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McKenzie DR, Kliassov EG, Dash RC, Foo WC, Jones CK, Jiang X. Pathologist-performed ultrasound-guided fine-needle aspirations of the thyroid: A single institution observational study. Cancer Cytopathol 2022; 130:735-739. [PMID: 35481943 DOI: 10.1002/cncy.22590] [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: 03/01/2022] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Ultrasound-guided fine-needle aspiration biopsies (USFNAs) are increasingly performed by pathologists. This study was designed to assess the diagnostic yield and characterization of thyroid nodules biopsied at a teaching hospital setting in which both attending physicians and trainees are involved in the performance of USFNAs. METHODS A retrospective study of pathologist-performed USFNAs of thyroid cases was performed over a period of 9 years at a tertiary medical center. Data collected included patient characteristics and The Bethesda System diagnostic categories. RESULTS Over the study period, 1531 USFNAs of thyroid nodules were performed in the pathology-based clinic, with 1209 lesions in females and 322 in males. Ninety-three percent of samples were sufficient for diagnosis (n = 1420). The majority of nodules biopsied were benign (65.4%, n = 1002). Overall, 3.1% of nodules biopsied were diagnostic of malignancy (n = 47). The number of USFNAs over the years showed a rapid increase initially, with a coronavirus disease 2019-related decrease in 2020. CONCLUSIONS The authors report their experience with thyroid USFNA over nearly a decade. The most common diagnosis was benign and the second most common was Bethesda category III. Lesions that were diagnostic of malignancy were relatively uncommon. Over the study period, the results showed that at a large tertiary care center in which USFNAs were performed by trainees as well as attending physicians, the diagnostic yield was good with a majority of thyroid nodules biopsied associated with a definitive diagnosis.
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Affiliation(s)
- David R McKenzie
- Department of Pathology, Duke University Medical Center, Duke University, Durham, North Carolina
| | - Evelyna G Kliassov
- Department of Pathology, Duke University Medical Center, Duke University, Durham, North Carolina
| | - Rajesh C Dash
- Department of Pathology, Duke University Medical Center, Duke University, Durham, North Carolina
| | - Wen-Chi Foo
- Department of Pathology, Duke University Medical Center, Duke University, Durham, North Carolina
| | - Claudia K Jones
- Department of Pathology, Duke University Medical Center, Duke University, Durham, North Carolina
| | - Xiaoyin Jiang
- Department of Pathology, Duke University Medical Center, Duke University, Durham, North Carolina
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2
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Taha I, Al-Thani H, El-Menyar A, Asim M, Al-Sulaiti M, Tabeb A. Diagnostic accuracy of preoperative palpation- versus ultrasound-guided thyroid fine needle aspiration cytology: an observational study. Postgrad Med 2020; 132:465-472. [PMID: 32163318 DOI: 10.1080/00325481.2020.1741298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Thyroid fine needle aspiration (FNA) is the mainstay for diagnosis of malignancy, and is an integral part of current thyroid nodule assessment. The present study analyzes the diagnostic accuracy of palpation-directed versus ultrasound guided fine-needle aspiration in patients who underwent surgery for thyroid nodules. METHODS A retrospective chart review of all consecutive patients who had FNA biopsy (palpation or ultrasound guided) of thyroid nodules and underwent thyroid gland surgery between 1998 and 2014 was conducted. The FNA findings of the palpation-guided and ultrasound-guided groups were compared for baseline characteristics. Moreover, the diagnostic accuracy of FNA findings and surgical histopathology results were analyzed. RESULTS A total of 1174 patients were included in the study with a mean age of 46.3 ± 11.7 years and the majority were females (75.5%). Among the study population, 392 (33.4%) patients underwent US-guided FNA; 570 (48.6%) had palpation-guided FNA in clinic and no FNA was done in 212 (18%) cases. Patients underwent US-guided FNA were more likely to have suspicion of malignancy (p = 0.001), and had indeterminate findings (p = 0.001). On the other hand, palpation-guided FNA group had significantly higher frequency of benign cytology (p = 0.001). With respect to the suspicion for malignancy as well as malignancy, the US-guided group had a similar diagnostic accuracy in comparison to the palpation group. The proportion of malignancy finding on US-guided FNA (8.9%) was higher than the palpation-guided FNA (6.4%) that had been confirmed on postoperative histopathological examination (p = 0.95). CONCLUSION The present study demonstrates higher sensitivity of US-guided thyroid FNA biopsies over palpation-guided FNA for the suspicion of malignancy; however, the accuracy is comparable. Moreover, both groups showed more postoperative malignancy in the benign and unsatisfactory categories than predicted in the Bethesda system. Further prospective studies are needed to underpin a realistic correlation between FNA and final histopathology reports.
