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Gąsiorowski O, Leszczyński J, Kaszczewska J, Stępkowski K, Kaszczewski P, Baryła M, Gałązka Z. Comparison of Fine-Needle Aspiration Cytopathology with Histopathological Examination of the Thyroid Gland in Patients Undergoing Elective Thyroid Surgery: Do We Still Need Fine-Needle Aspiration Cytopathology? Diagnostics (Basel) 2024; 14:236. [PMID: 38337752 PMCID: PMC10854902 DOI: 10.3390/diagnostics14030236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The thyroid gland is responsible for various functions, but it is susceptible to pathologies. The gold standard for preliminarily diagnosing thyroid abnormalities is fine-needle aspiration cytology (FNAC), although it has some limitations; thus, postoperative histopathological examination confirms the diagnosis. The aim of the present study was to compare preoperative FNAC results with postoperative histopathological examination. METHODS This study is a retrospective study based on FNAC and postoperative histopathology examination, which were compared and analyzed. RESULTS This study included 344 patients between 18 and 86 years old (mean age: 53.06 ± 13.89), comprising 274 females and 70 males (mean ages 52.72 ± 13.86 and 54.39 ± 14.05, respectively) with a 3.9:1 female-to-male ratio. Statistical significance between the FNAC and histopathology results was observed (p = 0.0000), and 86 (25.00%) patients were found to have been diagnosed incorrectly based on FNAC. The sensitivity of FNAC was 92.31%, and its specificity was 82.08%, with positive and negative predictive values of 68.57% and 96.08%, respectively. CONCLUSIONS Due to many factors, FNAC may lead to over- or under-diagnosis, increasing the chances of complications associated with the selected treatment. However, we do not have any other more accurate tools; therefore, FNAC should still remain as the gold standard of preliminary examination.
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Affiliation(s)
- Oskar Gąsiorowski
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, ul. Żwirki i Wigury 61, 02-091 Warsaw, Poland; (J.K.); (K.S.); (P.K.); (M.B.); (Z.G.)
| | - Jerzy Leszczyński
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, ul. Żwirki i Wigury 61, 02-091 Warsaw, Poland; (J.K.); (K.S.); (P.K.); (M.B.); (Z.G.)
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Mahmoud SAE, Enaba ME, Shareef MM, Hafez YM, Abbas I. Comparison the accuracy of thyroid sono-elastography vs. ultrasound-guided fine needle aspiration cytology with thyroid malignancy diagnosis histopathology. Endocr Regul 2024; 58:129-137. [PMID: 38861538 DOI: 10.2478/enr-2024-0014] [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: 06/13/2024] Open
Abstract
Objective. The intend of the present study was to assess the diagnostic performance of strain elastography in investigating the thyroid nodule malignancy taking the surgical biopsy as a gold standard reference test. Methods. The study included 120 patients with 123 thyroid nodules, of which 67 had total thyroidectomy. The American College of Radiology Thyroid Imaging Reporting and Data Systems (ACR-TIRADS) were evaluated for all nodules. All suspicious nodules were referred for a fine needle aspiration cytology (FNAC) if they fulfilled the required size. Strain elastography was performed for each suspicious nodule. Ultrasound-guided FNAC was performed for all suspicious nodules. Total thyroidectomy was performed in those whom the suspicious nodules were proven by FNAC. Results. Strain ratio had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of 84%, 81%, 95%, 85%, and 84%, respectively, with a cut point 1.96. Elasticity score had a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 100%, 80%, 95%, 85% and 87%, respectively, with a cut point 0.96. The elasticity score had a statistically significantly odds ratio for detecting the benignity 3.9 C. I (1.6-9.3). Conclusion. Strain elastography has a high diagnostic performance in detecting the malignant as well as benign nodules, thus it can limit the rate of unneeded FNAC or surgery especially among B3 and B4 groups with indeterminate cytology.
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Affiliation(s)
- Sarah Abd Elmageed Mahmoud
- 1Internal Medicine Department, Tanta University Hospital, Faculty of Medicine, University of Tanta, Tanta, AL Gharbia, Egypt
| | - Mohamed Elsayed Enaba
- 1Internal Medicine Department, Tanta University Hospital, Faculty of Medicine, University of Tanta, Tanta, AL Gharbia, Egypt
| | - Mohamed Moustafa Shareef
- 2Pathology Department, Tanta University Hospital, Faculty of Medicine, University of Tanta, Tanta, AL Gharbia, Egypt
| | - Yasser Moustafa Hafez
- 2Pathology Department, Tanta University Hospital, Faculty of Medicine, University of Tanta, Tanta, AL Gharbia, Egypt
| | - Ibrahim Abbas
- 3Diagnostic Radiology Department, Faculty of Medicine, University of Tanta, Tanta, AL Gharbia, Egypt
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Yuang K, Al-Bahadili H, Chang A. An Unexpected Finding of Poorly Differentiated Thyroid Carcinoma in a Toxic Thyroid Nodule. JCEM CASE REPORTS 2023; 1:luad052. [PMID: 37908574 PMCID: PMC10580452 DOI: 10.1210/jcemcr/luad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Indexed: 11/02/2023]
Abstract
Poorly differentiated thyroid carcinoma (PDTC) is a rare entity of thyroid cancer with an intermediate clinical behavior between differentiated and anaplastic thyroid cancer. Here we present a patient who was referred to the endocrinology clinic for evaluation of hyperthyroidism and multinodular goiter. Due to presence of right toxic thyroid nodules and compressive symptoms, the patient underwent right lobectomy and isthmectomy, where surgical pathology revealed PDTC in the right thyroid lobe. Based on this unusual case of malignancy within a toxic nodule, we propose further evaluation of hot nodules with concerning features such as growth rate. Furthermore, exploration of relative sodium iodine symporter (NIS) expression in PDTC may help us better understand how iodine uptake changes as PDTC develops, which may impact our approach to assessing and treating PDTC in the future.
