1
|
Barcelos RN, Camacho CP, da Conceição de O C Mamone M, Ikejiri ES, Vanderlei FAB, Yang JH, Padovani RP, Martins LAL, Biscolla RPM, Macellaro D, Lindsey SC, Maciel RMB, Martins JRM. Risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy in thyroid nodules with diameters greater than 4 centimeters. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e000644. [PMID: 37364146 PMCID: PMC10661008 DOI: 10.20945/2359-3997000000644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/04/2023] [Indexed: 06/28/2023]
Abstract
Objective The risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy (FNAB) of thyroid nodules (TN) with diameters ≥ 3-4 cm remains controversial. However, some groups have indicated surgical treatment in these patients regardless of the FNAB results. We aimed to evaluate the diagnostic accuracy of the FNAB in systematically resected ≥4 cm TN and if the risk of malignancy is higher in these patients. Subjects and methods We retrospectively evaluated 138 patients (142 nodules) with TN with diameters ≥4 cm who underwent thyroidectomy. Results The FNAB results were nondiagnostic/unsatisfactory (ND/UNS) in 2.1% of the cases and benign in 51.4%. They indicated atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 23.9% of cases, follicular neoplasia/suspicious for a follicular neoplasm (FN/SFN) in 9.2%, suspicion of malignancy (SUS) in 8.5%, and malignant in 4.9%. The histopathological analysis after thyroidectomy revealed a thyroid cancer rate of 100% in the FNABs classified as malignant, 33.3% in SUS cases, 7.7% in FN/SFN, 17.6% in AUS/FLUS, and 4.1% in benign FNABs. None of the ND/UNS FNABs were malignant. The global malignancy diagnosis was 14.8% (n = 21). However, the rate of false negatives for FNAB was low (4.1%). Conclusion We showed that the risk of malignancy in nodules with diameters ≥4 cm was higher compared to the risk of thyroid cancer in TN in general. However, we found a low rate of false-negative cytological results; therefore, our data do not justify the orientation of routine resection for these larger nodules.
Collapse
Affiliation(s)
- Rafaela N Barcelos
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Cléber P Camacho
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Laboratório de Inovação Molecular e Biotecnologia, Programa de Pós-graduação em Medicina, Universidade Nove de Julho (Uninove), São Paulo, SP, Brasil
| | - Maria da Conceição de O C Mamone
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Elza S Ikejiri
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Felipe A B Vanderlei
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Ji H Yang
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rosália P Padovani
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Leandro A L Martins
- Laboratório de Anatomia Clínica e Patológica, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Rosa Paula M Biscolla
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Danielle Macellaro
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Susan C Lindsey
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rui M B Maciel
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - João Roberto M Martins
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil,
| |
Collapse
|
2
|
Baser OO, Koseoglu D, Cetin Z, Catak M, Kizilkaya H. Benign cytology does not rule out malignancy in thyroid nodules larger than 4 cm. Diagn Cytopathol 2022; 50:508-512. [DOI: 10.1002/dc.25024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/08/2022] [Accepted: 07/20/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Ozden Ozdemir Baser
- Department of Endocrinology and Metabolism Yozgat City Hospital Yozgat Turkey
| | - Derya Koseoglu
- Department of Endocrinology and Metabolism Hitit University Erol Olcok Education and Research Hospital Corum Turkey
| | - Zeynep Cetin
- Department of Endocrinology and Metabolism Amasya University Sabuncuğlu Serefeddin Education and Research Hospital Amasya Turkey
| | - Merve Catak
- Department of Endocrinology and Metabolism Gaziosmanpasa University Tokat Turkey
| | | |
Collapse
|
3
|
Steinmetz-Wood SN, Kennedy AG, Tompkins BJ, Gilbert MP. Navigating the Debate on Managing Large (≥4 cm) Thyroid Nodules. Int J Endocrinol 2022; 2022:6246150. [PMID: 35469125 PMCID: PMC9034904 DOI: 10.1155/2022/6246150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Discordant practice guidelines for managing large thyroid nodules may result in unnecessary surgeries and costs. Recent data suggest similar false-negative rates in fine needle aspiration (FNA) biopsies between small (<4 cm) and large (≥4 cm) nodules, indicating that monitoring rather than surgery may be appropriate for large biopsy-negative nodules. We investigated the management of thyroid nodules ≥4 cm to determine the proportion of surgeries not necessary for diagnostic purposes and examined for potential predictors. METHODS This was a retrospective cohort study of patients who received a FNA of nodule(s) ≥4 cm between 11/1/2014 and 10/31/2019 at the University of Vermont Medical Center. A surgery was considered unnecessary if the FNA result was benign in the absence of any of the following: compressive symptoms, family history of thyroid cancer in a first degree relative, history of neck irradiation, toxic nodule or toxic multinodular goiter, or substernal extension. Data were analyzed with Wilcoxon rank sum tests, chi square, or Fisher's exact tests. RESULTS 177 patients had a ≥4 cm nodule during the timeframe and half (54.2%) had surgery. Patients who underwent surgery were significantly younger (51.5 years vs. 62 years; P < 0.001), more likely to report obstructive symptoms (34.4% vs. 12.1%; P < 0.001) and had a larger nodule size (5.0 cm vs. 4.7 cm; P=0.26). Forty-one patients with benign (Bethesda II) FNA results had surgery, all with negative surgical pathology. Thirteen percentage (23/177) of surgeries were potentially not necessary for diagnostic purposes. CONCLUSION Approximately half of our patients with ≥4 cm nodules had surgery, with 13% having surgery not necessary for diagnostic purposes revealing opportunities for improving care and costs.
Collapse
Affiliation(s)
| | - Amanda G. Kennedy
- Department of Medicine Quality Program, The Larner College of Medicine at The University of Vermont, Burlington, VT, USA
| | - Bradley J. Tompkins
- Department of Medicine Quality Program, The Larner College of Medicine at The University of Vermont, Burlington, VT, USA
| | | |
Collapse
|
4
|
Kihara M, Miyauchi A, Hirokawa M, Masuoka H, Higashiyama T, Onoda N, Ito Y, Miya A. Long-term outcomes of cytologically benign thyroid tumors: a retrospective analysis of 3,102 patients at a single institution. Endocr J 2021; 68:1373-1381. [PMID: 34275959 DOI: 10.1507/endocrj.ej21-0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Some thyroid tumors that are cytologically diagnosed as benign may be pathologically diagnosed as malignant. Here, we investigated the long-term outcomes of patients with thyroid tumors with benign cytology, and the factors for malignancy. We retrospectively reviewed the cases of 3,102 patients with thyroid tumors >1 cm cytologically diagnosed as benign at our hospital during a 1-year period from January 2007. The median follow-up duration for all patients was 68.7 (range 0.0-168.7) months. Immediate surgery and delayed surgery were performed in 393 and 148 patients, respectively. Eventually, 541 (17.4%) of the 3,102 patients underwent a thyroidectomy, and 2,561 (82.6%) were observed without surgery. Among the surgically treated patients, the tumors of 525 (97.0%) and 16 (3.0%) were pathologically diagnosed as benign and malignant, respectively. There was no significant difference in age, gender, tumor size, serum thyroglobulin level at surgery, or the tumor volume-doubling rate (TV-DR) between the benign and malignant cases. Only the ultrasonographic findings based on our hospital's classification system were directly and significantly linked to pathological diagnosis (p < 0.01). Among the tumors of the 667 patients who were followed without surgery for >10 years, 89.9% remained unchanged and 7.2% were reduced in size. Ultrasonographic evaluation provides important information for therapeutic decision-making regarding surgery versus observation for cytologically benign tumors.
Collapse
Affiliation(s)
- Minoru Kihara
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akira Miyauchi
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | | | - Hiroo Masuoka
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | | | - Naoyoshi Onoda
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Yasuhiro Ito
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akihiro Miya
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| |
Collapse
|
5
|
Abstract
Thyroid nodules may be discovered in a variety of settings. Familiarity with their management is important for medical specialists. Workup should start with history and physical examination, proceed to laboratory studies, and then to imaging. Nodules are selected for fine needle aspiration (FNA) biopsy based on imaging criteria. Most nodules can be accurately diagnosed on cytopathology, but some may require additional molecular testing to evaluate risk of malignancy. Patients with malignant lesions require additional investigation before referral to an experienced thyroid surgeon. Those who have benign lesions may require monitoring by periodic ultrasound to identify nodules requiring reevaluation.
Collapse
Affiliation(s)
- Elizabeth H Holt
- Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, Yale Medical School, PO Box 208020, New Haven, CT 06520-8020, USA.
| |
Collapse
|
6
|
Kim HK, Kim SY, Lee YS, Soh EY, Chang HS, Park CS. Suspicious thyroid nodules ≥4 cm require diagnostic lobectomy regardless of their benign fine needle aspiration results. Asian J Surg 2021; 45:1113-1116. [PMID: 34511361 DOI: 10.1016/j.asjsur.2021.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND/OBJECTIVE The diagnostic accuracy of fine needle aspiration biopsy (FNAB) seems limited in large thyroid nodules with Bethesda Cat. 2 result. We aimed to determine the incidence of carcinoma with benign cytology and the reason for the high false-positive rate in thyroid nodules ≥4 cm. METHODS The records of 103 patients with thyroid nodules ≥4 cm with preoperative cytological diagnosis of Bethesda Cat. 2 who underwent thyroidectomy were consecutively reviewed. Characteristics between patients with malignant vs. benign pathology were compared. RESULTS Forty patients (38.8%) had malignancy. Malignancy was subclassified into follicular variant of papillary thyroid carcinoma (43%), minimally invasive follicular thyroid carcinoma (20.0%), and minimally invasive Hurthle cell thyroid carcinoma (10.9%). Patients with malignant cytology had significantly more suspicious ultrasound findings than those with benign cytology (p = 0.001). CONCLUSIONS Preoperative FNAB showed high false-negative rates in patients with thyroid nodules ≥4 cm with benign cytology. These nodules have a high malignancy rate with suspicious ultrasound findings.
Collapse
Affiliation(s)
- Hyeung Kyoo Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Surgery, Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Soo Young Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Euy Young Soh
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hang-Seok Chang
- Department of Surgery, Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Cheong Soo Park
- Department of Surgery, CHA Ilsan Medical Center, Goyang-si, Republic of Korea
| |
Collapse
|
7
|
Erkinuresin T, Demirci H. Diagnostic accuracy of fine needle aspiration cytology of thyroid nodules. ACTA ACUST UNITED AC 2020; 7:61-66. [PMID: 32037778 DOI: 10.1515/dx-2019-0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/23/2019] [Indexed: 11/15/2022]
Abstract
Background Routine application of fine needle aspiration cytology (FNAC) has decreased unnecessary referral of thyroid nodules for surgical treatment and has also increased the cancer rates found in surgery materials. Success of thyroid FNAC depends on skilled aspiration, skilled cytological interpretation and rational analysis of cytological and clinical data. The aim of this study was to determine the diagnostic accuracy rates of thyroid FNAC results obtained in our institution. Methods The data from FNAC and thyroidectomy reports of patients presenting with goiter and who had been evaluated from 1st January 2014 to 1st March 2018 were used. There were 149 patients in total who had undergone thyroidectomy following FNAC. The Bethesda System for Reporting Thyroid Cytology was used in all cytological diagnoses. Results The sensitivity of thyroid FNAC for malignant cases was 57.89%, specificity was 88.10%, false-positive rate was 11.90%, false-negative rate was 42.11%, positive predictive value was 52.38%, negative predictive value was 90.24% and accuracy rate was 82.52%. "Focus number" variable was detected as the factor that affected the accurate prediction of FNAC and thyroidectomy results by the pathologist. Conclusions This study showed that there was a moderate conformity between thyroid FNAC and thyroidectomy cyto-histopathological diagnosis in malignant cases. As two or more nodules have a negative effect on the physician's diagnosis of malignant nodules, we think that a more sensitive approach is needed in the determination of these cases. Sampling defects may affect this non-matching.