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Affiliation(s)
- Ibrahim Taha
- Department of Surgery, Hamad General Hospital (HGH) , Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Hamad General Hospital (HGH) , Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital (HGH) , Doha, Qatar.,Clinical Medicine, Weill Cornell Medical College , Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital (HGH) , Doha, Qatar
| | | | - Abdelhakem Tabeb
- Department of Surgery, Hamad General Hospital (HGH) , Doha, Qatar
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3
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de Koster EJ, de Geus-Oei LF, Dekkers OM, van Engen-van Grunsven I, Hamming J, Corssmit EPM, Morreau H, Schepers A, Smit J, Oyen WJG, Vriens D. Diagnostic Utility of Molecular and Imaging Biomarkers in Cytological Indeterminate Thyroid Nodules. Endocr Rev 2018; 39:154-191. [PMID: 29300866 DOI: 10.1210/er.2017-00133] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/27/2017] [Indexed: 12/21/2022]
Abstract
Indeterminate thyroid cytology (Bethesda III and IV) corresponds to follicular-patterned benign and malignant lesions, which are particularly difficult to differentiate on cytology alone. As ~25% of these nodules harbor malignancy, diagnostic hemithyroidectomy is still custom. However, advanced preoperative diagnostics are rapidly evolving.This review provides an overview of additional molecular and imaging diagnostics for indeterminate thyroid nodules in a preoperative clinical setting, including considerations regarding cost-effectiveness, availability, and feasibility of combining techniques. Addressed diagnostics include gene mutation analysis, microRNA, immunocytochemistry, ultrasonography, elastosonography, computed tomography, sestamibi scintigraphy, [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET), and diffusion-weighted magnetic resonance imaging.The best rule-out tests for malignancy were the Afirma® gene expression classifier and FDG-PET. The most accurate rule-in test was sole BRAF mutation analysis. No diagnostic had both near-perfect sensitivity and specificity, and estimated cost-effectiveness. Molecular techniques are rapidly advancing. However, given the currently available techniques, a multimodality stepwise approach likely offers the most accurate diagnosis, sequentially applying one sensitive rule-out test and one specific rule-in test. Geographical variations in cytology (e.g., Hürthle cell neoplasms) and tumor genetics strongly influence local test performance and clinical utility. Multidisciplinary collaboration and implementation studies can aid the local decision for one or more eligible diagnostics.
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Affiliation(s)
- Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf M Dekkers
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jaap Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Smit
- Department of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Division of Radiotherapy and Imaging, Institute of Cancer Research, and Department of Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
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4
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Abad-Licham M, Galvez-Olortegui J, Astigueta J, Díaz-Plasencia J. Diagnostic validity of fine-needle capillary cytology in palpable tumours at the Oncology Institute of Peru. Ecancermedicalscience 2018; 12:805. [PMID: 29492099 PMCID: PMC5828675 DOI: 10.3332/ecancer.2018.805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Indexed: 11/06/2022] Open
Abstract
Objective To evaluate the diagnostic validity of fine-needle capillary cytology (FNCC) in palpable tumours. Material and methods A retrospective, single-tray, cross-sectional diagnostic test study was carried out. We reviewed the cytological reports of the case files of the Cytology Unit of the Northern Regional Institute of Neoplastic Diseases (IREN) from January 2012 to December 2016. Results A total of 332 patients were selected, with an average age of 54.77 years (range 13-90 years); 61.4% of patients were female. The most frequent anatomical sites were lymph nodes (49.7%), thyroid (13.3%), breast (12.3%) and soft tissues (11.4%). Twenty-five cytologies did not have a histological correlation and six showed an atypical result. In the lymph node study, the most frequent pathology was metastatic carcinoma (49.7%), followed by lymphoma (13.3%). The FNCC had a sensitivity of 99.55%, a specificity of 98.77%, a positive predictive value of 99.55% and a negative predictive value of 98.77%. The positive likelihood ratio was 80.63%. Conclusions FNCC is a useful, safe, reliable and economical ambulatory technique with minimal complications and high diagnostic accuracy.
