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Nabahati M, Moazezi Z, Fartookzadeh S, Mehraeen R, Ghaemian N, Sharbatdaran M. The comparison of accuracy of ultrasonographic features versus ultrasound-guided fine-needle aspiration cytology in diagnosis of malignant thyroid nodules. J Ultrasound 2019; 22:315-321. [PMID: 30972642 DOI: 10.1007/s40477-019-00377-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/02/2019] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To compare the diagnostic accuracy of sonographic features with ultrasound-guided fine-needle aspiration (FNA) cytology in the detection of malignant thyroid nodules. METHODS This analytical cross-sectional study was conducted on patients with the diagnosis of thyroid nodule, who underwent ultrasound-guided FNA in Shahid Beheshti teaching hospital, Babol, northern Iran, between 2015 and 2017. The characteristics of the nodules obtained from ultrasonography were recorded. Regression analysis was used to assess the relation between sonographic findings and malignancy. We also used a receiver operator characteristics analysis to estimate the ability of ultrasound to predict the characteristic features of malignancy, as estimated by the area under the curve. RESULTS In total, 898 thyroid nodules were included in the study, of which 55 (6.1%) were malignant and 843 (93.9%) were benign. There were significant positive associations between malignancy and hypoechogenicity [odds ratio (OR) 3.577, 95% confidence interval (CI) 2.045-6.256], fine calcification (OR 5.849, 95% CI 2.642-12.949), irregular margin (OR 4.366, 95% CI 2.284-8.345) and taller-than-wide shape (OR 5.199, 95% CI 2.125-12.721). The overall accuracies of hypoechogenicity, irregular margin, taller-than-wide shape and fine calcification were 0.804, 0.729, 0.705 and 0.575, respectively. CONCLUSION According to the present study, the use of ultrasonography (along with ultrasound-guided FNA) is very effective in the diagnosis, follow-up, and indication for surgery of a thyroid nodule.
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Affiliation(s)
- Mehrdad Nabahati
- Department of Radiology, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Zoleika Moazezi
- Department of Endocrinology, Rohani Hospital, Babol University of Medical Sciences, Ganjafrooz Street, Babol, Mazandaran, 47176-47745, Iran.
| | - Soude Fartookzadeh
- Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Rahele Mehraeen
- Department of Radiology, Rohani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Naser Ghaemian
- Department of Radiology, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Majid Sharbatdaran
- Department of Pathology, Rohani Hospital, Babol University of Medical Sciences, Babol, Iran
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Neagoe OC, Ionica M, Mazilu O. Cervical ultrasound assessment of thyroid nodules at risk of malignancy: single-center experience. G Chir 2017; 38:233-238. [PMID: 29280703 DOI: 10.11138/gchir/2017.38.5.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The increasing diagnosis of thyroid nodules makes proper assessment of their nature and course of treatment essential, considering that thyroidectomy may be unnecessary and only contribute to higher healthcare system costs. Although criteria have been proposed for the stratification of these patients according to risk by use of cervical ultrasound and fine needle aspiration biopsy (FNAB), not all medical units may be equipped or have access to trained medical professionals to perform FNAB. The aim of this study was to show that cervical ultrasound may be sufficient for the evaluation of thyroid nodules in the treatment decision-making process. PATIENTS AND METHODS 206 patients with single thyroid nodules and nodular goiter were assessed through cervical ultrasound and FNAB for the correlation between pretreatment classification and final diagnosis on histological examination. RESULTS 26.5% of single nodes proved malignant on paraffin studies, as compared to only 14% of nodular goiters. FNAB recorded a sensibility of 33.3%, specificity of 93.3%, false-negative rate of 50% and false-positive rate of 12.5%, whereas cervical ultrasound recorded a sensibility of 92.3%, specificity of 75.3%, false-negative rate of 2.8% and false-positive rate of 48.9%. CONCLUSION Cervical ultrasound evaluation is a reliable method in the preoperative diagnosis of thyroid cancer patients.