Collapse
Affiliation(s)
- Taskin Erkinuresin
- Department of Pathology, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Hakan Demirci
- Department of Family Medicine, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Yildirim, 16310 Bursa, Turkey
| |
Collapse
|
8
|
Chung SR, Baek JH, Choi YJ, Sung TY, Song DE, Kim TY, Lee JH. The relationship of thyroid nodule size on malignancy risk according to histological type of thyroid cancer. Acta Radiol 2020; 61:620-628. [PMID: 31554409 DOI: 10.1177/0284185119875642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Although several studies have examined the value of thyroid nodule size as a malignancy predictor, the results are conflicting. Purpose To investigate the relationship between nodule size and malignancy risk and to evaluate the impact of nodule size on the false-negative rate of fine needle aspiration or core needle biopsy according to the histological type of thyroid cancer. Material and Methods From January 2013 to December 2013, 3970 thyroid nodules that underwent ultrasound-guided fine needle aspiration or core needle biopsy were retrospectively reviewed. We assessed the relationship between nodule size and malignancy risk according to histological type of thyroid cancer. In addition, we compared the false-negative rate by thyroid nodule size category. Results Of 3970 thyroid nodules, 1170 nodules were malignant. For papillary thyroid carcinoma, nodule size was inversely related to malignancy risk, whereas in nodules of follicular carcinoma and follicular variant papillary thyroid carcinoma, nodule size was positively related to malignancy risk ( P < 0.001). The false-negative rate tended to increase as nodule size increased ( P = 0.002) for all nodules and the overall false-negative rate was 2.3%. Conclusion Overall, nodule size does not correlate with risk of malignancy, but the relationship between nodule size and malignancy risk depends on the histological type of thyroid cancer.
Collapse
Affiliation(s)
- Sae Rom Chung
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Tae-Yon Sung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Tae Yong Kim
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| |
Collapse
|
9
|
Tan L, Tan YS, Tan S. Diagnostic accuracy and ability to reduce unnecessary FNAC: A comparison between four Thyroid Imaging Reporting Data System (TI-RADS) versions. Clin Imaging 2020; 65:133-137. [PMID: 32470834 DOI: 10.1016/j.clinimag.2020.04.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Thyroid Imaging Reporting Data System (TI-RADS) is used to characterize thyroid nodules while reducing unnecessary FNAC. Over the years, several versions of TI-RADS have been developed but there is no consensus on which TI-RADS is the best system. This study aimed to compare the diagnostic accuracy and ability of ACR TI-RADS, EU TI-RADS, K TI-RADS, AI TI-RADS to eliminate unnecessary FNAC. METHODS In this prospective study, thyroid nodules were characterized by using the four TI-RADS systems and US-guided FNAC was done for nodule with the highest ACR TI-RADS score. Correlation between TI-RADS and FNAC results were analyzed. RESULTS Out of 244 thyroid nodules, 100 nodules with either size <1 cm (43 nodules) non-diagnostic or inconclusive FNAC results (57 nodules) were excluded. Seven nodules (4.9%) were confirmed to be malignant on FNAC. K TI-RADS showed 100% sensitivity and NPV but the lowest specificity (40.2%). EU TI-RADS had the highest specificity (83.2%) but the lowest sensitivity (57.1%) and NPV (97.4%). ACR TI-RADS had an average sensitivity (85.7%) and NPV (98.6%). The specificity of ACR TI-RADS (51.1%) was lower than EU TI-RADS but higher than K TI-RADS. AI TI-RADS showed higher specificity (61.8% vs 51.1%, p < 0.05) but comparable NPV and sensitivity to ACR TI-RADS. AI TI-RADS was able to avoid the highest number of unnecessary FNAC (62.5%) followed by ACR TI-RADS(54.2%), EU TI-RADS(37.5%) and K TI-RADS(11.8%). CONCLUSION AI TI-RADS is a more simple scoring system with better overall diagnostic performance and ability to exclude unnecessary FNAC with high NPV. ADVANCES IN KNOWLEDGE Highest number of unnecessary FNAC thyroid could be prevented by applying AI TI-RADS.
Collapse
Affiliation(s)
- Lingsze Tan
- Radiology Department, Taiping Hospital, Jalan Taming Sari, 34000 Taiping, Perak, Malaysia.
| | - Ying Sern Tan
- Radiology Department, Taiping Hospital, Jalan Taming Sari, 34000 Taiping, Perak, Malaysia
| | - Suzet Tan
- Radiology Department, Taiping Hospital, Jalan Taming Sari, 34000 Taiping, Perak, Malaysia
| |
Collapse
|
10
|
Al-Hakami HA, Alqahtani R, Alahmadi A, Almutairi D, Algarni M, Alandejani T. Thyroid Nodule Size and Prediction of Cancer: A Study at Tertiary Care Hospital in Saudi Arabia. Cureus 2020; 12:e7478. [PMID: 32351856 PMCID: PMC7188016 DOI: 10.7759/cureus.7478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Thyroid noduleshave become relatively common in clinical practice,and their prevalence increases with age. The majority of thyroid nodules are benign, with 5-15% being malignant. There are a number of well-established predictors of malignancy in thyroid nodules, but thyroid nodule size has been a cause for concern for many researchers and results of the studies are still controversial about their probability of malignancy. Up to the current knowledge, there is no published study that evaluates if thyroid nodule size is associated with the risk of malignancy in Saudi Arabia, so in this study, we aim to find that. Methods This is a retrospective study of 987 patients who underwent thyroid nodule fine-needle aspiration (FNA) and subsequent thyroidectomy for thyroid nodules measuring ≥ 1 cm. Results Thyroid cancer was more prevalent in males than females, and in patients who were older than or equal to 45 years. Nodular size of 1 - 1.9 cm was more prevalent among cancer patients than in benign cases (p<0.001). Conclusions The highest malignancy risk was observed in nodules <2 cm and no increase in malignancy risk for nodules >2 cm. Nevertheless, when examined by type of thyroid malignancy, the rate of follicular carcinoma and other rare malignancy increased with increasing nodule size.
Collapse
Affiliation(s)
- Hadi Afandi Al-Hakami
- Otolaryngology, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Raneem Alqahtani
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | | | - Dakheelallah Almutairi
- Otolaryngology, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Mohammed Algarni
- Otolaryngology, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, SAU
| | - Talal Alandejani
- Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.,Otolaryngology, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| |
Collapse
|
11
|
Jinih M, Faisal F, Abdalla K, Majeed M, Achakzai AA, Heffron C, McCarthy J, Redmond HP. Association between thyroid nodule size and malignancy rate. Ann R Coll Surg Engl 2020; 102:43-48. [PMID: 31865760 PMCID: PMC6937614 DOI: 10.1308/rcsann.2019.0156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2019] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The diagnostic performance of ultrasound-fine needle aspiration to identify thyroid nodules harbouring malignancy remains variable. The aim of this study was to determine thyroid nodule size and cytological classification as predictors of malignancy risk. MATERIALS AND METHODS We conducted a retrospective cohort analysis at an academic hospital involving 499 consecutive patients who underwent thyroid surgery between 2004 and 2015. RESULTS A total of 503 thyroid nodules (499 patients, 84% female; mean age 50.8 years, standard deviation, SD, 15.4 years) were analysed. Of these, 19.5% were malignant. The mean (± SD) nodule size was 3.28 ± 1.63 cm and 3.27 ± 1.54 cm for benign and malignant nodules, respectively. The odds of malignancy for thyroid nodules less than 3.0 cm was similar to those for nodules of 3.0 cm or greater (0.26 compared with 0.29; p=0.77). Overall, the sensitivity and specificity of fine-needle aspiration in this cohort were 71.4% and 100%, respectively. The overall false negative rate was 5.4%. When the cut-off of 3.0 cm was used, the false negative rate in thyroid nodules less than 3.0 cm was 0% compared with 7.0% in nodules of 3.0 cm or greater. Thus, class (p<0.01) but not nodule size (p=0.49), was associated with higher malignancy risk. CONCLUSIONS Our results suggest that thyroid nodule size did not accurately predict the risk of thyroid malignancy irrespective of fine-needle aspiration cytology. Routine diagnostic thyroid lobectomy solely owing to thyroid nodule size of 3.0 cm or greater is currently not justified.
Collapse
Affiliation(s)
- M Jinih
- Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - F Faisal
- School of Medicine, University College Cork, Cork, Ireland
| | - K Abdalla
- Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - M Majeed
- Department of ENDOCRINE SURGERY, Cork University Hospital, Wilton, Cork, Ireland
| | - AA Achakzai
- Department of ENDOCRINE SURGERY, Cork University Hospital, Wilton, Cork, Ireland
| | - C Heffron
- Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland
| | - J McCarthy
- Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland
| | - HP Redmond
- Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland
- Department of ENDOCRINE SURGERY, Cork University Hospital, Wilton, Cork, Ireland
| |
Collapse
|
12
|
Kizilgul M, Shrestha R, Radulescu A, Evasovich MR, Burmeister LA. Thyroid nodules over 4 cm do not have higher malignancy or benign cytology false-negative rates. Endocrine 2019; 66:249-253. [PMID: 31144224 DOI: 10.1007/s12020-019-01964-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/20/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Whether thyroid nodules 4 cm or larger with benign cytology carry a higher risk of malignancy, and should be managed differently than smaller nodules remains controversial. We aimed to evaluate the malignancy rate and benign cytology false-negative rate in thyroid nodules ≥4 cm compared with those <4 cm. METHODS All thyroidectomies between January 2010 and December 2014 were reviewed. Patient demographics, preoperative sonographic nodule size, fine needle aspiration cytology (FNAC), and final surgical pathology results were compared for index nodules ≥4 vs. <4 cm. RESULTS A total of 490 index nodules with preoperative FNAC were identified. A total of 137 nodules were ≥4 cm and 353 nodules were <4 cm. The prevalence of carcinoma was lower (23 vs. 53%) in nodules ≥4 vs. <4 cm (p < 0.0001). The false-negative rate of benign FNAC for ≥4 and <4 cm index nodule was 5.2% and 5.9%, respectively (p = 1.000). CONCLUSIONS This study shows that thyroid nodules ≥4 cm do not have a higher malignancy rate at surgery nor higher benign cytology false-negative rate than smaller nodules. Thyroid nodules over 4 cm do not require resection, to rule out malignancy, based on size alone.