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Affiliation(s)
- Milagros Abad-Licham
- Graduate School, Antenor Orrego Private University, Trujillo 13007, Peru.,Pathology Department, Regional Institute of Neoplastic Diseases, Trujillo 13601, Peru.,Scientia Clinical and Epidemiological Research Institute, Trujillo 13007, Peru
| | - Jose Galvez-Olortegui
- Graduate School, Antenor Orrego Private University, Trujillo 13007, Peru.,Scientia Clinical and Epidemiological Research Institute, Trujillo 13007, Peru
| | - Juan Astigueta
- Graduate School, Antenor Orrego Private University, Trujillo 13007, Peru.,Scientia Clinical and Epidemiological Research Institute, Trujillo 13007, Peru.,Urology Department, Regional Institute of Neoplastic Diseases, Trujillo 13601, Peru
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Kang R, Goodney PP, Wong SL. Importance of cost-effectiveness and value in cancer care and healthcare policy. J Surg Oncol 2016; 114:275-80. [PMID: 27334052 PMCID: PMC5048466 DOI: 10.1002/jso.24331] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/04/2016] [Indexed: 12/23/2022]
Abstract
The cost of cancer care has increased by five fold over the last three decades. As our healthcare system shifts from volume to value, greater scrutiny of interventions with clinical equipoise is required. Traditionally, QALYs and ICER have served as surrogate markers for value. However, this approach fails to incorporate all stakeholders' viewpoints. Prostate cancer, low risk DCIS, and thyroid cancer are used as a framework to discuss value and cost-effectiveness. J. Surg. Oncol. 2016;114:275-280. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ravinder Kang
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Philip P Goodney
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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6
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Tillman BN, Glazer TA, Ray A, Brenner JC, Spector ME. A lean neck mass clinic model: Adding value to care. Laryngoscope 2015; 125:2509-13. [PMID: 26256915 DOI: 10.1002/lary.25535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/23/2015] [Accepted: 07/06/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To demonstrate that ultrasound-guided fine needle aspiration (USFNA) with on-site cytopathologic analysis eliminates unnecessary diagnostic testing, return visits, and repeat procedures and optimizes quality of care. STUDY DESIGN Retrospective cohort. METHODS Sixty-one new patients (28 female; 33 male; age range=19-85 years) were seen in our dedicated neck mass clinic over a 1-year period. All patients underwent USFNA of masses located in neck levels I-VI (n=40), parotid gland (n=20), or parapharyngeal space (n=1). Each patient underwent two USFNA passes followed by on-site cytopathologic analysis with additional passes if required for diagnosis. RESULTS Diagnosis was made in 93.4% (n=57) of patients, allowing for counseling and treatment planning at the first visit. To obtain a diagnosis, more than half (57.4%, n=35) of our patients required additional passes, which implies that they would have required an additional visit without on-site cytopathologic analysis. Treatment included observation in 42.6% (n=26) of patients, surgery in 32.8 % (n=20) of patients, and nonsurgical treatment (chemotherapy, radiation, other) in 24.6% (n=15) of patients. The average time from check-in to checkout including the clinic visit, biopsy, and treatment counseling was 103 minutes, and the average round trip mileage traveled per patient was 127.6 miles. CONCLUSIONS The adult neck mass is a commonly encountered scenario in otolaryngology. For the patient, this can be a stressful situation in which timely and accurate diagnosis is critical. A dedicated lean neck mass clinic model with USFNA and on-site cytopathologic analysis can be both an efficient part of one's practice and a valuable addition to patient care. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | | | - Amrita Ray
- Department of Otolaryngology-Head and Neck Surgery
| | - J Chad Brenner
- Department of Otolaryngology-Head and Neck Surgery.,Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery.,Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
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7
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Mangla G, Arora VK, Singh N. Clinical audit of ultrasound guided fine needle aspiration in a general cytopathology service. J Cytol 2015; 32:6-11. [PMID: 25948936 PMCID: PMC4408685 DOI: 10.4103/0970-9371.155223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Studies on ultrasonography (USG) guided fine needle aspiration cytology (FNAC) have been conducted in specialized settings such as thyroid, breast, and intra-abdominal aspirates. There is a paucity of literature on the practices of guided FNAC in a general cytopathology service. Aim: The aim was to determine prevailing practices of USG guided FNAC in a general cytopathology service of a teaching hospital. Settings and Design: Metropolitan hospital, clinical audit. Materials and Methods: Audit of 112 USG guided percutaneous FNAC done over 12 months. Statistical Analysis: Data were coded, entered in an excel spreadsheet and analyzed by translating into percentages and proportions. Results: The 112 guided FNACs included constituted 36 thyroid (32.14%), 45 intra-abdominal (40.17%), 11 breast (9.82%), 10 superficial lymph node (8.92%) and 10 soft tissue and miscellaneous (8.92%) lesions. Previous freehand FNAC was documented on the requisition forms in 14 cases. The reports were: Inadequate 33 (29.46%), nondiagnostic descriptive 35 (31.25%) or diagnostic 44 (39.28%). Inadequacy rates of aspirates from thyroid were 11 (30.56%) breast were 2 (18.18%), and intra-abdominal lesions were 13 (28.88%). Majority of the reports were nonstructured: 108 (96.42%) and nonrecommendatory: 101 (90.17%). Conclusions: Reporting practices varied and did not conform to a uniform structure. The inadequacy rates of breast and thyroid aspirates were comparable to the rates in the literature. Comparable studies were not available for intra-abdominal aspirates.