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Cipolletta Campanile A, Malzone MG, Losito NS, Botti G, Chiofalo MG, Faggiano A, Siciliano R, Colao A, Pezzullo L, Fulciniti F. Accuracy of Fine Needle Cytology in Histological Prediction of Papillary Thyroid Carcinoma Variants: a Prospective Study. Endocr Pathol 2017. [PMID: 28639242 DOI: 10.1007/s12022-017-9488-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Fine needle cytology (FNC) is a crucial procedure in the preoperative diagnosis of thyroid tumors. Papillary thyroid carcinoma (PTC), in its classic variant (cPTC), is the most common malignant neoplasm of the thyroid. Several histological variants of PTC have been described, each one with its own characteristics and prognosis. The ability of FNC to identify the variants represents a challenge even for a skilled pathologist. The aim of this study was to evaluate the diagnostic cytological accuracy of FNC in PTC and to look for specific features that could predict the different variants. This was a single center prospective study on 128 patients who received a diagnosis of PTC on FNC. The smears were blindly reviewed by two cytopathologists to create a frequency score (0, 1, 2, 3) of the features for each variant. The cytological parameters were divided into three groups: architectural, nucleo-cytoplasmic, and background features. Univariate analysis was performed by chi-square test with Yates correction and Fisher exact test as appropriate. Multiple regression analysis was performed among the variables correlated at the linear correlation. The correlation study between cytology and histology showed an accuracy of FNC in classic, follicular, and oncocytic PTC variants of 63.5, 87.5, and 87% respectively. Familiarity with cytological features may allow an early diagnosis of a given PTC variant on FNC samples. This is fundamental in a preoperative evaluation for the best surgical approach and subsequent treatment.
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Affiliation(s)
- Anna Cipolletta Campanile
- Pathology and Cytopathology Unit, National Cancer Institute "Fondazione G. Pascale", via Mariano Semmola, 80131, Naples, Italy
| | - Maria Gabriella Malzone
- Pathology and Cytopathology Unit, National Cancer Institute "Fondazione G. Pascale", via Mariano Semmola, 80131, Naples, Italy.
| | - Nunzia Simona Losito
- Pathology and Cytopathology Unit, National Cancer Institute "Fondazione G. Pascale", via Mariano Semmola, 80131, Naples, Italy
| | - Gerardo Botti
- Pathology and Cytopathology Unit, National Cancer Institute "Fondazione G. Pascale", via Mariano Semmola, 80131, Naples, Italy
| | - Maria Grazia Chiofalo
- Thyroid Surgery Unit, National Cancer Institute "Fondazione G. Pascale", Naples, Italy
| | - Antongiulio Faggiano
- Thyroid Surgery Unit, National Cancer Institute "Fondazione G. Pascale", Naples, Italy
| | - Roberta Siciliano
- Department of Industrial Engineering, University of Naples "Federico II", via Claudio - 21, 80131, Naples, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Pansini - 5, 80131, Naples, Italy
| | - Luciano Pezzullo
- Thyroid Surgery Unit, National Cancer Institute "Fondazione G. Pascale", Naples, Italy
| | - Franco Fulciniti
- Clinical Cytopathology Service, Institute of Pathology, via A. Franzoni - 45, 6601, Locarno, Switzerland