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Affiliation(s)
- Kimberly Yuang
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Huda Al-Bahadili
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Alan Chang
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Stony Brook University Hospital, Stony Brook, NY 11794, USA
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Barry E, Gilley DR, Tassone P. A case of vagal paraganglioma initially diagnosed as metastatic thyroid cancer from fine-needle aspiration. Am J Otolaryngol 2023; 44:103744. [PMID: 36628912 DOI: 10.1016/j.amjoto.2022.103744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Elsie Barry
- University of Missouri School of Medicine, Degree Program, 1 Hospital Drive, Columbia, MO, USA.
| | - David R Gilley
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Patrick Tassone
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
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Muacevic A, Adler JR, Junaid M, Aldosari AA, Amer KA, Mubarki MH, Alharbi SM, Al-Qannass AM. Association of Fine-Needle Aspiration of Thyroid Nodules With Final Histopathology in Diagnosing Thyroid Malignancy: A Single Institute Retrospective Study. Cureus 2022; 14:e31733. [PMID: 36569680 PMCID: PMC9769783 DOI: 10.7759/cureus.31733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Fine needle aspiration cytology (FNAC) is the gold standard for detecting thyroid nodules. It is a cost-efficient approach that affords prompt and accurate evaluation. It is crucial in deciding to treat patients with suspected malignancy of thyroid nodules that might have thyroid surgery. According to findings in cytology, patients may be observed when the cytology is benign, and surgery can be performed if the cytology is malignant, which leads to a reduction in the incidence of unneeded surgery. Aim The current study aims to assess the concordance between FNAC of thyroid nodules with final histopathology and identify the different types of detected thyroid lesions. Methodology A retrospective record-based study reviewed the medical files of all patients presenting to the Armed Forces Hospital, Southern region, with suspected thyroid nodules from April 2018 to January 2020. Data were extracted using pre-structured data extraction sheet to avoid inconsistency. Data extracted included patients' demographic data, swelling laterality, size, ultrasound, and histopathological findings. Results The baseline characteristics of studied samples in the present study: Forty-seven samples had a mean age of 44.27 (SD=±13.5) years, and 85.1% were female gender. The study showed that 12.5% of benign samples were lymphocytic in histopathology, 25% suspicious for follicular neoplasm samples were benign multi-nodular goiter in histopathology, and all 100% of samples suspicious for malignancy were malignant in final histopathology. Conclusions The current study showed that the malignancy rate of the examined nodules was not uncommon in FNAC and histopathology. Where papillary carcinoma was the most detected malignancy, the diagnosis of malignancy using FNAC is a cost-efficient approach that affords prompt and accurate evaluation. Once diagnosed, these cases should be subjected to surgery.