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Affiliation(s)
- Gunjan Mangla
- Department of Pathology, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Vinod Kumar Arora
- Department of Pathology, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Navjeevan Singh
- Department of Pathology, University College of Medical Sciences and GTB Hospital, New Delhi, India
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8
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Liu CC, Lui J, Oddone Paolucci E, Rudmik L. Systematic Review of the Quality of Economic Evaluations in the Otolaryngology Literature. Otolaryngol Head Neck Surg 2014; 152:106-15. [DOI: 10.1177/0194599814556725] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective To evaluate the quality of economic evaluations published in the otolaryngology—head and neck surgery literature, which will identify methodologic weaknesses that can be improved on in future studies. A secondary objective is to identify factors that may be associated with higher quality economic evaluations. Data Sources Ovid Medline (including PubMed), Embase, and the National Health Services Economic Evaluation databases. Review Methods A systematic search was performed of the aforementioned databases according to PRISMA guidelines. The search was performed using otolaryngology key terms combined with the term cost. A manual search of 36 otolaryngology journals was also performed. Included studies were graded using the Quality of Health Economics Studies instrument, a 16-item checklist providing a total quality score of 100. Results Fifty studies were identified, and the mean quality rating was 54.7/100 (SD = 30.9). The most commonly omitted methodology components were a lack of discussion of limitations and biases, failure to address the negative outcomes of examined interventions, and a lack of a robust sensitivity analysis. Higher quality economic evaluations were associated with a higher journal impact factor (correlation coefficient r = 0.62, P = .0001), having an author with a PhD in health economics ( r = 0.56, P = .0001), and having authors who have published prior economic evaluations ( r = 0.46, P = .001). Conclusion Results from this study have demonstrated that there are several methodological domains that can be improved on when publishing economic evaluations in the otolaryngology literature. Authors should follow recommended methodological and reporting guidelines to optimize the transparency and accuracy of the overall conclusions.
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Affiliation(s)
- C. Carrie Liu
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Canada
| | - Justin Lui
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Canada
| | - Elizabeth Oddone Paolucci
- Departments of Surgery and Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada
| | - Luke Rudmik
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Canada
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Abstract
Thyroid nodules are common and, depending on the detection technique used, can affect 50% or greater of the population. The primary diagnostic test to assess the nature of these nodules is fine-needle aspiration cytology. Most thyroid nodules are benign and often are multiple. However, the morphology of these nodules may mimic neoplasms showing features such as papillary growth, micro-follicles and even oncocytic metaplasia. Lesions with these features may be considered indeterminate for neoplasm or malignancy, and often require surgical excision to define their nature. The role of cytopathology in this area is to screen those definitely benign nodules, thus preventing surgery and reassuring both the patient and the clinician. In this review, we demonstrate many of the morphological manifestations of nodular goiter and stress the necessity of careful preparatory techniques. Although the past several years have witnessed the development of molecular testing to refine diagnostic cytology in the thyroid, it is still the role of the cytopathologist to identify those "indeterminant" nodules which should be tested. Thus, the cytopathologist contributes both an essential diagnostic and an important cost saving role which hopefully will continue in the future.