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Janczak D, Pawlowski W, Dorobisz T, Janczak D, Dorobisz K, Leśniak M, Ziomek A, Chabowski M. An evaluation of the diagnostic efficacy of fine needle aspiration biopsy in patients operated for a thyroid nodular goiter. Onco Targets Ther 2016; 9:5819-5823. [PMID: 27703381 PMCID: PMC5036625 DOI: 10.2147/ott.s111275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Thyroid cancer (TC) comprises 1% of all carcinomas and is the most common malignancy of the endocrine system. The disease is more common in women, with its peak morbidity observed in 40-50-year-old patients. The main risk factors include radiation, iodine deficiency, hereditary background, and genetic mutations. Among all diagnosed thyroid nodules, 5%-30% will evolve into cancer. The gold-standard procedure in the preoperative evaluation of a nodular goiter, apart from ultrasonography, is fine needle aspiration (FNA) biopsy. The FNA biopsy is favored for its simplicity, safety, and high specificity and sensitivity rates. AIM The aim of our study was to evaluate the clinical efficacy of FNA based on the patients' register. MATERIALS AND METHODS In the Department of Surgery at the 4th Military Teaching Hospital in Wroclaw, 2,133 patients underwent thyroid surgery for thyroid goiter between 1996 and 2015. One hundred and eight cases of TC were diagnosed and of these, 66 patients had a preoperative FNA. RESULTS Fourteen FNA biopsies (21%) revealed cancer, all of which were confirmed in the postoperative histopathology, although six cases of FNA-diagnosed cancer revealed a different histological type postoperatively. Eighteen FNA biopsies (27%) were suspected of being malignant. A disturbingly high rate of "benign" FNA biopsies (32 cases; 48%) revealed TC after surgery. CONCLUSION It is of great importance that the quality and quantity of FNA biopsies that are performed have been improved, especially due to the wide adoption of the Bethesda cytological evaluation system. FNA biopsy remains an obligatory and valuable diagnostic tool in thyroid nodules, but it is still insufficient as a standard procedure. A preoperative biopsy should always be related to all the available clinical data in order to provide the best treatment option for each patient individually.
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Affiliation(s)
- Dariusz Janczak
- Department of Surgery, 4th Military Teaching Hospital; Department of Clinical Nursing, Division of Nursing in Surgical Procedures
| | | | - Tadeusz Dorobisz
- Department of Surgery, 4th Military Teaching Hospital; Department of Clinical Basics of Physiotherapy
| | - Dawid Janczak
- Department of Palliative Care Nursing, Faculty of Health Science
| | - Karolina Dorobisz
- Department of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Wroclaw, Poland
| | | | | | - Mariusz Chabowski
- Department of Surgery, 4th Military Teaching Hospital; Department of Clinical Nursing, Division of Nursing in Surgical Procedures
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Schmidt RL, Factor RE, Witt BL, Layfield LJ. Quality Appraisal of Diagnostic Accuracy Studies in Fine-Needle Aspiration Cytology: A Survey of Risk of Bias and Comparability. Arch Pathol Lab Med 2013; 137:566-575. [DOI: 10.5858/arpa.2012-0199-ra] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Context.—The quality of diagnostic accuracy studies is determined by 2 key factors: risk of bias and comparability. Bias can distort accuracy estimates and poor reporting impairs comparability. While diagnostic accuracy studies for fine-needle aspiration cytology (FNAC) are frequently published, the methodologic issues associated with this body of literature have never been reviewed.Objective.—To assess the quality of design and reporting of diagnostic test accuracy studies in FNAC.Data Sources.—Diagnostic accuracy studies were identified by a Medline (US National Library of Medicine) search. Sixty-four FNAC diagnostic test accuracy studies were randomly selected for structured review with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) survey. Studies were divided between 2 time periods: 2000-2001 and 2009-2011.Conclusions.—Diagnostic test accuracy studies of FNAC suffer from numerous deficiencies in study design, which negatively affect the reliability of accuracy estimates.