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Alhassan R, Al Busaidi N, Al Rawahi AH, Al Musalhi H, Al Muqbali A, Shanmugam P, Ramadhan FA. Features and diagnostic accuracy of fine needle aspiration cytology of thyroid nodules: retrospective study from Oman. Ann Saudi Med 2022; 42:246-251. [PMID: 35933603 PMCID: PMC9357295 DOI: 10.5144/0256-4947.2022.246] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Fine needle aspiration cytology (FNAC) of the thyroid has been a reliable and cost-effective method for diagnosing thyroid disorders. Since FNAC results are usually operator dependent, there is a compelling need to explore FNAC accuracy among Omanis. OBJECTIVE Describe cytological features of FNAC and assess FNAC accuracy compared to the postsurgical histopathology report. DESIGN Retrospective diagnostic accuracy study SETTING: Tertiary care center. PATIENTS AND METHODS Our study included adult Omani adult patients with thyroid nodules who underwent FNAC from 2014 to 2017 and had final pathology results for patients who underwent thyroid surgery. The results were classified according to the UK Royal college of Pathologists 'Thy' categories. Accuracy of FNAC was calculated by determining false and true positive and negative results based on histopathology findings. MAIN OUTCOME MEASURES FNAC accuracy (sensitivity and specificity) compared to the postsurgical histopathology. SAMPLE SIZE 867 patients with 1359 ultrasound guided FNACs of thyroid nodule; 137 underwent surgery. RESULTS The mean age of the 867 patients was 43.7 (13.3) years, with a median of 42 years, and 87.8% were females. Out of 1359 FNACs, 1001 (73.7%) were benign (Thy2), 119 (8.8%) were atypia of undetermined significance or follicular lesion of undetermined significance (Thy3a), 31 (2.3%) were follicular neoplasm or suspicious for a follicular neoplasm (Thy3f), 52 (3.8%) were suspicious for malignancy (Thy4), 55 (4%) were malignant (Thy5), 101 (7.4%) as Unsatisfactory (Thy1). Only 137 patients underwent thyroid surgery, and the FNAC reports were compared with their final histopathology reports. The sensitivity, specificity and total accuracy of FNAC were 80.2%, 98.9% and 89.9%, respectively. The positive and negative predictive values of FNAC were 98.6% and 84.3%, respectively. CONCLUSION Our study findings confirmed that FNAC of the thyroid is a sensitive, specific, and accurate initial tool for the diagnosis of thyroid lesions. Most of the FNACs were benign with a very low malignancy rate. Due to the minimal chance of false negative results and the slow-growing nature of thyroid malignancy, it is important that patients with benign FNAC should have periodic clinical and radiological follow-up. LIMITATIONS Retrospective design and single-center study, and thyroid nodule size unavailable. CONFLICT OF INTEREST None.
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Affiliation(s)
- Rafie Alhassan
- From the Department of Endocrine, The Royal Hospital, Seeb, Oman
| | - Noor Al Busaidi
- From the Department of Endocrine, The Royal Hospital, Seeb, Oman
| | | | - Hilal Al Musalhi
- From the Department of Endocrine, The Royal Hospital, Seeb, Oman
| | - Ali Al Muqbali
- From the Department of Endocrine, The Royal Hospital, Seeb, Oman
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Hermansyah D, Siregar DR, Siregar ESH, Nasution IPA, Harahap AAK, Firsty NN, Siregar KB. The Accuracies of Fine-Needle Aspiration Biopsy without Ultrasound Guidance versus Frozen-Section Examination of Thyroid Nodule Diagnosis in Teaching Hospital Universitas Sumatera Utara: Single-Center Experience. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The urgency to determine the most applicable methodological approach in thyroid nodules diagnosis workup is unquestionably important due to a significant increase in its prevalence globally. To date, fine-needle aspiration biopsy (FNAB) is the most recommended procedure to diagnose preoperatively even though the certain role of frozen-section examination (FSE) intraoperatively were significant as well to be administered at some circumstances.
AIM: This study aims to measure the diagnostic accuracies of FNAB and FSE and determine the role of each procedure in the current thyroid nodules’ workup.
MATERIALS AND METHODS: This retrospective study was conducted at teaching hospital of Universitas Sumatera Utara, Indonesia. We included and investigated both FNAB and FSE in 106 patients; the results were compared to the final histopathological report, in which statistical analyses were conducted.
RESULTS: Most of the nodules are malignant after histopathological confirmation. From the fourfold contingency table, we were able to subtract several diagnostic parameters of the procedures. The FSE substantially disclosed better performance in sensitivity, specificity, positive predictive value (PPV), negative predictive value, and remarkably the accuracy. After several in-depth analyses, it is apparent that a higher rate of false-negative in FNAB is inducing its substandard performance, especially when the guidance of ultrasonography was not applied in this study. Furthermore, an analysis toward the concordance between both procedures results is revealing a significant improvement on almost every parameter, indicated by 100.0% specificity and PPV.
CONCLUSION: Although the outcomes in this study are not corresponding to the current guidelines, we acknowledged several limitations in this study, However, the role of FSE in thyroid nodule workup should be reconsidered since we found that the procedure is exhibiting a potential to assist the current method, even though the influence of its certain pitfall remained questionable.
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Radzina M, Ratniece M, Putrins DS, Saule L, Cantisani V. Performance of Contrast-Enhanced Ultrasound in Thyroid Nodules: Review of Current State and Future Perspectives. Cancers (Basel) 2021; 13:5469. [PMID: 34771632 PMCID: PMC8582579 DOI: 10.3390/cancers13215469] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022] Open
Abstract
Ultrasound has been established as a baseline imaging technique for thyroid nodules. The main advantage of adding CEUS is the ability to assess the sequence and intensity of vascular perfusion and hemodynamics in the thyroid nodule, thus providing real-time characterization of nodule features, considered a valuable new approach in the determination of benign vs. malignant nodules. Original studies, reviews and six meta-analyses were included in this article. A total of 624 studies were retrieved, and 107 were included in the study. As recognized for thyroid nodule malignancy risk stratification by US, for acceptable accuracy in malignancy a combination of several CEUS parameters should be applied: hypo-enhancement, heterogeneous, peripheral irregular enhancement in combination with internal enhancement patterns, and slow wash-in and wash-out curve lower than in normal thyroid tissue. In contrast, homogeneous, intense enhancement with smooth rim enhancement and "fast-in and slow-out" are indicative of the benignity of the thyroid nodule. Even though overlapping features require standardization, with further research, CEUS may achieve reliable performance in detecting or excluding thyroid cancer. It can also play an operative role in guiding ablation procedures of benign and malignant thyroid nodules and metastatic lymph nodes, and providing accurate follow-up imaging to assess treatment efficacy.
