
- Endocrine Surgery Section, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Yongchun Wang
- Endocrine Surgery Section, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Martha A. Zeiger
- Endocrine Surgery Section, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Electron Kebebew
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
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Sellami M, Tababi S, Mamy J, Zainine R, Charfi A, Beltaief N, Sahtout S, Besbes G. Interest of fine-needle aspiration cytology in thyroid nodule. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:159-64. [DOI: 10.1016/j.anorl.2011.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 01/07/2011] [Accepted: 01/23/2011] [Indexed: 10/18/2022]
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Wémeau JL, Sadoul JL, d'Herbomez M, Monpeyssen H, Tramalloni J, Leteurtre E, Borson-Chazot F, Caron P, Carnaille B, Léger J, Do C, Klein M, Raingeard I, Desailloud R, Leenhardt L. Guidelines of the French society of endocrinology for the management of thyroid nodules. ANNALES D'ENDOCRINOLOGIE 2011; 72:251-281. [PMID: 21782154 DOI: 10.1016/j.ando.2011.05.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 05/13/2011] [Indexed: 01/21/2023]
Abstract
The present document is a follow-up of the clinical practice guidelines of the French Society of Endocrinology, which were established for the use of its members and made available to scientific communities and physicians. Based on a critical analysis of data from the literature, consensuses and guidelines that have already been published internationally, it constitutes an update of the report on the diagnostic management of thyroid nodules that was proposed in France, in 1995, under the auspices of the French National Agency for Medical Evaluation (l'Agence nationale d'évaluation médicale). The current guidelines were deliberated beforehand by a number of physicians that are recognised for their expertise on the subject, coming from the specialities of endocrinology (the French Thyroid Research Group) and surgery (the French Association for Endocrine Surgery), as well as representatives from the fields of biology, ultrasonography, cytology and nuclear medicine. The guidelines were presented and submitted for the opinion of the members of the Society at its annual conference, which was held in Nice from 7-10 October 2009. The amended document was posted on the website of the Society and benefited from additional remarks of its members. The final version that is presented here was not subjected to methodological validation. It does not claim to be universal in its scope and will need to be revised in concert with progress made in technical and developmental concepts. It constitutes a document that the Society deems useful for distribution concerning the management of thyroid nodules, which is current, efficient and cost effective.
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Affiliation(s)
- J-L Wémeau
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France.
| | - J-L Sadoul
- Endocrinologie, hôpital de l'Archet, CHU 06202 Nice cedex, France
| | - M d'Herbomez
- Département de médecine nucléaire, centre de biologie pathologie, centre hospitalier régional, 59037 Lille cedex, France
| | - H Monpeyssen
- Centre de radiologie, imagerie médicale et échographie thyroïdienne, hôpital Necker, 141, rue de Sèvres, 75015 Paris, France
| | - J Tramalloni
- Centre de radiologie, imagerie médicale et échographie thyroïdienne, hôpital Necker, 141, rue de Sèvres, 75015 Paris, France
| | - E Leteurtre
- Inserm U560, service d'anatomie pathologique, CHRU de Lille, Lille, France
| | - F Borson-Chazot
- Hôpital Louis-Pradel, CHU des hospices civils de Lyon, 28, avenue Doyen-Lépine, 69500 Bron, France
| | - P Caron
- CHU Larrey, avenue du Jean-Poulhès, 31400 Toulouse, France
| | - B Carnaille
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France
| | - J Léger
- Service d'endocrinologie et diabétologie pédiatriques, hôpital Robert-Debré, 48, boulevard Sérurier, 75935 Paris cedex 19, France
| | - C Do
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France
| | - M Klein
- Service d'endocrinologie, CHU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - I Raingeard
- Service des maladies métaboliques et endrocriennes, hôpital Lapeyronie, 34295 Montpellier cedex 5, France
| | - R Desailloud
- Service d'endocrinologie, diabétologie et nutrition, hôpital Sud, CHU d'Amiens, avenue René-Laënnec, 80054 Amiens, France
| | - L Leenhardt
- Service de médecine nucléaire, hôpital Pitié-Salpêtrière, université Paris VI, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Lacout A, Marcy PY, Thariat J. RE: Role of Duplex Doppler US for thyroid nodules: looking for the "sword" sign. Korean J Radiol 2011; 12:400-1. [PMID: 21603302 PMCID: PMC3088860 DOI: 10.3348/kjr.2011.12.3.400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 03/03/2011] [Indexed: 11/20/2022] Open
Abstract
Duplex Doppler US may be useful for the detection of thyroid malignancies that show either anarchic winding or penetrating "sword like" neoangiogenic vessels. It may be helpful in selecting nodules that should undergo fine needle aspiration biopsy.