Collapse
Affiliation(s)
- Muhammed Kizilgul
- Department of Medicine, Surgery University of Minnesota, Minneapolis, MN, USA
- Department of Endocrinology and Metabolism, UHS Diskapi Training and Research Hospital, Ankara, Turkey
| | - Rupendra Shrestha
- Department of Medicine, Surgery University of Minnesota, Minneapolis, MN, USA
| | - Angela Radulescu
- Department of Medicine, Surgery University of Minnesota, Minneapolis, MN, USA
| | - Maria R Evasovich
- Department of Medicine, Surgery University of Minnesota, Minneapolis, MN, USA
| | - Lynn A Burmeister
- Department of Medicine, Surgery University of Minnesota, Minneapolis, MN, USA.
| |
Collapse
|
13
|
Agrafiotis AC, Sokolow Y, Ruiz-Patino M, D’Haene N, Salmon I, Corvilain B, Cappello M. Treatment of solitary thyroid nodules according to size, preoperative fine-needle aspiration cytology and frozen section: a retrospective single centre study. Acta Chir Belg 2019; 119:294-302. [PMID: 30614397 DOI: 10.1080/00015458.2018.1527566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: In order to avoid unnecessary thyroidectomies, it is important to predict the nature of thyroid nodules the more accurately possible. The size of the nodule as a predictive factor for malignancy is very controversial. Another point of debate is the accuracy of preoperative fine-needle aspiration cytology (FNAC) and frozen section (FS). The aim of our study is to correlate the nodule size with the final histological diagnosis and to estimate the accuracy of preoperative FNAC and FS. Methods: Retrospective study including 387 operated patients with ultrasound-detected solitary thyroid nodules from 01 January 2001 to 31 December 2013. The following data were collected: patient age and sex, nodule size, FNAC, FS and final histology results. Results: The odds ratio for malignancy within nodules <40 mm was 2.12 (95% CI: 1.104-4.084). The specificity of FNAC was 97.78% and the negative predictive value (NPV) was 97.78% for nodules ≥40 mm and 93.2% and 96.5% for nodules <40 mm, respectively. The observed specificity and NPV of FS ranged from 98% to 100% and from 87.4% to 98%, respectively. When combining FNAC and FS, the specificity and the NPV were 99% and 98%, respectively. Conclusions: The nodule size is not a predictive factor for thyroid cancer and therefore nodules ≥40 mm should not be routinely resected. A lege artis preparation and performance of FNAC along with an expertise on cytological interpretation can considerably diminish false-negative rate. FS can offer additional accuracy on FNAC results and should, therefore, be a part of patient treatment.
Collapse
Affiliation(s)
| | - Youri Sokolow
- Department of Thoracic Surgery, Erasme University Hospital, Brussels, Belgium
| | - Maria Ruiz-Patino
- Department of Thoracic Surgery, Erasme University Hospital, Brussels, Belgium
| | - Nicky D’Haene
- Department of Pathology, Erasme University Hospital, Brussels, Belgium
| | - Isabelle Salmon
- Department of Pathology, Erasme University Hospital, Brussels, Belgium
| | - Bernard Corvilain
- Department of Endocrinology, Erasme University Hospital, Brussels, Belgium
| | - Matteo Cappello
- Department of Thoracic Surgery, Erasme University Hospital, Brussels, Belgium
| |
Collapse
|
14
|
Gram SB, Rasmussen JH, Feldt-Rasmussen U, Bentzen J, Lelkaitis G, von Buchwald C, Hahn CH. Risk of Thyroid Cancer in 1,504 Patients Referred for Thyroid Surgery with Assumed Benign Histology. Eur Thyroid J 2019; 8:246-255. [PMID: 31768335 PMCID: PMC6873058 DOI: 10.1159/000500539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/16/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The aims of this study were to report the risk of thyroid malignancy in cases of either benign fine-needle aspiration (FNA) or without FNA performed, and to investigate possible predictive factors for thyroid malignancy in a population with recent moderately low iodine intake. METHODS All patients referred for thyroid surgery in a tertiary cancer centre between 2000 and 2016 were included (n = 3,703). After excluding cases indicating malignant histology, we included group 1: patients with benign FNA (n = 764), and group 2: patients without FNA (n = 740), leaving 1,504 eligible for further investigation. Information on age, gender, tracheal compression or dislocation, thyroid specimen weight, scintigraphy, ultrasound, medically treated thyrotoxicosis, serum stimulating thyroid hormone, indication for surgery, TNM classification, stage, and outcome were retrieved. RESULTS The malignancy risk was 7.6% (58/764) in group 1 and 6.8% (50/740) in group 2. Patients with T2-4 tumours constituted 2.2% (33/1,504). In the combined groups, ultrasound verified that solitary solid tumour was predictive for malignancy (p = 0.01 by χ2, and OR = 1.69, p = 0.02 in multiple logistic regression). For group 1 patients, thyrotoxicosis (which in this case was medically treated) was a significant predictive factor for malignancy (p = 0.04). CONCLUSIONS The risk of malignancy of 7.6% and 6.8% was high, considering that patients with malignant FNA, suspicious FNA, or clinical findings indicating malignancy were excluded, and 2.2% of these malignancies were stages T2-4. In cases with solitary solid tumour on ultrasound, the risk of malignancy should not be ignored, even with benign FNA.
Collapse
Affiliation(s)
- Signe Buhl Gram
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
- *Signe Buhl Gram, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, F2073, Blegdamsvej 9, DK–Copenhagen 2100 (Denmark), E-Mail
| | - Jacob Høygaard Rasmussen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Jens Bentzen
- Department of Oncology, Herlev Hospital, Copenhagen University, Copenhagen, Denmark
| | - Giedrius Lelkaitis
- Department of Pathology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Christoffer Holst Hahn
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| |
Collapse
|
15
|
Karadeniz E, Yur M, Temiz A, Akçay MN. Malignancy risk for thyroid nodules larger than 4 cm and diagnostic reliability of ultrasound-guided FNAB results. Turk J Surg 2019; 35:13-18. [PMID: 32550298 DOI: 10.5578/turkjsurg.4029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 02/21/2018] [Indexed: 11/15/2022]
Abstract
Objectives Our aim in the present study was to investigate the relation between thyroid nodule diameter and malignancy, and the diagnostic accuracy of fine needle aspiration biopsy (FNAB) for thyroid nodules larger than 4 cm. Material and Methods Preoperative patient demographics such as age and gender, thyroid nodule diameter, FNAB results and postoperative pathology results were recorded. The relation between age, gender, thyroid nodule size of the patients and malignancy was examined. Also, the sensitivity, specificity, false negativity, false positivity and accuracy rates of FNBA of the patients whose thyroid nodule size was lower than 4 cm and the ones whose thyroid nodule size was higher than 4 cm were analyzed. Results There was no significant difference between males and females in terms of malignancy rate (p= 0.15). There was no significant relation between malignancy and patient age (p= 0.92). No significant difference was found between the group with thyroid nodule diameter of > 4 cm and the group thyroid with nodule diameter of <4 cm in terms of malignancy (p= 0.91). In the group with thyroid nodule diameter of > 4 cm, sensitivity, specificity, false negativity, false positivity, and accuracy rates of FNAB were 15%, 100%, 84%, 0%, and 70%, respectively. In the group with thyroid nodule diameter of <4 cm, sensitivity, specificity, false negativity, false positivity, and accuracy rates of FNAB were 53%, 100%, 46%, 0% and 80%, respectively. Conclusion Our study put forward that thyroid nodule diameter is not the only predictor parameter whilst predicting malignancy. However, it was observed that FNAB sensitivity and false negativity were higher when the thyroid nodules with > 4 cm diameter were compared to the thyroid nodules with <4 cm diameter.
Collapse
Affiliation(s)
- Erdem Karadeniz
- Atatürk Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Erzurum, Türkiye
| | - Mesut Yur
- Trabzon Kanuni Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, Trabzon, Türkiye
| | - Ayetullah Temiz
- Erzurum Bölge Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, Erzurum, Türkiye
| | - Müfide Nuran Akçay
- Atatürk Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Erzurum, Türkiye
| |
Collapse
|
16
|
Cipriani NA, White MG, Angelos P, Grogan RH. Large Cytologically Benign Thyroid Nodules Do Not Have High Rates of Malignancy or False-Negative Rates and Clinical Observation Should be Considered: A Meta-Analysis. Thyroid 2018; 28:1595-1608. [PMID: 30280990 DOI: 10.1089/thy.2018.0221] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Management of large thyroid nodules is controversial, as data are conflicting regarding overall rates of malignancy (ROM) in all nodules and frequency of false-negative fine-needle aspiration results (FNR) in cytologically benign nodules. This meta-analysis aimed to evaluate and compare ROM and FNR in small versus large nodules published in the literature. Methods: Articles indexed in PubMed, written in English, published electronically or in print on or prior to December 8 2017 were searched for "false negative thyroid size or cm" and "malignancy rates benign thyroid nodules." Three hundred fifty-two unique citations were identified. Multiple reviewers selected a final set of 35 articles that contained nodules stratified by size (3, 4, or 5 cm), with benign or all cytologic diagnoses, and with postsurgical histologic diagnoses. Multiple observers extracted data, including numbers of total, cytologically benign, and histologically malignant nodules. Size cutoffs of 3, 4, and/or 5 cm were analyzed in 14, 24, and 1 article, respectively. Results: ROM in all nodules ≥3 cm (13.1%) and ≥4 cm (20.9%) was lower than those <3 cm (19.6%) and <4 cm (19.9%; odds ratio [OR] = 0.72 [confidence interval (CI) 0.64-0.81] and OR = 0.85 [CI 0.77-0.95]). FNR in nodules ≥3 cm (7.2%) was not different from smaller nodules (5.7%; OR = 1.47 [CI 0.80-2.69]). FNR in nodules ≥4 cm (6.7%) was slightly higher than those <4 cm (4.5%; OR = 1.38 [CI 1.06-1.80]). The most frequently reported false-negative diagnosis was papillary thyroid carcinoma. Conclusions: Rates of malignancy and false-negative FNA results vary but, in most studies, are not higher in larger nodules. Patients with large, cytologically benign thyroid nodules need not undergo immediate surgical resection, as false-negative FNA rates are low and are expected to decrease in light of nomenclature revision of a subset of follicular variants of papillary thyroid carcinoma.
Collapse
Affiliation(s)
- Nicole A Cipriani
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Michael G White
- Endocrine Surgery Research Program Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Peter Angelos
- Endocrine Surgery Research Program Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Raymon H Grogan
- Department of Endocrine Surgery, Baylor St. Luke's Medical Center, Houston, Texas
| |
Collapse
|
17
|
Chieng JSL, Lee CH, Karandikar AA, Goh JPN, Tan SSS. Accuracy of ultrasonography-guided fine needle aspiration cytology and significance of non-diagnostic cytology in the preoperative detection of thyroid malignancy. Singapore Med J 2018; 60:193-198. [PMID: 30182131 DOI: 10.11622/smedj.2018105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Thyroid fine-needle aspiration cytology (FNAC) is an established investigation for the preoperative evaluation of thyroid nodules and is often done under ultrasonography guidance. While its accuracy has been widely reported, there is little evidence in the literature on the approach to non-diagnostic cytology results. In our study, we aimed to determine the diagnostic performance of ultrasonography-guided thyroid FNAC for the preoperative diagnosis of thyroid cancer at our institution and evaluate the significance of a non-diagnostic thyroid FNAC. METHODS We retrospectively reviewed the thyroid ultrasonography studies and medical records of all patients who underwent both thyroid FNAC and subsequent thyroid surgery at our institution from 2011 to 2013. FNAC results were correlated with the final histological diagnosis from surgery and the ultrasonography studies were reviewed for suspicious sonographic features. RESULTS FNAC predicted malignancy with sensitivity, specificity, positive predictive value, negative predictive value, false positive rate, false negative rate and total accuracy of 90.7%, 53.6%, 43.3%, 93.7%, 46.4%, 9.3% and 64.1%, respectively. We found that only one of 26 nodules with non-diagnostic FNAC results was proven malignant on a second FNAC and subsequent thyroidectomy. CONCLUSION The accuracy of ultrasonography-guided FNAC at our institution was comparable to that reported in the literature. There appears to be very low probability of malignancy in sonographically benign nodules with initial non-diagnostic FNAC results.