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Affiliation(s)
- Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Madara Ratniece
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
| | - Davis Simanis Putrins
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Laura Saule
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Vito Cantisani
- Department of Radiological, Anatomopathological and Oncological Sciences, Sapienza University of Rome, 00100 Rome, Italy;
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Khaled CS, Khalifeh IM, Shabb NS. Interpretive Errors in Fine-Needle Aspiration of Thyroid: A 13-Year Institutional Experience in Lebanon. Acta Cytol 2021; 66:23-35. [PMID: 34571506 DOI: 10.1159/000519075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/13/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Fine-needle aspiration (FNA) is a worldwide established diagnostic tool for the assessment of patients with thyroid nodules. All thyroid FNA interpretive errors (IEs) were reviewed at the American University of Beirut Medical Center over a 13-year period, in order to identify and analyze them. MATERIALS AND METHODS All FNAs and their corresponding pathology results are correlated yearly for quality assurance. Discrepant cases are segregated into sampling errors and IEs. All thyroid FNAs with IEs were collected from 2005 to 2017. FNA and pathology slides were reviewed by trained, board-certified cytopathologists, adhering to the latest Bethesda criteria. Reasons for erroneous diagnoses were studied. RESULTS There was a total of 11 IEs out of 340 thyroid FNAs followed by surgical resection. Five benign follicular nodules (BFNs) were misinterpreted as suspicious for carcinoma. Focal nuclear atypia in cyst-lining or follicular cells and a monotonous population of macrophages misinterpreted as Hurthle cells (HCs) were the causes of IEs in this category. Four Hashimoto's thyroiditis (HT) cases were misinterpreted as suspicious for malignancy. Innate atypia of HCs and sampling misinterpretation were the causes of IEs in HT. One medullary and 1 follicular carcinoma were misinterpreted as suspicious for follicular neoplasm and BFN, respectively. Nine cases were better classified after review. CONCLUSION Thyroid FNA IEs can be mitigated by meticulous screening and identification of all elements on FNA smears. Awareness of focal nuclear atypia in reactive cyst-lining and follicular cells in BFN, as well as HCs in HT, is highlighted. Adherence to The Bethesda System for Reporting Thyroid Cytopathology and consulting experienced cytopathologists significantly decrease IEs.
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Affiliation(s)
- Chirine S Khaled
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ibrahim M Khalifeh
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nina S Shabb
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Abičić I, Prpić T, Bogović V, Milanković SG, Mihalj H, Včeva A, Zubčić Ž, Šestak A, Rezo M. Characteristics of Malignant Thyroid Tumors: A Retrospective Study on 320 Patients. Acta Clin Croat 2021; 59:108-114. [PMID: 34219892 PMCID: PMC8212610 DOI: 10.20471/acc.2020.59.s1.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Papillary thyroid cancer accounts for 80-85% of diagnosed thyroid cancers, while follicular, medullary, and anaplastic cancers are diagnosed significantly less frequently. This study aimed to show the characteristics of malignant thyroid tumors. In this retrospective study, we analyzed data from 320 patients who underwent thyroid surgery from January 2018 to December 2019. We recorded and statistically analyzed basic demographic data, data of the cytological and pathohistological findings, and tumor characteristics (size, multifocality, extrathyroidal and lymphovascular invasion). Thyroid cancer was diagnosed in 95 patients. The incidence of thyroid cancer was higher in women than in men, but without a significant difference (p=0.46). There was a significant difference between preoperative cytological findings and definitive pathohistological diagnosis (p=0.001). There was no significant difference between genders in tumor size, extrathyroidal and lymphovascular invasion, and multifocality. There were significantly more thyroid cancers with a lymphovascular invasion that were less than 2 cm in size (p=0.04). In our opinion, it is important to emphasize the value of early diagnostics and analysis of the malignant tumor characteristics that are major prognostic factors for survival in patients with thyroid cancer.