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Affiliation(s)
- Alexis Lacout
- Department of Radiology, Centre d'imagerie Médicale, Centre Médico Chirurgical (CMC), France
| | - Pierre Yves Marcy
- Head & Neck and Interventional Radiology, Department Antoine Lacassagne Cancer Research Institute, France
| | - Juliette Thariat
- Department of Radiation Oncology, Antoine Lacassagne Cancer Research Institute, France
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Davey DD, Neal MH. Coding changes in the United States front and center. Cancer Cytopathol 2011; 119:310-4. [DOI: 10.1002/cncy.20159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 03/29/2011] [Accepted: 03/30/2011] [Indexed: 01/20/2023]
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Cross PA, Poller D. The Bethesda thyroid terminology and progress towards international agreement on thyroid FNA cytology reporting. Cytopathology 2011; 21:71-4. [PMID: 21054820 DOI: 10.1111/j.1365-2303.2010.00749.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Cibas ES. Fine-needle aspiration in the work-up of thyroid nodules. Otolaryngol Clin North Am 2010; 43:257-71, vii-viii. [PMID: 20510713 DOI: 10.1016/j.otc.2010.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Fine-needle aspiration (FNA) is the crucial diagnostic test used for the evaluation of patients with a thyroid nodule. The result of an FNA determines if a patient can be followed with repeated examinations or referred for surgery. The value of FNA can be enhanced by attention to technical details. Communication between operator and pathologist is essential. A pathologist's interpretation is aided if essential clinical information is provided on a requisition form. Although reporting terminology has been varied and confusing in the past, a proposal for a uniform reporting system provides 6 clearly defined and clinically relevant reporting categories and promises to standardize the reporting of thyroid FNA results.
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Affiliation(s)
- Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Abstract
Nodular thyroid disease is common in the United States and throughout the world. Although most thyroid nodules are benign in nature, certain clinical, radiographic, and cytologic features are associated with an increased risk of malignancy. A clear understanding of these risk factors assists in the decision-making process when evaluating a patient with a thyroid nodule. It is this process that ultimately determines whether or not a patient is referred for surgery. This article provides a framework for clinicians to risk-stratify and appropriately manage patients with thyroid nodules.
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Affiliation(s)
- Matthew C Miller
- Department of Otolaryngology-Head and Neck Surgery, University of Rochester Medical Center, Box 629, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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Tilluckdharry NV, Krishnamani R, Denofrio D, Burman KD, Kim CS. Thyroid nodule and thyroid cancer management pre- and post-cardiac transplantation. J Heart Lung Transplant 2010; 29:831-7. [PMID: 20471862 DOI: 10.1016/j.healun.2010.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/03/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022] Open
Abstract
Thyroid nodules are common in the adult population. Widespread use of sensitive imaging studies often leads to their incidental discovery. Recent guidelines recommend thyroid-stimulating hormone determination and ultrasonography during initial nodule evaluation. Fine-needle aspiration is often performed to detect malignancy. However, the management of thyroid nodules in cardiac transplantation patients has not been directly addressed by recent guidelines. Confounding medications such as amiodarone and anti-coagulants present a management dilemma. The timing of fine-needle aspiration is crucial because (1) malignancy diagnosed pre-operatively usually precludes organ transplantation, and (2) patients undergoing solid-organ transplantation are at increased risk of developing de novo malignancies, including thyroid. With the rising incidence of thyroid cancer, donor-related malignancy will likely become a more prominent issue. This review addresses thyroid nodule management in the cardiac transplant population and provides recommendations for organ donation and transplantation in donors and recipients with thyroid cancer.
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Affiliation(s)
- Nicole V Tilluckdharry
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts 02111, USA
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Layfield LJ, Cibas ES, Baloch Z. Thyroid fine needle aspiration cytology: a review of the National Cancer Institute state of the science symposium. Cytopathology 2010; 21:75-85. [DOI: 10.1111/j.1365-2303.2010.00750.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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50
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Buley ID. Thyroid gland. Diagn Cytopathol 2010. [DOI: 10.1016/b978-0-7020-3154-0.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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