Collapse
Affiliation(s)
| | - Chau Hung Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | | | | | | |
Collapse
|
18
|
Chiofalo MG, Signoriello S, Fulciniti F, Avenia N, Ristagno S, Lombardi CP, Nicolosi A, Pelizzo MR, Perigli G, Polistena A, Panebianco V, Bellantone R, Calò PG, Boschin IM, Badii B, Di Maio M, Gallo C, Perrone F, Pezzullo L. Predictivity of clinical, laboratory and imaging findings in diagnostic definition of palpable thyroid nodules. A multicenter prospective study. Endocrine 2018; 61:43-50. [PMID: 29569123 PMCID: PMC5997121 DOI: 10.1007/s12020-018-1577-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/04/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess the role of clinical, biochemical, and morphological parameters, as added to cytology, for improving pre-surgical diagnosis of palpable thyroid nodules. METHODS Patients with a palpable thyroid nodule were eligible if surgical intervention was indicated after a positive or suspicious for malignancy FNAC (TIR 4-5 according to the 2007 Italian SIAPEC-IAP classification), or two inconclusive FNAC at a ≥3 months interval, or a negative FNAC associated with one or more risk factor. Reference standard was histological malignancy diagnosis. Likelihood ratios of malignancy, sensitivity, specificity, negative (NPV), and positive predictive value (PPV) were described. Multiple correspondence analysis (MCA) and logistic regression were applied. RESULTS Cancer was found in 433/902 (48%) patients. Considering TIR4-5 only as positive cytology, specificity, and PPV were high (94 and 91%) but sensitivity and NPV were low (61 and 72%); conversely, including TIR3 among positive, sensitivity and NPV were higher (88 and 82%) while specificity and PPV decreased (52 and 63%). Ultrasonographic size ≥3 cm was independently associated with benignity among TIR2 cases (OR of malignancy 0.37, 95% CI 0.18-0.78). In TIR3 cases the hard consistency of small nodules was associated with malignity (OR: 3.51, 95% CI 1.84-6.70, p < 0.001), while size alone, irrespective of consistency, was not diagnostically informative. No other significant association was found in TIR2 and TIR3. CONCLUSIONS The combination of cytology with clinical and ultrasonographic parameters may improve diagnostic definition of palpable thyroid nodules. However, the need for innovative diagnostic tools is still high.
Collapse
Affiliation(s)
- Maria Grazia Chiofalo
- Istituto Nazionale per lo studio e la Cura dei Tumori, Fondazione G. Pascale, IRCCS, Napoli, Italy
| | - Simona Signoriello
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Franco Fulciniti
- Istituto Nazionale per lo studio e la Cura dei Tumori, Fondazione G. Pascale, IRCCS, Napoli, Italy
- Istituto Cantonale di Patologia, Locarno, Switzerland
| | - Nicola Avenia
- Endocrinochirurgia, Università di Perugia, Terni, Italy
| | | | - Celestino Pio Lombardi
- Chirurgia Endocrina, Policlinico Gemelli, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - Angelo Nicolosi
- Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Maria Rosa Pelizzo
- Patologia Speciale Chirurgica, Azienda Ospedaliera Universitaria di Padova, Padova, Italy
| | - Giuliano Perigli
- Endocrinochirurgia e Chirurgia Miniinvasiva, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | | | | | - Rocco Bellantone
- Chirurgia Endocrina, Policlinico Gemelli, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - Pietro Giorgio Calò
- Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | | | - Benedetta Badii
- Endocrinochirurgia e Chirurgia Miniinvasiva, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Massimo Di Maio
- Istituto Nazionale per lo studio e la Cura dei Tumori, Fondazione G. Pascale, IRCCS, Napoli, Italy
- Università di Torino, Turin, Italy
| | - Ciro Gallo
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Francesco Perrone
- Istituto Nazionale per lo studio e la Cura dei Tumori, Fondazione G. Pascale, IRCCS, Napoli, Italy
| | - Luciano Pezzullo
- Istituto Nazionale per lo studio e la Cura dei Tumori, Fondazione G. Pascale, IRCCS, Napoli, Italy.
| |
Collapse
|
19
|
Dong Y, Mao M, Zhan W, Zhou J, Zhou W, Yao J, Hu Y, Wang Y, Ye T. Size and Ultrasound Features Affecting Results of Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1367-1377. [PMID: 29120064 DOI: 10.1002/jum.14472] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 08/12/2017] [Accepted: 08/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Our goal was to assess the diagnostic efficacy of ultrasound (US)-guided fine-needle aspiration (FNA) of thyroid nodules according to size and US features. METHODS A retrospective correlation was made with 1745 whole thyroidectomy and hemithyroidectomy specimens with preoperative US-guided FNA results. All cases were divided into 5 groups according to nodule size (≤5, 5.1-10, 10.1-15, 15.1-20, and >20 mm). For target nodules, static images and cine clips of conventional US and color Doppler were obtained. Ultrasound images were reviewed and evaluated by two radiologists with at least 5 years US working experience without knowing the results of pathology, and then agreement was achieved. RESULTS The Bethesda category I rate was higher in nodules larger than 15 mm (P < .05). The diagnostic accuracy was best in nodules of 5 to 10 mm in diameter. The sensitivity, accuracy, PPV, and LR for negative US-guided FNA results were better in nodules with a size range of 5 to 15 mm. The specificity, negative predictive value (NPV), and LR for positive results and the Youden index rose with increasing nodule size. Seventeen false-positive and 60 false-negative results were found in this study. The false-negative rate rose with increasing nodule size. However, the false-positive rate was highest in the group containing the smallest nodules. Nodules with circumscribed margins and those that were nonsolid and nonhypoechoic and had no microcalcifications correlated with Bethesda I FNA results. Nodules with circumscribed margins and those that were nonsolid, heterogeneous, and nonhypoechoic and had increased vascularity correlated with false-negative FNA results. Borders correlated with Bethesda I false-negative and false-positive FNA results. CONCLUSIONS Tiny nodules (≤5 mm) with obscure borders tended to yield false-positive FNA results. Large nodules (>20 mm) with several US features tended to yield false-negative FNA results.
Collapse
Affiliation(s)
- YiJie Dong
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - MinJing Mao
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Departments of Laboratory, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - WeiWei Zhan
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - JianQiao Zhou
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wei Zhou
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - JieJie Yao
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - YunYun Hu
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yan Wang
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - TingJun Ye
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| |
Collapse
|
20
|
Eszlinger M, Ullmann M, Ruschenburg I, Böhme K, Görke F, Franzius C, Adam S, Molwitz T, Landvogt C, Amro B, Hach A, Feldmann B, Graf D, Wefer A, Niemann R, Bullmann C, Klaushenke G, Santen R, Tönshoff G, Ivancevic V, Kögler A, Bell E, Lorenz B, Kluge G, Hartenstein C, Paschke R. Low Malignancy Rates in Fine-Needle Aspiration Cytologies in a Primary Care Setting in Germany. Thyroid 2017; 27:1385-1392. [PMID: 28982301 DOI: 10.1089/thy.2017.0167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reported results for thyroid nodule fine-needle aspiration (FNA) cytology mainly originate from tertiary centers. However, thyroid nodule FNA cytology is mainly performed in primary care settings for which the distribution of FNA Bethesda categories and their respective malignancy rates are largely unknown. Therefore, this study investigated FNA cytology malignancy rates of a large primary care setting to determine to what extent current evidence-based strategies for the malignancy risk stratification of thyroid nodules are applied and applicable in such primary care settings. METHODS In a primary care setting, 9460 FNAs of thyroid nodules were retrospectively analyzed from 8380 patients evaluated by one cytologist (I.R.) during a period of two years. The 8380 FNA cytologies were performed by 64 physicians in different private practices throughout Germany in primary care settings. RESULTS The cytopathologic results were classified according to the Bethesda System as non-diagnostic in 19%, cyst/cystic nodule in 21%, benign (including thyroiditis) in 48%, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 6%, follicular neoplasms/suspicious for follicular neoplasm (FN/SFN) in 4%, suspicious for malignancy (SFM) in 1%, and malignant in 1%. The proportion of patients proceeding to surgery or with a follow-up of at least one year and the observed risks of malignancy were 22%/8% for AUS/FLUS, 69%/17% for FN/SFN, 78%/86% for SFM, and 71%/98% for malignant. For 112 cytologically suspicious and malignant FNAs, there were 102 true positives and 10 false positives, considering histology as gold standard. CONCLUSION At variance with other data mostly originating from tertiary centers, these data demonstrate low percentages for malignant, SFM, FN/SFN, and AUS/FLUS, and high percentages for cysts/cystic nodules in this primary care setting in Germany. The risks of malignancy for malignant, SFM, AUS/FLUS, and FN/SFN FNA cytologies are according to Bethesda recommendations.
Collapse
Affiliation(s)
- Markus Eszlinger
- 1 Departments of Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Maha Ullmann
- 2 Divisions of Endocrinology and Nephrology, Department of Internal Medicine, Neurology, and Dermatology, University of Leipzig, Leipzig, Germany
| | - Ilka Ruschenburg
- 3 MVZ wagnerstibbe für Gynäkologie, Reproduktionsmedizin, Zytologie, Pathologie, und Innere Medizin GmbH , Einbeck, Germany
| | - Katharina Böhme
- 2 Divisions of Endocrinology and Nephrology, Department of Internal Medicine, Neurology, and Dermatology, University of Leipzig, Leipzig, Germany
| | - Fabian Görke
- 2 Divisions of Endocrinology and Nephrology, Department of Internal Medicine, Neurology, and Dermatology, University of Leipzig, Leipzig, Germany
| | | | | | | | | | - Bassam Amro
- 8 Praxis für Nuklearmedizin , Oldenburg, Germany
| | - Anja Hach
- 9 Institut für Radiologie und Nuklearmedizin , Bremerhaven, Germany
| | - Berit Feldmann
- 10 Endokrinologie und Diabetologie im Zentrum , Stuttgart, Germany
| | - Dieter Graf
- 11 Praxisgemeinschaft Auf dem Meere , Lüneburg, Germany
| | - Antje Wefer
- 12 Radiologie und Nuklearmedizin in der Gottorpstraße , Oldenburg, Germany
| | - Rainer Niemann
- 13 Radiologie Oldenburg, Praxis Stehen und Partner GbR , Oldenburg, Germany
| | | | | | - Reinhard Santen
- 16 Endokrinologische Gemeinschaftspraxis, Zentrum für Hormon- und Stoffwechselstörungen , Frankfurt/Main, Germany
| | | | - Velimir Ivancevic
- 18 Radiologisch-Nuklearmedizinische Gemeinschaftspraxis , Celle, Germany
| | - Andreas Kögler
- 18 Radiologisch-Nuklearmedizinische Gemeinschaftspraxis , Celle, Germany
| | | | - Bernd Lorenz
- 20 Schilddrüsen- und Hormon-Praxis , Gera, Germany
| | - Gerald Kluge
- 21 Diagnostisches Zentrum Göttingen, Gemeinschaftspraxis für Radiologie und Nuklearmedizin , Göttingen, Germany
| | - Christoph Hartenstein
- 22 Schilddrüse Stuttgart, Fachärzte für Innere Medizin und Nuklearmedizinische Schilddrüsendiagnostik , Stuttgart, Germany
| | - Ralf Paschke
- 1 Departments of Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- 23 Division of Endocrinology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
21
|
Large (≥3cm) thyroid nodules with benign cytology: Can Thyroid Imaging Reporting and Data System (TIRADS) help predict false-negative cytology? PLoS One 2017; 12:e0186242. [PMID: 29023564 PMCID: PMC5638398 DOI: 10.1371/journal.pone.0186242] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/27/2017] [Indexed: 11/22/2022] Open
Abstract
Background There is controversy about the accuracy of the fine-needle aspiration (FNA) cytology results in large sized thyroid nodules. Our aim was to evaluate the false-negative rate of FNA for large thyroid nodules and the usefulness of the Thyroid Imaging Reporting and Data System (TIRADS) in predicting false-negative cytology for large thyroid nodules with benign cytology. Methods 632 thyroid nodules larger than or equal to 3cm in size with subsequent benign cytology on US-guided FNA were included. US features of internal composition, echogenicity, margin, calcifications, and shape were evaluated, and nodules were classified according to TIRADS. TIRADS category 3 included nodules without any of the following suspicious features:solidity, hypoechogenicity or marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape. Category 4a, 4b, 4c, and 5 were assigned to nodules showing one, two, three or four, or five suspicious US features, respectively. US features associated with malignancy for these lesions were analyzed and malignancy risk according to TIRADS was calculated. Results Of the 632 lesions, 23 lesions(3.6%) were malignant and 609(96.4%) were benign, suggesting a 3.6% false-negative rate for FNA cytology. Of the 23 malignant lesions, final pathology was mainly follicular carcinoma minimally invasive(65.2%, 15/23) and the follicular variant of papillary carcinoma(26.1%, 6/23). The malignancy risks of categories 3, 4a, 4b, and 4c nodules were 0.9%, 4.6%, 10.0%, and 11.8%, respectively. Conclusion Large thyroid nodules with benign cytology had a relatively high false-negative risk of 3.6% and TIRADS was helpful in predicting false-negative cytology for these lesions.