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Affiliation(s)
- Ivan Abičić
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Tin Prpić
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Vjeran Bogović
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Stjepan Grga Milanković
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Hrvoje Mihalj
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Andrijana Včeva
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Željko Zubčić
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Anamarija Šestak
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Matej Rezo
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
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11
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Linhares SM, Handelsman R, Picado O, Farrá JC, Lew JI. Fine needle aspiration and the Bethesda system: Correlation with histopathology in 1,228 surgical patients. Surgery 2021; 170:1364-1368. [PMID: 34134896 DOI: 10.1016/j.surg.2021.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fine-needle aspiration combined with the Bethesda System for Reporting Thyroid Cytopathology is indispensable in the diagnostic evaluation of thyroid nodules. Their increased detection over the last few decades mandates the determination of which thyroid nodules require surgical management for malignancy. This study examines the correlation of fine-needle aspiration to final histopathology of dominant thyroid nodules in a large series of surgical patients undergoing thyroidectomy at a single academic institution. METHODS A retrospective review of prospectively collected data of 1,228 patients who underwent fine-needle aspiration for a dominant thyroid nodule and thyroidectomy from a single institution between 2010 and 2019 was performed. The cases were stratified into all 6 Bethesda categories. Fine-needle aspiration results were compared to index thyroid nodule malignancy on final histopathology. RESULTS Of 1,228 patients who underwent thyroidectomy, the overall malignancy rate was 53%. When fine-needle aspiration was stratified by the Bethesda System for Reporting Thyroid Cytopathology, malignancy rate was 29% for nondiagnostic; 11% for benign; 51% for atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS); 47% for follicular neoplasm/suspicious for follicular neoplasm (FN/SFN); 84% for suspicious for malignancy (SFM); and 98% for malignant results on final histopathology. There was a false positive rate of 1% and false negative rate ranging from 7 to 11%. CONCLUSION Fine-needle aspiration of a dominant thyroid nodule in patients who underwent thyroidectomy had an overall malignancy rate of 53%. False negative and false positive rates are within the reported range in surgical patient populations. The majority of patients with AUS/FLUS, FN/SFN and SFM results with underlying malignancy received the appropriate surgical resection.
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Affiliation(s)
- Samantha M Linhares
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL.
| | - Rachel Handelsman
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
| | - Omar Picado
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
| | - Josefina C Farrá
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
| | - John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
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12
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Alshathry AH, Almeshari NZ, Alarifi AS, Aleidy AM, Aldhahri S. The Prevalence of Thyroid Papillary Microcarcinoma in Patients With Benign Thyroid Fine Needle Aspiration. Cureus 2020; 12:e11820. [PMID: 33274171 PMCID: PMC7707137 DOI: 10.7759/cureus.11820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Aksu A, Karahan Şen NP, Acar E, Çapa Kaya G. Evaluating Focal 18F-FDG Uptake in Thyroid Gland with Radiomics. Nucl Med Mol Imaging 2020; 54:241-248. [PMID: 33088353 DOI: 10.1007/s13139-020-00659-2] [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] [Received: 03/28/2020] [Revised: 07/17/2020] [Accepted: 07/23/2020] [Indexed: 01/14/2023] Open
Abstract
Purpose The aim of this study was to evaluate the ability of 18F-FDG PET/CT texture analysis to predict the exact pathological outcome of thyroid incidentalomas. Methods 18F-FDG PET/CT images between March 2010 and September 2018 were retrospectively reviewed in patients with focal 18F-FDG uptake in the thyroid gland and who underwent fine needle aspiration biopsy from this area. The focal uptake in the thyroid gland was drawn in 3D with 40% SUVmax threshold. Features were extracted from volume of interest (VOI) using the LIFEx package. The features obtained were compared in benign and malignant groups, and statistically significant variables were evaluated by receiver operating curve (ROC) analysis. The correlation between the variables with area under curve (AUC) value over 0.7 was examined; variables with correlation coefficient less than 0.6 were evaluated with machine learning algorithms. Results Sixty patients (70% train set, 30% test set) were included in the study. In univariate analysis, a statistically significant difference was observed in 6 conventional parameters, 5 first-, and 16 second-order features between benign and malignant groups in train set (p < 0.05). The feature with the highest benign-malignant discriminating power was GLRLMRLNU (AUC:0.827). AUC value of SUVmax was calculated as 0.758. GLRLMRLNU and SUVmax were evaluated to build a model to predict the exact pathology outcome. Random forest algorithm showed the best accuracy and AUC (78.6% and 0.849, respectively). Conclusion In the differentiation of benign-malignant thyroid incidentalomas, GLRLMRLNU and SUVmax combination may be more useful than SUVmax to predict the outcome.