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Affiliation(s)
- Zubair W Baloch
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Perelman School of Medicine, 3400 Spruce Street, Founders 6, Philadelphia, PA 19104, USA.
| | - Virginia A LiVolsi
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Perelman School of Medicine, 3400 Spruce Street, Founders 6, Philadelphia, PA 19104, USA.
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Najafzadeh M, Marra CA, Lynd LD, Wiseman SM. Cost-effectiveness of using a molecular diagnostic test to improve preoperative diagnosis of thyroid cancer. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:1005-1013. [PMID: 23244801 DOI: 10.1016/j.jval.2012.06.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/10/2012] [Accepted: 06/22/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Fine-needle aspiration biopsy (FNAB) is a safe and inexpensive diagnostic procedure for evaluating thyroid nodules.Up to 25% of the results from an FNAB, however, may not be diagnostic or may be indeterminate, leading to a subsequent diagnostic thyroid surgery. A new molecularly based diagnostic test could potentially reduce indeterminate cytological results and, with high accuracy, provide a definitive diagnosis for cancer in thyroid nodules. The aim of the study was to estimate the cost-effectiveness of utilizing a molecular diagnostic (DX) test as an adjunct to FNAB, compared with NoDX, to improve the preoperative diagnosis of thyroid nodules. METHODS We constructed a patient-level simulation model to estimate the clinical and economic outcomes of using a DX test compared with current practice (NoDX) for the diagnosis of thyroid nodules. By using a cost-effectiveness framework, we measured incremental clinical benefits in terms of quality-adjusted life-years and incremental costs over a 10-year time horizon. RESULTS Assuming 95% sensitivity and specificity of the Dx test when used as an adjunct to FNAB, the utilization of the DX test resulted in a gain of 0.046 quality-adjusted life-years (95% confidence interval 0.019-0.078) and a saving of $1087 (95% confidence interval $691-$1533) in direct costs per patient. If the cost of the Dx test is less than $1087 per test, we expect to save quality-adjusted life-years and reduce costs when it is utilized. Sensitivity of the DX test, compared with specificity, had a larger influence on the overall outcomes.
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Affiliation(s)
- Mehdi Najafzadeh
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
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Moberly AC, Vural E, Nahas B, Bergeson TR, Kokoska MS. Ultrasound-guided needle aspiration: Impact of immediate cytologic review. Laryngoscope 2010; 120:1979-84. [DOI: 10.1002/lary.21061] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Glehr M, Leithner A, Gruber G, Wretschitsch P, Zacherl M, Kroneis T, Quehenberger F, Windhager R. A New Fine-Needle Aspiration System. Surg Innov 2010; 17:136-41. [DOI: 10.1177/1553350610364991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The main reasons for fine needle aspiration (FNA) failure are insufficient number of cells in the sample, nonrepresentative samples, and contamination of samples. The aim of this study was to measure the number of cells harvested by a new needle system with an aeration aperture (Thyrosampler) in comparison with a conventional FNA system (C-FNA). Methods. Under a double-blind setting, 30 aspirations, 15 with each system (C-FNA, Thyrosampler), were done in randomized order and recorded. Results. The median total number of cells was 59 680 cells/mL with C-FNA and 396 400 cells/mL with Thyrosampler. The needle system with the aeration aperture led to a significantly higher cell amount (564% more cells than the conventional system; P < .005) in needle aspiration biopsy. Conclusion. The new system with the vacuum release feature leads to a significantly higher cell amount in needle aspiration biopsy, which is a well-defined benefit.