Collapse
|
22
|
Bozbıyık O, Öztürk Ş, Ünver M, Erol V, Bayol Ü, Aydın C. Reliability of fine needle aspiration biopsy in large thyroid nodules. Turk J Surg 2017; 33:10-13. [PMID: 28589181 DOI: 10.5152/ucd.2017.3329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/28/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Fine needle aspiration biopsy provides one of the most important data that determines the treatment algorithm of thyroid nodules. Nevertheless, the reliability of fine needle aspiration biopsy is controversial in large nodules. The aim of this study was to evaluate the adequacy of fine needle aspiration biopsy in thyroid nodules that are four cm or greater. MATERIAL AND METHODS We retrospectively examined 219 patients files who underwent thyroidectomy for thyroid nodules that were greater than four centimeter between May 2007 and December 2012. Seventy-four patients with hyperthyroidism, and 18 patients without preoperative fine needle aspiration cytology were excluded from the study. Histopathologic results after thyroidectomy were compared with preoperative cytology results, and sensitivity and specificity rates were calculated. RESULTS False-negativity, sensitivity and specificity rates of fine needle aspiration biopsy of thyroid nodules were found to be 9.7%, 55.5%, and 85%, respectively. Within any nodule of the 127 patients, 28 (22.0%) had thyroid cancer. However, when only nodules of at least 4 cm were evaluated, thyroid cancer was detected in 22 (17.3%) patients. CONCLUSION In this study, fine needle aspiration biopsy of large thyroid nodules was found to have a high false-negativity rate. The limitations of fine-needle aspiration biopsy should be taken into consideration in treatment planning of thyroid nodules larger than four centimeters.
Collapse
Affiliation(s)
- Osman Bozbıyık
- Clinic of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Şafak Öztürk
- Clinic of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Mutlu Ünver
- Clinic of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Varlık Erol
- Clinic of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ümit Bayol
- Clinic of Pathology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Cengiz Aydın
- Clinic of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| |
Collapse
|
23
|
Godazandeh G, Kashi Z, Zargarnataj S, Fazli M, Ebadi R, Kerdabadi EH. Evaluation the Relationship Between Thyroid Nodule Size with Malignancy and Accuracy of Fine Needle Aspiration Biopsy (FNAB). Acta Inform Med 2016; 24:347-350. [PMID: 28077891 PMCID: PMC5203751 DOI: 10.5455/aim.2016.24.347-350] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/10/2016] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Some studies have shown largest thyroid nodule size, especially ≥4cm that can predict malignancy and reduce fine needle aspiration biopsy (FNAB) accuracy. Therefore, this study is designed to evaluate relationship between thyroid nodule sizes with malignancy and its effect on FNBA accuracy. MATERIALS AND METHODS a retrospective analytical study design aims to investigate all patients with thyroid nodules who referred to surgery department of Imam-Khomeini Hospital of Mazandaran University of Medical Sciences in Sari from 20 March 2008 to 22 March 2014. We collected patient's demographic data, nodules size, FNAB reports and final pathology (after surgery) reports from their medical records. All data were analyses performed by SPSS18. RESULTS 167 patients (153 women) with mean age of 41.56±13.24 years old were enrolled for this study. In final pathology; 38 patients (22.8%) had malignant nodules. The mean age of patients with or without malignant nodules were 34.93±11.86 and 42.37±12.26 years old, respectively (P=0.002). The mean size of benign and malignant nodules were 2.91±1.29 cm and 3.38±1.86 cm, respectively (P=0.15). 25.2% of <4 cm nodules and 17.9% of ≥4 cm nodules were diagnosed as a malignant (P=0.29). FNAB was done on 95 patients that reported benign in 60 patients (63.2%), malignant in 18 patients (18.9%) and suspicious in 17 patients (17.9%). Positive and negative results of FNAB in all nodules were 3.5% and 6.3%, in <4cm nodules were 5.8% and 6.2% and in ≥4cm nodules were zero and 6.7%, respectively. The sensitivity, specificity, Positive predict value (PPV), negative predict value (NPV) and overall accuracy (OA) of FNAB in all nodules were 76.19%, 96.49%, 88.88%, 91.66% and 91.02%, and in <4cm nodules were 78.57%, 94.11%, 84.61%, 91.42% and 89.58%, and in ≥4cm nodules were 71.4%, 100%, 100%, 92% and 93.33%, respectively. CONCLUSION the results of this study revealed that the size of the thyroid nodules is not reliable at predicting malignancy and should not be applied in medical decision making. FNAB showed good specificity but the sensitivity was low in our study. In ≥4cm nodules; FNAB sensitivity was decreased and accompanied by higher false-negative results. Furthermore, FNABs with suspicious results were associated with high probability of malignancy.
Collapse
Affiliation(s)
- Gholamali Godazandeh
- Department of Thoracic Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Kashi
- Department of Endocrinology, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sadegh Zargarnataj
- Department of General Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehran Fazli
- Young Researcher and Elite Club, Kazerun Branch, Islamic Azad University, Kazerun, Iran
| | - Robab Ebadi
- Jupiter Medical Group, Meadow Springs Medical Center, WA, Australia
| | | |
Collapse
|
24
|
Raguin T, Schneegans O, Rodier JF, Volkmar PP, Sauleau E, Debry C, Debonnecaze G, Ghnassia JP, Dupret-Bories A. Value of fine-needle aspiration in evaluating large thyroid nodules. Head Neck 2016; 39:32-36. [PMID: 27299703 DOI: 10.1002/hed.24524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The American Thyroid Association (ATA) recommends using ultrasound-guided fine-needle aspiration (FNA) in order to evaluate supracentimetric and suspect thyroid nodules. The purpose of this study was to evaluate the effective use of FNA before surgery for nodules over 3 cm in diameter. METHODS In this retrospective study, we analyzed the results of ultrasound-guided FNA and postoperative histological analysis in 843 nodules >3 cm. RESULTS The FNA was informative in 42.6%. The correlation with the final histological analysis was 94.8% for benign nodules and 71.0% for malignant nodules. The FNA had a positive predictive value of 71%, a specificity of 97%, a sensitivity of 56%, and a 4.7% rate of false-negative results. CONCLUSION Because there is a nonnegligible FNA risk of error, notably allowing the evolution of a cancer in 1 of 20 cases, the FNA data should not delay surgical intervention for potentially suspect nodules >3 cm in diameter. © 2016 Wiley Periodicals, Inc. Head Neck 39: 32-36, 2017.
Collapse
Affiliation(s)
- Thibaut Raguin
- Service ORL et Chirurgie Cervico-faciale, CHU de Strasbourg, Strasbourg Cedex, France
| | | | - Jean-François Rodier
- Service de Chirurgie Viscérale et Thyroïdienne, Clinique Saint-Anne, Strasbourg, France
| | | | - Eric Sauleau
- Service de Santé Publique, CHU de Strasbourg, France
| | - Christian Debry
- Service ORL et Chirurgie Cervico-faciale, CHU de Strasbourg, Strasbourg Cedex, France
| | - Guillaume Debonnecaze
- Service d'Otorhinolaryngologie et Chirurgie Cervico-faciale, CHU de Toulouse, Toulouse, France
| | | | - Agnès Dupret-Bories
- Service d'Otorhinolaryngologie et Chirurgie Cervico-faciale, Institut Universitaire du Cancer, Toulouse, France
| |
Collapse
|
25
|
Hammad AY, Noureldine SI, Hu T, Ibrahim Y, Masoodi HM, Kandil E. A meta-analysis examining the independent association between thyroid nodule size and malignancy. Gland Surg 2016; 5:312-7. [PMID: 27294039 DOI: 10.21037/gs.2015.11.05] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Tumor size is recognized as an important predictor of malignancy in many types of cancers. However, there is no clear line of characterization when it comes to the association between thyroid nodule size and malignancy risk prediction; and the current data remains inconsistent across different studies. The aim of our study is to examine the association between nodule size and malignancy using meta-analysis of the current literature. METHODS Data sources were gathered through systemic search of PubMed, Embase and other scientific databases for articles published between January 1, 1996 and June 1, 2013. A reference group with nodule sizes <3 cm was set as a control group. Two other nodule size categories were established and these included nodules from 3-5.9 cm and nodules ≥6 cm in size. Primary outcome was a histologically proven malignancy per nodule size category. The effect sizes of clinicopathologic parameters, which are the quantitative measures of association strength between two variables, were calculated by the means of odds ratios (OR). The effect sizes were then combined using a random-effects model. RESULTS Seven studies met our inclusion criteria with 10,817 thyroid nodules evaluated. Malignancy was identified in 2,206 (20.4%) nodules. After adjusting for patient age and gender, nodules that measured 3-5.9 cm had a 26% greater malignancy risk compared to those measuring <3 cm [OR, 1.26; 95% confidence interval (CI): 1.13-1.39]. However, nodules 6 cm or larger had a 16% lower risk of malignancy compared to those measuring <3 cm (OR, 0.84; 95% CI: 0.73-0.98). CONCLUSIONS Thyroid nodule size predicts cancer risk. However, a threshold effect of thyroid nodule size 6 cm or greater is significantly associated with a more benign disease.