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Affiliation(s)
- Ayşegül Aksu
- Department of Nuclear Medicine, School of Medicine, Dokuz Eylul University, İzmir, Turkey
| | | | - Emine Acar
- Department of Nuclear Medicine, Kent Hospital, İzmir, Turkey.,Department of Translational Oncology, Institute of Health Sciences, Dokuz Eylul University, İzmir, Turkey
| | - Gamze Çapa Kaya
- Department of Nuclear Medicine, School of Medicine, Dokuz Eylul University, İzmir, Turkey
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14
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Poller DN, Doyle V, Trimboli P, Bongiovanni M. Rates of Thy 1-non-diagnostic thyroid fine needle aspiration using the UK Royal College of Pathologists Thy Terminology. A systematic review of the literature comparing patients who undergo rapid on-site evaluation and those who do not. Cytopathology 2020; 31:502-508. [PMID: 32003044 DOI: 10.1111/cyt.12804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/08/2020] [Accepted: 01/27/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The UK Royal College of Pathologists (RCPath) Thy terminology is an internationally recognised system for reporting thyroid fine needle aspiration. The terminology has been used throughout the UK and Ireland, in some parts of Italy and Switzerland, and elsewhere in the world. There is no systematic review of the literature specifically addressing the use of the non-diagnostic for cytological diagnosis-Thy1/Thy 1c category in the UK RCPath terminology. METHODS A comprehensive literature search of online databases was conducted in October 2019 specifically examining overall reported rates of Thy1 and Thy1c in aspirates classified according to the UK Thy terminology. RESULTS Twenty-five articles were identified showing a Thy1 rate of 13.4% (2540/18 920). The studies were then stratified according to whether or not the patients underwent rapid on-site evaluation (ROSE): 6.0% (353/5841; range 3.0%-10.9%) of ROSE aspirates were Thy1 whereas 18.5% (2072/11 204; range 7.9%-43.3%) of non-ROSE patients were Thy1; (P < .05). Three studies from 2016 reported Thy1c rates of 5.4%, 6.5% and 10.6%, respectively, implying Thy1 rates excluding Thy1c aspirates of 20.9%, 8.7% and 12.7%, respectively. CONCLUSION This systematic review of the literature shows relatively high rates of aspirates non-diagnostic for cytological diagnosis-Thy1 in the peer-reviewed published literature using the UK terminology. Utilisation of ROSE appears to produce lower rates of Thy1 aspirates and ROSE should be considered if rates of non-diagnostic for cytological diagnosis-Thy1/Thy 1c are high.
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Affiliation(s)
- David N Poller
- Department of Pathology, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - Victoria Doyle
- Department of Pathology, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Cantonal Hospital Authority, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, Universita della Svizzera Italiana (USI), Lugano, Switzerland
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15
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Barasa M, Abdallah A. Cyto-histologic discordancy in patients undergoing thyroidectomy at Aga Khan University Hospital. Pan Afr Med J 2019; 32:135. [PMID: 31303908 PMCID: PMC6607341 DOI: 10.11604/pamj.2019.32.135.16524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 12/27/2018] [Indexed: 11/24/2022] Open
Abstract
Fine needle aspiration cytology (FNAC) findings are the basis upon which decision and type surgery is made. Therefore the diagnostic accuracy and utility of FNAC being such an integral tool in management of thyroid lesions must be evaluated for cyto-histologic discrepancy from time to time as a quality assurance measure. The objective was to compare thyroid fine-needle aspiration cytology (FNAC) with final histopathological findings at in patients undergoing thyroidectomy. This was a cross-sectional retrospective study at Aga Khan university hospital, Nairobi. Cyto-histologic discrepancy was found in 19(25%) of cases with false positive and negative rates at 9% and 16%. False positive results constituted 7(9%) while 12(16%) were false negative findings. The higher cyto-histological discordancy than seen previous studies could be due to sampling error and cytological mis-interpretation. Our study found higher than expected cyto-histologic discrepancy.
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Affiliation(s)
- Moses Barasa
- General Surgery, Aga Khan University, Nairobi, Kenya
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16
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Wang Z, Lv J, Zou X, Huang Z, Zhang H, Liu Q, Jiang L, Zhou X, Zhu W. A three plasma microRNA signature for papillary thyroid carcinoma diagnosis in Chinese patients. Gene 2019; 693:37-45. [PMID: 30684524 DOI: 10.1016/j.gene.2019.01.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/17/2018] [Accepted: 01/11/2019] [Indexed: 01/07/2023]
Abstract
Whether plasma miRNAs could be used as novel non-invasive biomarkers in diagnosing papillary thyroid carcinoma (PTC) remains unknown. In this study, we designed a four-phase study to identify differentially expressed plasma miRNAs in Chinese PTC patients. Exiqon panel was initially utilized to conduct plasma miRNA profile (3 PTC pools VS. 1 healthy control (HC) pool; each 10 samples were pooled as 1 sample). The dysregulated miRNAs were then analyzed in the training (30 PTC VS. 30 HCs), testing (57 PTC VS. 54 HCs) and external validation phases (33 PTC VS. 30HCs). The identified miRNAs were further affirmed in benign nodules (2 nodular goiter (NG) pool VS. 1 HC pool). We also verified the expression of identified miRNAs in 17 matched malignant and normal tissue samples, NG plasma samples (29 PTC VS. 29 NG) and plasma exosomes (25 PTC VS. 25 HCs). Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic value of the identified miRNAs. As a result, the screening phase demonstrated 30 dysregulated plasma miRNAs in PTC patients compared with HCs. After multiphase experiment processes, miR-346, miR-10a-5p and miR-34a-5p were found significantly elevated in PTC plasma samples relative to HCs. The areas under the ROC curve (AUC) of the three-miRNA panel for the training, testing and validation phases were 0.926, 0.811 and 0.816, separately. The panel could also differentiate PTC from NG with the AUC of 0.877. MiR-346 and miR-34a-5p but not miR-10a-5p were up-regulated in PTC tissues. And the three miRNAs showed consistently up-regulation in PTC plasma exosomes. In conclusion, our study established a three-miRNA panel in plasma with considerable clinical value in discriminating PTC from HC or NG.