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13
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Kauf TL. The greater estimated expense associated with USGFNAB may still be a reasonable expenditure to achieve an additional correct diagnosis, but that is for individual practices and providers to decide. Head Neck 2010; 32:821-3. [PMID: 20474073 DOI: 10.1002/hed.21394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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14
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Can AS. Cost-effectiveness comparison between palpation- and ultrasound-guided thyroid fine-needle aspiration biopsies. BMC Endocr Disord 2009; 9:14. [PMID: 19445710 PMCID: PMC2688006 DOI: 10.1186/1472-6823-9-14] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 05/16/2009] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study is to perform a cost-effectiveness comparison between palpation-guided thyroid fine-needle aspiration biopsies (P-FNA) and ultrasound-guided thyroid FNA biopsies (USG-FNA). METHODS Each nodule was considered as a case. Diagnostic steps were history and physical examination, TSH measurement, Tc99m thyroid scintigraphy for nodules with a low TSH level, initial P-FNA versus initial USG-FNA, repeat USG-FNA for nodules with initial inadequate P-FNA or USG-FNA, hemithyroidectomy for inadequate repeat USG-FNA. American Thyroid Association thyroid nodule management guidelines were simulated in estimating the cost of P-FNA strategy. American Association of Clinical Endocrinologists guidelines were simulated for USG-FNA strategy. Total costs were estimated by adding the cost of each diagnostic step to reach a diagnosis for 100 nodules. Strategy cost was found by dividing the total cost to 100. Incremental cost-effectiveness ratio (ICER) was calculated by dividing the difference between strategy cost of USG-FNA and P-FNA to the difference between accuracy of USG-FNA and P-FNA. A positive ICER indicates more and a negative ICER indicates less expense to achieve one more additional accurate diagnosis of thyroid cancer for USG-FNA. RESULTS Seventy-eight P-FNAs and 190 USG-FNAs were performed between April 2003 and May 2008. There were no differences in age, gender, thyroid function, frequency of multinodular goiter, nodule location and diameter (median nodule diameter: 18.4 mm in P-FNA and 17.0 mm in USG-FNA) between groups. Cytology results in P-FNA versus USG-FNA groups were as follows: benign 49% versus 62% (p = 0.04), inadequate 42% versus 29% (p = 0.03), malignant 3% (p = 1.00) and indeterminate 6% (p = 0.78) for both. Eleven nodules from P-FNA and 18 from USG-FNA group underwent surgery. The accuracy of P-FNA was 0.64 and USG-FNA 0.72. Unit cost of P-FNA was 148 Euros and USG-FNA 226 Euros. The cost of P-FNA strategy was 534 Euros and USG-FNA strategy 523 Euros. Strategy cost includes the expense of repeat USG-FNA for initial inadequate FNAs and surgery for repeat inadequate USG-FNAs. ICER was -138 Euros. CONCLUSION Universal application of USG-FNA for all thyroid nodules is cost-effective and saves 138 Euros per additional accurate diagnosis of benign versus malignant thyroid nodular disease. TRIAL REGISTRATION ClinicalTrials.gov, NCT00571090.
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Affiliation(s)
- Ahmet Selçuk Can
- Division of Endocrinology and Metabolism, Department of Medicine, Private Gayrettepe Florence Nightingale Hospital, Gayrettepe, Beşiktaş, Istanbul, Turkey.
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16
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Kocjan G, Ramsay A, Beale T, O’Flynn P. Head and neck cancer in the UK: what is expected of cytopathology? Cytopathology 2009; 20:69-77. [DOI: 10.1111/j.1365-2303.2009.00647.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Linkov F, Ferris RL, Yurkovetsky Z, Marrangoni A, Velikokhatnaya L, Gooding W, Nolan B, Winans M, Siegel ER, Lokshin A, Stack BC. Multiplex analysis of cytokines as biomarkers that differentiate benign and malignant thyroid diseases. Proteomics Clin Appl 2008; 2:1575-1585. [PMID: 19234619 DOI: 10.1002/prca.200780095] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Thyroid cancer incidence is increasing, and its diagnosis can be challenging. Fine needle biopsy, the principal clinical tool to make a tissue diagnosis, leads to inconclusive diagnoses in up to 30% of the cases, leading to surgery. Advances in proteomics are improving abilities to diagnose malignant conditions using small samples of tissue or body fluids. We hypothesized that analysis of serum growth factors would uncover diagnostically informative differences between benign and malignant thyroid conditions. Using xMAP profiling, we evaluated concentrations of 19 cytokines, chemokines, and growth factors. We used sera from 23 patients with cancer (Malignant group), 24 patients with benign nodular thyroid disease (Benign group), and 23 healthy subjects (Normal group). In univariate analysis, five factors (epithelial growth factor, hepatocyte growth factor, Interleukins-5 and -8, and regulated upon activation, normally T-expressed and presumably secreted (RANTES) distinguished subjects with thyroid disease from the Normal group. In multivariate analysis, the set {Interleukin-8, hepatocyte growth factor, monocyte-induced γ interferon, interleukin-12 p40} achieved noteworthy discrimination between Benign and Malignant groups (area under the receiver operating characteristics curve was 0.81 (95% confidence interval: 0.65-0.90)). Multiplex panels of serum biomarkers may be promising tools to diagnose cancer in patients presenting with evidence of nodular thyroid disease.
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Affiliation(s)
- Faina Linkov
- Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
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