Collapse
Affiliation(s)
- AbdulRahman Y Hammad
- 1 Dvision of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA ; 2 Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 3 Department of Biostatistics and Bioinformatics, Tulane University School of Public Health, New Orleans, LA, USA
| | - Salem I Noureldine
- 1 Dvision of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA ; 2 Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 3 Department of Biostatistics and Bioinformatics, Tulane University School of Public Health, New Orleans, LA, USA
| | - Tian Hu
- 1 Dvision of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA ; 2 Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 3 Department of Biostatistics and Bioinformatics, Tulane University School of Public Health, New Orleans, LA, USA
| | - Yasin Ibrahim
- 1 Dvision of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA ; 2 Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 3 Department of Biostatistics and Bioinformatics, Tulane University School of Public Health, New Orleans, LA, USA
| | - Hammad M Masoodi
- 1 Dvision of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA ; 2 Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 3 Department of Biostatistics and Bioinformatics, Tulane University School of Public Health, New Orleans, LA, USA
| | - Emad Kandil
- 1 Dvision of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA ; 2 Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 3 Department of Biostatistics and Bioinformatics, Tulane University School of Public Health, New Orleans, LA, USA
| |
Collapse
|
26
|
Bestepe N, Ozdemir D, Tam AA, Dellal FD, Kilicarslan A, Parlak O, Ersoy R, Cakir B. Malignancy risk and false-negative rate of fine needle aspiration cytology in thyroid nodules ≥4.0 cm. Surgery 2016; 160:405-12. [PMID: 27157121 DOI: 10.1016/j.surg.2016.03.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/16/2016] [Accepted: 03/26/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to evaluate malignancy rate and to determine false negativity of fine needle aspiration biopsy (FNAB) in thyroid nodules ≥4.0 cm. METHODS The medical records of patients who underwent thyroidectomy between January 2007 and December 2014 were reviewed. Demographic and clinical data as well as preoperative ultrasonography findings were analyzed. The nodules in these patients were grouped as ≥4.0 cm and <4.0 cm according to ultrasonography measurements. Nodules <4.0 cm were further divided into 1.0-3.9 cm and <1.0 cm. Histopathologically malignant nodules with preoperative benign cytology were defined as having false-negative FNAB. RESULTS There were 1,008 nodules that measured ≥4.0 cm, 4,013 nodules that measured 1.0-3.9 cm, and 540 that measured nodules <1.0 cm. Based on histopathologic findings, 8.5%, 10.2%, and 25.6% of nodules ≥4.0 cm, 1.0-3.9 cm, and <1.0 cm were malignant, respectively (P < .001). There was no significant difference between 1.0-3.9-cm and ≥4.0-cm nodules with respect to malignancy (P = .108). False-negativity rates were 4.7% in nodules ≥4.0 cm, 2.2% in nodules measuring 1.0-3.9 cm, and 4.8% in <1.0-cm nodules. Nodules measuring <1.0 cm and ≥4.0 cm had similar false-negativity rates (P = .93), while 1.0-3.9-cm nodules had statistically lower false-negativity rates than those found in the other two groups (P = .03 and P < .001, respectively). CONCLUSION Of the nodules that were operatively excised, nodules ≥4.0 cm had a similar risk of malignancy as nodules 1.0-3.9 cm. The rate of false-negative FNAB in nodules ≥4.0 cm was twice as high as in nodules 1.0-3.9 cm; however, we do not think it is high enough to recommend a routine operation when cytology results are benign.
Collapse
Affiliation(s)
- Nagihan Bestepe
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey.
| | - Didem Ozdemir
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Abbas Ali Tam
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Fatma Dilek Dellal
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Aydan Kilicarslan
- Department of Pathology, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Omer Parlak
- Department of General Surgery, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| |
Collapse
|
27
|
Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, Lim HK, Moon WJ, Na DG, Park JS, Choi YJ, Hahn SY, Jeon SJ, Jung SL, Kim DW, Kim EK, Kwak JY, Lee CY, Lee HJ, Lee JH, Lee JH, Lee KH, Park SW, Sung JY. Ultrasonography Diagnosis and Imaging-Based Management of Thyroid Nodules: Revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol 2016; 17:370-95. [PMID: 27134526 PMCID: PMC4842857 DOI: 10.3348/kjr.2016.17.3.370] [Citation(s) in RCA: 607] [Impact Index Per Article: 75.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/22/2016] [Indexed: 12/13/2022] Open
Abstract
The rate of detection of thyroid nodules and carcinomas has increased with the widespread use of ultrasonography (US), which is the mainstay for the detection and risk stratification of thyroid nodules as well as for providing guidance for their biopsy and nonsurgical treatment. The Korean Society of Thyroid Radiology (KSThR) published their first recommendations for the US-based diagnosis and management of thyroid nodules in 2011. These recommendations have been used as the standard guidelines for the past several years in Korea. Lately, the application of US has been further emphasized for the personalized management of patients with thyroid nodules. The Task Force on Thyroid Nodules of the KSThR has revised the recommendations for the ultrasound diagnosis and imaging-based management of thyroid nodules. The review and recommendations in this report have been based on a comprehensive analysis of the current literature and the consensus of experts.
Collapse
Affiliation(s)
- Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jin Chung
- Department of Radiology, Ewha Womans University School of Medicine, Seoul 07985, Korea
| | - Eun Joo Ha
- Department of Radiology, Ajou University School of Medicine, Suwon 16499, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul 04763, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Se Jeong Jeon
- Department of Radiology, Wonkwang University Hospital, Iksan 54538, Korea
| | - So Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Dong Wook Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Chang Yoon Lee
- Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea
| | - Hui Joong Lee
- Department of Radiology, Kyungpook National University Hospital, Daegu 41944, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Joon Hyung Lee
- Department of Radiology, Dong-A University Medical Center, Busan 49201, Korea
| | - Kwang Hui Lee
- Department of Radiology, Newwoori Namsan Hospital, Busan 46224, Korea
| | - Sun-Won Park
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea
| | - Jin Young Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul 07442, Korea
| | | |
Collapse
|
28
|
Kulstad R. DO ALL THYROID NODULES >4 CM NEED TO BE REMOVED? AN EVALUATION OF THYROID FINE-NEEDLE ASPIRATION BIOPSY IN LARGE THYROID NODULES. Endocr Pract 2016; 22:791-8. [PMID: 26919652 DOI: 10.4158/ep151150.or] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Controversy exists regarding the ability of fine-needle aspiration (FNA) biopsy to rule out malignancy when thyroid nodules exceed 4 cm in diameter. The goal of this study was to provide data regarding FNA accuracy in a clinical setting for detecting/ruling out malignancy in large thyroid nodules (≥4 cm) and discuss FNA utility in guiding surgical decisions. METHODS All thyroid FNA cases performed at Marshfield Clinic from 1/1/2000 to 12/31/2010 followed by complete or partial thyroidectomy on nodules of at least 4 cm were identified. Demographics, medical history, nodule biopsy characteristics, surgical procedures, and diagnosis data were abstracted. FNA was compared to histologic evaluation of surgical specimens. RESULTS A total of 198 patients with large thyroid nodules were identified. Most had a single large nodule, but ~40% were multinodular, and 206 total nodules were assessed. Females outnumbered males, and the mean age was ~50 years. After surgery, cancer was histologically identified in 49/206 (23.8%) nodules, including 9/123 nodules that had been categorized as benign by FNA, corresponding to a false-negative rate of 7.3%. Sensitivity/specificity for detecting malignancy by FNA was ~80%. The positive predictive value (PPV) was just below 60%, and the negative predictive value (NPV) was 93% but rose to 96% when papillary microcarcinomas were excluded. CONCLUSION While FNA sensitivity in large nodules was relatively low, NPV was high, especially if incidental papillary microcarcinomas were excluded. When cancer prevalence and NPV are known, FNA can be a reliable "rule out" test in nodules ≥4 cm. This information is critical and can help guide the surgery decision, especially in high-risk patients. The decision for surgery should not be solely based on nodule size but should consider additional factors including cancer prevalence, clinical history, ultrasound features, surgical risk, and life expectancy. ABBREVIATIONS FNA = fine-needle aspiration NPV = negative predictive value PPV = positive predictive value.
Collapse
|
29
|
Lee L, Mitmaker EJ, Chabot JA, Lee JA, Kuo JH. Cost-Effectiveness of Diagnostic Lobectomy Versus Observation for Thyroid Nodules >4 cm. Thyroid 2016; 26:271-9. [PMID: 26715288 DOI: 10.1089/thy.2015.0300] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The management of thyroid nodules >4 cm with benign cytology after fine-needle aspiration biopsy (FNAB) is controversial. FNAB is associated with a high false-negative rate in this setting, and may result in a delayed diagnosis and management of thyroid cancer. However, the majority of these nodules are benign. Therefore, the objective of this study was to determine the cost-utility of observation versus surgical management for thyroid nodules >4 cm with benign cytology after FNAB. METHODS A microsimulation model comparing routine thyroid lobectomy with observation for low-risk patients with >4 cm thyroid nodules with benign FNAB cytology was constructed. Costs, quality-adjusted life-years (QALYs), and life-years gained were calculated over a lifetime time horizon from a U.S. Medicare perspective. RESULTS The proportion of patients undergoing thyroid lobectomy for benign final pathology was 40% in the observation strategy versus 66% in the surgical strategy (p < 0.001). Overall, the surgical strategy was associated with higher lifetime costs compared with the observation strategy (incremental difference: + US$12,992 [confidence interval (CI) 13,042-13,524]), but also more QALYs (+0.12 QALYs [CI 0.02-0.24]) and longer life expectancy (+1.67 years [CI 1.00-2.41]). Incremental lifetime costs were lower for patients <55 years compared with those ≥55 years (+11,181 vs. +14,811, p < 0.001). The probability of cost-effectiveness of the surgical strategy was 49% at a $100k/QALY threshold or 65% at a $100k/life-year gained threshold. CONCLUSIONS Routine thyroid lobectomy is associated with improved outcomes at an acceptable cost compared with observation for thyroid nodules >4 cm with benign cytology after FNAB. Surgical resection may be a cost-effective strategy to rule out malignancy in these nodules.
Collapse
Affiliation(s)
- Lawrence Lee
- 1 Division of General Surgery, Department of Surgery, McGill University Health Centre , Montreal, Canada
| | - Elliot J Mitmaker
- 1 Division of General Surgery, Department of Surgery, McGill University Health Centre , Montreal, Canada
| | - John A Chabot
- 2 Division of GI/Endocrine Surgery, Department of Surgery, Columbia University Medical Center , New York, New York
| | - James A Lee
- 2 Division of GI/Endocrine Surgery, Department of Surgery, Columbia University Medical Center , New York, New York
| | - Jennifer H Kuo
- 2 Division of GI/Endocrine Surgery, Department of Surgery, Columbia University Medical Center , New York, New York
| |
Collapse
|
30
|
Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
| |
Collapse
|
31
|
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8544] [Impact Index Per Article: 1068.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
Collapse
Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
| | | | | | | |
Collapse
|
32
|
Nakamura H, Hirokawa M, Ota H, Kihara M, Miya A, Miyauchi A. Is an Increase in Thyroid Nodule Volume a Risk Factor for Malignancy? Thyroid 2015; 25:804-11. [PMID: 25872408 DOI: 10.1089/thy.2014.0567] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Most benign thyroid nodules found on fine-needle aspiration cytology (FNAC) can be followed with periodic ultrasonography. During follow-up, when nodules grow, re-aspiration or surgical resection for a histologic diagnosis is recommended. However, there is little evidence regarding the malignancy risk associated with nodule growth. METHOD We retrospectively reviewed the records of 542 patients with FNAC-diagnosed adenomatous nodules (ANs) who underwent surgery in 2011-2012 at Kuma Hospital. Among them, 196 patients had surgical resection because of nodule volume growth (median, 1.94 times; range, 1.21-27.60) during the observation period (mean, 45.9 months). Excluding nodule growth, the remaining 346 patients underwent surgery for various reasons including the large size of nodules or the appearance of undefined ultrasound features suspicious for malignancy during follow-up. For comparison, we reviewed 409 patients with FNAC-diagnosed follicular neoplasms (FNs) operated on in 2011-2013. Most (n=327) underwent surgery shortly after the FNAC diagnosis, while 82 patients were observed for a period of time and had a late operation due to nodule volume growth (median, 2.70 times; range, 1.27-15.82). RESULTS The histologic diagnoses of the 196 growing FNAC-diagnosed ANs were 158 ANs, 32 follicular adenomas (FAs), 4 follicular tumors of uncertain malignant potential (FT-UMP; 2%), and 2 malignancies (1%). The 346 patients who underwent surgery for reasons other than nodular growth had 16 FT-UMP (4.6%) and 16 malignancies (4.6%). This suggests that nodule growth itself is not a risk factor for malignancy. On the other hand, there were 23 FT-UMP (28%) and 15 malignancies (18.3%) in the 82 growing FNAC-diagnosed FNs, while 44 FT-UMP (13.5%) and 54 malignancies (16.5%) in the 327 FNAC-diagnosed FN patients who underwent immediate surgery. The malignant potential was significantly higher in the growing-FN group than the immediate-surgery FN group (p<0.05). No significant difference was found in the volume change between the benign and the FT-UMP plus malignant group in the growing FNs, suggesting that a growth rate does not correlate with malignant potential. CONCLUSION This is the first demonstration that the malignancy risk is low in FNAC-diagnosed ANs, even if the nodules grow significantly, whereas FNs have a higher risk when they grow.