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Affiliation(s)
- Zhiyan Wang
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, PR China; Department of Pediatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, PR China
| | - Jinru Lv
- Department of Emergency, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, PR China
| | - Xuan Zou
- First Clinical College of Nanjing Medical University, 140 Hanzhong Road, Nanjing 210029, PR China
| | - Zebo Huang
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, PR China; Department of Oncology, The Affiliated Hospital of Jiangnan University, 200 Huihe Road, Wuxi 214062, Jiangsu Province, PR China
| | - Huo Zhang
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, PR China
| | - Qingxie Liu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, PR China
| | - Lin Jiang
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, PR China.
| | - Xin Zhou
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, PR China.
| | - Wei Zhu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, PR China; Department of Oncology, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, No.1399 West Road, Shengze Town, Wujiang District, Suzhou 215000, China.
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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.
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Affiliation(s)
| | - Chau Hung Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
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18
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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.
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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
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Emre A, Akbulut S, Sertkaya M, Bitiren M, Kale IT, Bulbuloglu E, Colak C. Assessment of clinical and pathological features of patients who underwent thyroid surgery: A retrospective clinical study. World J Clin Cases 2018; 6:20-26. [PMID: 29564354 PMCID: PMC5852395 DOI: 10.12998/wjcc.v6.i3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/31/2017] [Accepted: 02/28/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate whether there was any correlation between the clinical parameters and final pathological results among patients who underwent thyroid surgery.
METHODS We retrospectively analyzed parameters, including age, sex, complete blood cell count parameters, nodule diameter, nodule localization, thyroid function testing, and pathology reports, in patients who underwent thyroid surgery. The patients were divided into malignant (n = 92) and benign (n = 413) groups depending on the final pathological results. Both groups were compared for demographic and clinical parameters. The Kolmogorov-Smirnov normality test was used to determine if the quantitative variables had a normal distribution. The nonparametric Mann-Whitney U test was used to compare quantitative data that were not normally distributed, and Pearson’s chi-squared test was used to compare the qualitative data. The correlation between the final pathological results and fine-needle aspiration biopsy findings was calculated using the cross-tabulation method.
RESULTS This study included 406 women and 99 men aged between 15 and 85 years. No significant differences were found between the groups with respect to age, sex, white blood cell count, neutrophil count, lymphocyte count, thrombocyte count, red cell distribution width, platelet distribution width, mean platelet volume, platecrit, nodule localization, and thyroid function testing. On the other hand, there were significant differences between the groups with respect to nodule size (P = 0.001), cervical lymphadenopathy (P = 0.0001) and nodular calcification (P = 0.0001). Compared with the malignant group, the benign group had a significantly greater nodule size (35.4 mm vs 27.6 mm). The best cut-off point (≤ 28 mm) for nodule size, as determined by the receiver operating characteristic curve, had a sensitivity and specificity of 67.7% and 64.4%, respectively. The correlation between fine-needle aspiration biopsy and the final pathological results was assessed using the cross-table method. The sensitivity and specificity of fine-needle aspiration biopsy were 60% and 98%, respectively.
CONCLUSION This study showed that significant differences existed between the malignant and benign groups with regard to nodule size, cervical lymphadenopathy, and nodular calcification.