Collapse
Affiliation(s)
| | | | - Hisashi Ota
- 3 Department of Laboratory, Kuma Hospital , Kobe, Japan
| | - Minoru Kihara
- 4 Department of Surgery, Kuma Hospital , Kobe, Japan
| | - Akihiro Miya
- 4 Department of Surgery, Kuma Hospital , Kobe, Japan
| | | |
Collapse
|
33
|
Le AR, Thompson GW, Hoyt BJA. Thyroid Fine-needle aspiration biopsy: an evaluation of its utility in a community setting. J Otolaryngol Head Neck Surg 2015; 44:12. [PMID: 25890284 PMCID: PMC4373075 DOI: 10.1186/s40463-015-0063-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 02/12/2015] [Indexed: 01/21/2023] Open
Abstract
Background Thyroid cancer rates are on the rise worldwide with over 5000 new cases estimated in Canada in 2012. The American Thyroid Association recommends the use of fine-needle aspiration biopsy (FNA) in the workup of thyroid nodules. Studies show that thyroid FNA accuracy may vary based on interpretation by cytopathologists in academic versus community centres. To date, there has been no literature published addressing the accuracy or utility of preoperative FNA in a Canadian community center. Our goals were to demonstrate the accuracy of thyroid FNA at our centre, and to compare our results to those published in the literature. Methods Medical records for patients who underwent thyroidectomy performed by two otolaryngologists in Fredericton, NB, between September 2008 and February 2013 were reviewed. 125 patients with 197 FNAs were analyzed. Fisher’s Exact test was used to compare the malignancy rates in each FNA category, and Chi-Square test was used for FNA distribution comparison. Results The distribution of all FNA diagnoses at our centre was as follows: 38 (19%) benign, 100 (51%) inconclusive, 8 (4%) suspicious for malignancy, 2 (1%) malignant, and 49 (25%) unsatisfactory. FNA distribution was significantly different between our centre and comparison centres (Chi-Square p < 0.05). Our malignancy rates within each category using each FNA sample as a data point were 26.3%, 29.0%, 75%, 100% and 12.2% respectively. Comparison to other community studies revealed that we have significantly higher malignancy rates with benign FNAs (Fisher’s exact p = <0.05). Analysis using our most malignant FNA data yielded similar results. Conclusion Thyroid FNA accuracy varies between institutions, and this may affect its utility in the workup of a thyroid nodule at some centres. Expert cytopathology opinions may be an asset in interpreting FNA samples in small community centres where volumes are relatively low, however our data do not support this assertion. It is essential that physicians continue to use clinical judgment first and foremost when evaluating thyroid nodules.
Collapse
Affiliation(s)
- Andre R Le
- Memorial University Faculty of Medicine, S-1758B 300 Prince Phillip Drive, St John's, NL, A1B 3 V6, Canada.
| | - Gregory W Thompson
- Department of Otolaryngology - Head & Neck Surgery, Zone 3, Horizon Health Network, 700 Priestman St, Fredericton, NB, E3B 5 N5, Canada.
| | - Benjamin John A Hoyt
- Department of Otolaryngology - Head & Neck Surgery, Zone 3, Horizon Health Network, 700 Priestman St, Fredericton, NB, E3B 5 N5, Canada.
| |
Collapse
|
34
|
Kim JH, Kim NK, Oh YL, Kim HJ, Kim SY, Chung JH, Kim SW. The Validity of Ultrasonography-Guided Fine Needle Aspiration Biopsy in Thyroid Nodules 4 cm or Larger Depends on Ultrasonography Characteristics. Endocrinol Metab (Seoul) 2014; 29:545-52. [PMID: 25325261 PMCID: PMC4285035 DOI: 10.3803/enm.2014.29.4.545] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/10/2014] [Accepted: 01/27/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the validity of fine needle aspiration biopsy (FNAB) according to ultrasonography (US) characteristics in thyroid nodules 4 cm and larger. METHODS We retrospectively reviewed the cases of 263 patients who underwent thyroid surgery for thyroid nodules larger than 4 cm between January 2001 and December 2010. RESULTS The sensitivity of US-FNAB was significantly higher in nodules with calcifications (micro- or macro-) than those without (97.9% vs. 87.% P<0.05). The accuracy of US-FNAB was higher in large thyroid nodules with US features suspicious of malignancy, such as a solid component, ill-defined margin, hypoechogenicity or marked hypoechogenicity, or any calcifications (micro- or macro-) compared to thyroid nodules with none of these features. Furthermore, the accuracy improved as the number of these features increased. The overall false negative rate (FNR) was 11.9%. The FNR of thyroid nodules that appeared benign on US, such as mixed nodules (7.7%) or nodules without calcification (9.8%), trended toward being lower than that of solid nodules (17.9%) or nodules with any microcalcification or macrocalcification (33.3%). In nodules without suspicious features of malignancy, the FNR of US-FNAB was 0% (0/15). CONCLUSION We suggest individualized strategies for large thyroid nodules according to US features. Patients with benign FNAB can be followed in the absence of any malignant features in US. However, if patients exhibit any suspicious features, potential false negative results of FNAB should be kept in mind and surgery may be considered.
Collapse
Affiliation(s)
- Jin Hwa Kim
- Department of Endocrinology and Metabolism, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Korea
| | - Na Kyung Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Jeong Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yong Kim
- Department of Endocrinology and Metabolism, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
35
|
Shin JJ, Caragacianu D, Randolph GW. Impact of thyroid nodule size on prevalence and post-test probability of malignancy: a systematic review. Laryngoscope 2014; 125:263-72. [PMID: 24965892 DOI: 10.1002/lary.24784] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/26/2014] [Accepted: 05/27/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES/HYPOTHESIS Large thyroid nodules may be associated with higher risk of malignancy and less-accurate fine-needle aspiration (FNA) results, but there is currently no overarching consensus. We therefore tested two null hypotheses: 1) thyroid nodule size >3 to 4 cm is not associated with a higher baseline prevalence of malignancy (i.e., the associated pretest probability is the same, regardless of size), and 2) thyroid nodule size >3 to 4 cm is not associated with worse diagnostic accuracy (i.e., the associated sensitivity, false-negative rate, and post-test probability of malignancy is not affected by nodule diameter). STUDY DESIGN Computerized searches of PubMed, Embase, and The Cochrane Library through July 2013 were performed, supplemented with manual searches. METHODS A priori criteria were defined to determine inclusion and exclusion of studies. Searches and data extraction were performed by independent reviewers and focused on FNA histopathologic findings and their relationship to nodule size, study design, and potential confounders. RESULTS Criterion-meeting studies (n = 15) included a total of 13,180 participants. The preponderance of prospective comparative studies showed a statistically significantly higher prevalence of malignancy in large nodules. Although data are mixed, evidence from the best-reported studies suggests sensitivity, false-negative rates, and frequency of true negatives among benign FNA results are worse in large nodules. CONCLUSIONS Large nodules have a higher pretest probability of malignancy. Data from larger studies suggest reduced FNA diagnostic accuracy in nodules >3 to 4 cm in diameter. Surgery represents a reasonable clinical option for nodules >3 cm.
Collapse
|
36
|
Proietti A, Borrelli N, Giannini R, Romani R, Di Coscio G, Quilici F, Rago T, Miccoli P, Vitti P, Basolo F. Molecular characterization of 54 cases of false-negative fine-needle aspiration among 1347 papillary thyroid carcinomas. Cancer Cytopathol 2014; 122:751-9. [PMID: 24913568 DOI: 10.1002/cncy.21454] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/12/2014] [Accepted: 05/27/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) has been widely accepted as the most crucial step in the preoperative assessment of thyroid nodules, but the false-negative rates are generally reported to be between 3.6% and 10.2%. To lower the overall incidence of this false-negative testing, new reporting systems encourage the molecular testing of thyroid nodules. However, to the authors' knowledge, the role of molecular testing in false-negative FNA has not yet been evaluated. METHODS In total, 1347 consecutive papillary thyroid carcinomas (PTCs) with both cytological and histological diagnoses were collected from the same center. A blinded revision of the false-negative cases was performed. An analysis of the BRAF and Ras genes in the false-negative cases was then performed. RESULTS The false-negative rate at the time of primary FNA diagnosis was 4.8% (65 of 1347 cases). False-negative cases were 15 follicular variant PTCs, 2 classical variant, and 1 solid variant that lacked peculiar PTC cytomorphological features. Adequate cellular material for molecular analysis was available only in 54 of the 65 false-negative cases. Mutations were found in 6 cases (11%), and Ras alterations were present in 16 cases (29.6%). The addition of molecular analysis decreased the false-negative rate to 0.4% (5 of 1347 cases). CONCLUSIONS The results of the current study confirm the feasibility of BRAF and Ras analysis in routine FNA. However, when the false-negative FNA rate is low, the cost-benefit analysis of the detection of BRAF and Ras mutations should be carefully evaluated. Consequently, the authors suggest that preoperative molecular assessment could be helpful for benign nodules, but only in the presence of clinical suspicion of malignancy.
Collapse
Affiliation(s)
- Agnese Proietti
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Pathological Anatomy, University of Pisa, Pisa, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Varshney R, Forest VI, Zawawi F, Rochon L, Hier MP, Mlynarek A, Tamilia M, Payne RJ. Ultrasound-guided fine-needle aspiration of thyroid nodules: does size matter? Am J Otolaryngol 2014; 35:373-6. [PMID: 24524916 DOI: 10.1016/j.amjoto.2013.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/13/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE Some authors have questioned the benefit of fine-needle aspiration (FNA) of thyroid nodules ≥ 4 cm. They report that the results of the FNA are not as reliable when compared to nodules <4 cm. The aims of this study are to evaluate the accuracy and predictive values of ultrasound-guided FNA (USFNA) of thyroid nodules ≥ 4 cm and compare these findings to nodules <4 cm. METHODS A retrospective study of 998 patients who underwent thyroid surgery between 2006 and 2012 at the McGill University Thyroid Cancer Center was performed. USFNA and post-operative pathology diagnoses of nodules ≥ 4 cm versus those <4 cm were compared. Pre-operative USFNA results were divided into three groups: benign, indeterminate, and malignant/suspicious for malignancy subgroups. Post-operative results were separated into benign and malignant groups. RESULTS There were 225 patients with nodules ≥ 4 cm and 773 patients with nodules <4 cm. The sensitivity, specificity, positive predictive value and negative predictive value for USFNA of nodules ≥ 4 cm were 84.62% (CI 71.91-93.10), 91.49% (CI 79.6-97.58), 91.67% (CI 80.0-97.63) and 84.31% (CI 71.4-92.95), respectively. The sensitivity, specificity, positive predictive value and negative predictive value for USFNA of nodules <4 cm were 90.48% (CI 86.1-93.8), 85.92% (CI 75.6-93.02), 95.8% (CI 92.41-97.96) and 71.76% (CI 60.95-81.0), respectively. The difference in diagnostic accuracy of USFNA between both groups was not statistically significant (p>0.05). CONCLUSION This study shows that the sensitivity, specificity, positive predictive value and negative predictive value for USFNA of nodules ≥ 4 cm are similar to that of smaller nodules. It is therefore suggested that these nodules undergo USFNA.
Collapse
|
38
|
Wharry LI, McCoy KL, Stang MT, Armstrong MJ, LeBeau SO, Tublin ME, Sholosh B, Silbermann A, Ohori NP, Nikiforov YE, Hodak SP, Carty SE, Yip L. Thyroid Nodules (≥4 cm): Can Ultrasound and Cytology Reliably Exclude Cancer? World J Surg 2013; 38:614-21. [PMID: 24081539 DOI: 10.1007/s00268-013-2261-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
39
|
Lee S, Skelton TS, Zheng F, Schwartz KA, Perrier ND, Lee JE, Bassett RL, Ahmed S, Krishnamurthy S, Busaidy NL, Grubbs EG. The biopsy-proven benign thyroid nodule: is long-term follow-up necessary? J Am Coll Surg 2013; 217:81-8; discussion 88-9. [PMID: 23659946 DOI: 10.1016/j.jamcollsurg.2013.03.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/22/2013] [Accepted: 03/22/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Thyroid nodules are common, and of those biopsied by fine-needle aspiration (FNA), the majority will be benign colloid nodules (BCN). Current guidelines suggest these BCN should be followed by ultrasonographic examination (US) every 3 years, with no endpoint specified. This study evaluated if long-term follow-up of benign thyroid nodules was associated with change in treatment or improvement in diagnosing a missed malignancy compared with short-term follow-up. STUDY DESIGN All patients with FNA-based diagnosis of BCN at our institution from 1998 to 2009 were identified. Patients observed after the diagnosis were divided into short-term follow-up (<3 years) and long-term follow-up (≥3 years). Rates of repeat FNA, thyroidectomy, and malignancy detection were compared. RESULTS Of 738 patients with BCN, 92 patients underwent thyroid resection after the initial US. Six hundred forty-six patients were observed, of which 366 returned for 1 or more follow-up US: 226 in the short-term group (median 13 months) and 140 in the long-term group (median 57 months). There were more follow-up US in long-term vs short-term (medians 4 vs 2, p < 0.01), more repeat FNAs in the long-term group (18 of 140 vs 8 of 226, p < 0.01); but no difference in interval thyroidectomies (13 of 140 vs 31 of 226, p = 0.25) or malignant final pathology (0 of 13 vs 2 of 31, p > 0.99). For all patients undergoing surgery, pathology was malignant in 2 of 136 (1.5%). CONCLUSIONS Long-term follow-up of patients with BCN is associated with increased repeat FNA and US without improvement in the malignancy detection rate. After 3 years of follow-up, consideration should be given to ceasing long-term routine follow-up of biopsy-proven BCN.
Collapse
Affiliation(s)
- Sukhyung Lee
- Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Ahmadinejad M, Aliepour A, Anbari K, Kaviani M, Ganjizadeh H, Nadri S, Foroutani N, Meysami M, Almasi V. Fine-Needle Aspiration, Touch Imprint, and Crush Preparation Cytology for Diagnosing Thyroid Malignancies in Thyroid Nodules. Indian J Surg 2013; 77:480-3. [PMID: 26730049 DOI: 10.1007/s12262-013-0882-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 01/28/2013] [Indexed: 10/27/2022] Open
Abstract
Several methods are used to evaluate the thyroid nodules. The aim of this study was to determine the sensitivity, specificity, false positive and negative rates, positive predictive value (PPV), and negative predictive value (NPV) of touch imprint, crush preparation, and fine-needle aspiration (FNA) methods. This cross-sectional study was done in Shohada-ye Ashayer University Hospital in Khorramabad. All the patients who underwent thyroid surgery due to thyroid nodules in this hospital between March and September 2011 were evaluated. The thyroid nodules of all the patients were evaluated by touch imprint, crush preparation, FNA, and permanent pathology methods. Finally, the results of the first three methods were compared with the result of permanent pathology method. The mean age of 104 patients who underwent thyroid surgery was 42.6 ± 11.9 years old. Based on permanent pathology, touch imprint, crush preparation, and FNA methods, 15.3, 6.25, 6.25, and 4.4 % of thyroid nodules were malignant, respectively. Sensitivity, specificity, false positive rate, false negative rate, PPV, and NPV of FNA biopsy were 62.5, 100, 0, 37.5, 100, and 95.3 %, respectively. Also, sensitivity, specificity, false positive rate, false negative rate, PPV, and NPV of touch imprint and crush preparation were equal and were 80, 100, 0, 20, 100, and 96.7 %, respectively. Using touch imprint and crush preparation in evaluation of thyroid nodules for rapid evaluation of these nodules in operating rooms seems to be logical, and it can prevent further surgeries.
Collapse
Affiliation(s)
- Mojtaba Ahmadinejad
- Clinical Research Center, Shohada-ye Ashayer University Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran ; Clinical Research Center, Shohada-ye Ashayer University Hospital, Enghelab Street, Khorramabad, Lorestan Iran
| | - Asghar Aliepour
- Clinical Research Center, Shohada-ye Ashayer University Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Khatereh Anbari
- Clinical Research Center, Shohada-ye Ashayer University Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mojhgan Kaviani
- Clinical Research Center, Shohada-ye Ashayer University Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hasan Ganjizadeh
- Clinical Research Center, Shohada-ye Ashayer University Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Sedigheh Nadri
- Clinical Research Center, Shohada-ye Ashayer University Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Niloufar Foroutani
- Clinical Research Center, Shohada-ye Ashayer University Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Masoumeh Meysami
- Clinical Research Center, Shohada-ye Ashayer University Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Vahid Almasi
- Clinical Research Center, Shohada-ye Ashayer University Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| |
Collapse
|
41
|
Agcaoglu O, Aksakal N, Ozcinar B, Sarici IS, Ercan G, Kucukyilmaz M, Yanar F, Ozemir IA, Kilic B, Caglayan K, Yilmazbayhan D, Salmaslioglu A, Issever H, Ozarmagan S, Erbil Y. Factors that affect the false-negative outcomes of fine-needle aspiration biopsy in thyroid nodules. Int J Endocrinol 2013; 2013:126084. [PMID: 23935616 PMCID: PMC3712239 DOI: 10.1155/2013/126084] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 05/16/2013] [Accepted: 05/26/2013] [Indexed: 11/18/2022] Open
Abstract
Background. The purpose of this study was to assess the factors that affect the false-negative outcomes of fine-needle aspiration biopsies (FNABs) in thyroid nodules. Methods. Thyroid nodules that underwent FNAB and surgery between August 2005 and January 2012 were analyzed. FNABs were taken from the suspicious nodules regardless of nodule size. Results. Nodules were analyzed in 2 different groups: Group 1 was the false-negatives (n = 81) and Group 2 was the remaining true-positives, true-negatives, and false-positives (n = 649). A cytopathologist attended in 559 (77%) of FNAB procedures. There was a positive correlation between the nodule size and false-negative rates, and the absence of an interpreting cytopathologist for the examination of the FNAB procedure was the most significant parameter with a 76-fold increased risk of false-negative results. Conclusion. The contribution of cytopathologists extends the time of the procedure, and this could be a difficult practice in centres with high patient turnovers. We currently request the contribution of a cytopathologist for selected patients whom should be followed up without surgery.
Collapse
Affiliation(s)
- Orhan Agcaoglu
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Nihat Aksakal
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Beyza Ozcinar
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
- *Beyza Ozcinar:
| | - Inanc S. Sarici
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Gulcin Ercan
- General Surgery Clinic, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Meltem Kucukyilmaz
- General Surgery Clinic, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Fatih Yanar
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Ibrahim A. Ozemir
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Berkay Kilic
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Kasim Caglayan
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Dilek Yilmazbayhan
- Department of Pathology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Artur Salmaslioglu
- Department of Radiology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Halim Issever
- Department of Public Health, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Selcuk Ozarmagan
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| | - Yesim Erbil
- Department of General Surgery, Istanbul Medical School, Istanbul University, 34493 Capa, Istanbul, Turkey
| |
Collapse
|
42
|
Shrestha M, Crothers BA, Burch HB. The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-needle aspiration: a 10-year study from a single institution. Thyroid 2012; 22:1251-6. [PMID: 22962940 DOI: 10.1089/thy.2012.0265] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND False-negative rates for thyroid fine-needle aspiration (FNA) vary from 0.4% to 13%, but the effect of nodule size on the accuracy of thyroid FNA remains controversial. We hypothesized that large thyroid nodule size does not contribute to the risk of malignancy or the risk of a false-negative FNA. METHODS All thyroid FNAs performed at the Walter Reed Army Medical Center during September 2001-August 2011 were reviewed. A strict correlation between the biopsy site, location, and size of nodule on ultrasound (US) and pathology report was ensured. FNA results were classified as benign, atypical, follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), suspicious for malignancy (SM), or malignant, and the pathology result was categorized as either benign or malignant. Nodules were analyzed by size: 0.5-0.9 cm (group A), 1.0-3.9 cm (group B), and ≥ 4 cm (group C). Incidental thyroid cancer was not included. RESULTS Of 3013 patients undergoing FNA, 667 (22.1%) had surgery. Patients were excluded for nodules <0.5 cm, nondiagnostic FNA, or no preoperative US, leaving 540 patients with 695 nodules. Among patients referred for surgery, FNA results were benign in 417 nodules (60%), atypical in 22 (3.2%), FN/SFN in 122 (17.6%), SM in 77 (11.1%), and malignant in 57 (8.2%). Postoperative malignancy rates by FNA result were 7% if benign, 4.5% if atypical, 23% if FN/SFN, 33.8% if SM, and 78.9% if malignant. FNA accuracy was 60% in group A, 68.5% in group B, and 80.3% in group C (p=0.01). False-negative rates for FNA were 7.0% overall, 15.8% in group A, 6.3% in group B, and 7.1% in group C (p=0.25). Sensitivity and negative predictive value were highest in group B at 81.6% and 93.7%, respectively. The prevalence of malignancy was not different between groups. CONCLUSION Our results show that the thyroid nodule size ≥ 4 cm increases neither the risk of false-negative FNA results, nor the overall risk of malignancy. We also show a tendency toward a higher false-negative rate in subcentimeter nodules. We conclude that a large nodule size should not prompt automatic referral for thyroidectomy. An increased awareness of potential sampling error in subcentimeter nodules is warranted.
Collapse
Affiliation(s)
- Merica Shrestha
- Department of Endocrinology, Walter Reed National Military Medical Center, Bethesda, Maryland 20889, USA
| | | | | |
Collapse
|
43
|
Detection of Papillary Thyroid Carcinoma by Analysis of BRAF and RET/PTC1 Mutations in Fine-needle Aspiration Biopsies of Thyroid Nodules. World J Surg 2010; 34:2595-603. [DOI: 10.1007/s00268-010-0729-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|