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Affiliation(s)
- Arif Emre
- Department of Surgery, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras 46040, Turkey
| | - Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Mehmet Sertkaya
- Department of Surgery, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras 46040, Turkey
| | - Muharrem Bitiren
- Department of Pathology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras 46100, Turkey
| | - Ilhami Taner Kale
- Department of Surgery, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras 46040, Turkey
| | - Ertan Bulbuloglu
- Department of Surgery, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras 46040, Turkey
| | - Cemil Colak
- Department of Biostatistics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
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Incidence of differentiated thyroid carcinoma in multinodular goiter patients. INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Agarwal S, Jain D. Thyroid Cytology in India: Contemporary Review and Meta-analysis. J Pathol Transl Med 2017; 51:533-547. [PMID: 28994274 PMCID: PMC5700878 DOI: 10.4132/jptm.2017.08.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 08/04/2017] [Indexed: 12/29/2022] Open
Abstract
Fine-needle aspiration cytology (FNAC) is a screening test for triaging thyroid nodules, aiding in subsequent clinical management. However, the advantages have been overshadowed by the multiplicity of reporting systems and a wide range of nomenclature used. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was formulated in 2007, to give the world a uniform thyroid cytology reporting system, facilitating easy interpretation by the clinicians. Here, we review the status of thyroid FNAC in India in terms of various reporting systems used including a meta-analysis of the previously published data. An extensive literature search was performed using internet search engines. The reports with detailed classification system used in thyroid cytology were included. The meta-analysis of published data was compared with the implied risk of malignancy by TBSRTC. More than 50 studies were retrieved and evaluated. TBSRTC is currently the most widely used reporting system with different studies showing good efficacy and interobserver concordance. Ancillary techniques have, as of now, limited applicability and acceptability in thyroid cytology in India. Twenty-eight published articles met the criteria for inclusion in the meta-analysis. When compared with TBSRTC recommendations, the meta-analysis showed a higher risk of malignancy for categories I and III. Thyroid FNAC is practiced all over India. TBSRTC has found widespread acceptance, with most institutions using this system for routine thyroid cytology reporting. However, reasons for a high malignancy risk for categories I and III need to be looked into. Various possible contributing factors are discussed in the review.
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Affiliation(s)
- Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Gan TRX, Nga ME, Lum JHY, Wong WM, Tan WB, Parameswaran R, Ngiam KY. Thyroid cytology-nuclear versus architectural atypia within the “Atypia of undetermined significance/follicular lesion of undetermined significance” Bethesda category have significantly different rates of malignancy. Cancer Cytopathol 2017; 125:245-256. [DOI: 10.1002/cncy.21823] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 12/18/2016] [Accepted: 12/21/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Tiffany Rui Xuan Gan
- Yong Loo Lin School of Medicine, Department of Surgery; National University of Singapore; Singapore
| | - Min En Nga
- Department of Pathology; National University Hospital; Singapore
| | | | - Wendy Meihua Wong
- Division of Thyroid and Endocrine Surgery, Department of Surgery; National University Hospital; Singapore
| | - Wee Boon Tan
- Division of Thyroid and Endocrine Surgery, Department of Surgery; National University Hospital; Singapore
| | - Rajeev Parameswaran
- Division of Thyroid and Endocrine Surgery, Department of Surgery; National University Hospital; Singapore
| | - Kee Yuan Ngiam
- Division of Thyroid and Endocrine Surgery, Department of Surgery; National University Hospital; Singapore
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Cai H, Qiao Y, Xi H, Luo Q, Yuan X, Yang Y, Lv Z. Is TSH necessary for initial assessment of thyroid nodules? Clin Endocrinol (Oxf) 2017; 86:263-269. [PMID: 27581500 DOI: 10.1111/cen.13178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/18/2016] [Accepted: 08/30/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The use of thyrotropin (TSH) in the initial assessment of thyroid nodules is inefficient and leads to unnecessary assessment costs. We compared the total costs of thyroid nodule assessment with or without the use of TSH in the initial assessment. METHODS A total of 1808 patients with thyroid nodules received TSH, fine-needle aspiration (FNA) and thyroid scintigraphy (TS) assessment, including 83 autonomously functioning thyroid nodule (AFTN) cases and 1725 non-AFTN cases. The total costs of the TSH strategy and non-TSH strategies were compared. The ratio of single-use costs of FNA to TS (CFNA/TS ) was used as the main outcome measure. RESULTS Only when 6·03 ≤ CFNA/TS ≤ 27·17, the lowest total costs were associated with using the conventional TSH strategy. When CFNA/TS <6·03 or CFNA/TS >27·17, the lowest costs were found with FNA and TS, respectively. CONCLUSION From the perspective of cost economics, in iodine-sufficient areas, we recommend that the decision on the use of TSH for the initial assessment of thyroid nodules should be based on the testing costs of FNA and TS in that medical unit.
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Affiliation(s)
- Haidong Cai
- Department of Nuclear Medicine, Tongji University School of Medicine, Shanghai Tenth People's Hospital, Shanghai, China
| | - Yu Qiao
- Department of Blood Transfusion, Changhai Hospital, Shanghai, China
| | - Hao Xi
- Department of Pathology, Tongji University School of Medicine, Shanghai Tenth People's Hospital, Shanghai, China
| | - Qiong Luo
- Department of Nuclear Medicine, Tongji University School of Medicine, Shanghai Tenth People's Hospital, Shanghai, China
| | - Xueyu Yuan
- Department of Nuclear Medicine, Tongji University School of Medicine, Shanghai Tenth People's Hospital, Shanghai, China
| | - Yuehua Yang
- Department of Nuclear Medicine, Tongji University School of Medicine, Shanghai Tenth People's Hospital, Shanghai, China
| | - Zhongwei Lv
- Department of Nuclear Medicine, Tongji University School of Medicine, Shanghai Tenth People's Hospital, Shanghai, China
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