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Affiliation(s)
- Robert L. Schmidt
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
| | - Rachel E. Factor
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
| | - Benjamin L. Witt
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
| | - Lester J. Layfield
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
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Chung J, Youk JH, Kim JA, Kwak JY, Kim EK, Ryu YH, Son EJ. Initially non-diagnostic ultrasound-guided fine needle aspiration cytology of thyroid nodules: value and management. Acta Radiol 2012; 53:168-73. [PMID: 21969700 DOI: 10.1258/ar.2011.110133] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ultrasound (US)-guided fine needle aspiration cytology (FNAC) is an accurate, reliable, and simple method to identify a thyroid nodule as benign or malignant. However, non-diagnostic cytology results for thyroid nodules are a major limitation of US-guided FNAC. PURPOSE To investigate the incidence of thyroid cancer among cases with non-diagnostic results on FNAC and to provide suggestions for the management of thyroid nodules that are initially non-diagnostic by FNAC according to ultrasonographic findings. MATERIAL AND METHODS From July 2006 to December 2009, 10,317 thyroid nodules in 6684 consecutive patients underwent US-guided FNAC at our institute. Among these, 871 thyroid nodules (8.4%) were diagnosed as non-diagnostic on initial cytologic evaluation and 196 underwent a second or third FNAC. Twenty-seven thyroid nodules (18.9%) underwent surgery, while 116 thyroid nodules were cytologically confirmed as benign with no remarkable change on follow-up US were included. We retrospectively reviewed the US findings for a total of 143 thyroid nodules (123 benign nodules and 20 malignant nodules). The US features that we compared included composition, echogenicity, margin, calcifications, shape, and underlying echogenicity. RESULTS In total, thyroid cancer was diagnosed in 20 nodules (14.0%). The size of the nodule was significantly associated with malignancy (P < 0.05). Most of the sonographically probable benign nodules were found to be benign (97.6%). Suspicious nodules on US were thyroid cancer in 43.2% of cases. Marked hypoechogenicity, microlobulated or irregular margin, microcalcifications, and taller-than-wide shape were significant US findings that correlated with malignancy (P < 0.05). The diagnostic performance of ultrasound for initially non-diagnostic thyroid nodules was as follows: sensitivity of 90.0%, specificity of 65.0%, positive predictive value of 29.5%, and negative predictive value of 97.6%. CONCLUSION In terms of management of thyroid nodules with non-diagnostic FNAC cytology, US evaluation is a feasible and useful method for predicting malignancy.
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Affiliation(s)
| | | | | | | | | | - Young Hoon Ryu
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
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The Journal of Surgical Research – 2012. J Surg Res 2012. [DOI: 10.1016/j.jss.2011.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Coorough N, Hudak K, Buehler D, Selvaggi S, Sippel R, Chen H. Fine needle aspiration of the thyroid: a contemporary experience of 3981 cases. J Surg Res 2011; 170:48-51. [PMID: 21529829 DOI: 10.1016/j.jss.2011.02.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 02/07/2011] [Accepted: 02/28/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Fine needle aspiration (FNA) is an essential tool for the management of thyroid nodules. Recently, several national organizations have recommended FNA of all thyroid nodules >1 cm. With the increase use of imaging in the practice of medicine over the last decade, the number of incidentally discovered thyroid nodules is rising. Therefore, we analyzed our experience to determine if these changes in practice led to alterations in the population of patients undergoing FNA at our institution. MATERIALS AND METHODS Data were collected from 981 consecutive patients who underwent thyroid FNA at our institution between 2002 and 2009. Patients were divided in two groups: the early time period 2002-2005 (group 1) and later time period 2006-2009 (group 2). Data from the two groups were analyzed with t-test and χ(2) tests (SPSS, Inc., Chicago, IL). RESULTS Comparing the groups, the number of FNAs performed in the later time period increased significantly by 250%. Patients in the later time period (group 2) were more likely to be female and were significantly older. With regard to FNA diagnoses, the number of benign FNAs increased, while the percentage of FNAs diagnosed as malignant and as follicular neoplasm decreased. There also appears to be an increase in the incidence of thyroiditis. CONCLUSIONS The use of thyroid FNA has markedly increased during this contemporary series. This rise in thyroid FNA appears to be due to biopsy of benign thyroid nodules. With time, more females and older patients have undergone FNA, possibly reflecting the increased use of imaging studies in this patient population.
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Affiliation(s)
- Nicholas Coorough
- Department of Surgery, University of Wisconsin, Madison, Wisconsin 53792, USA
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McFadden DW, Souba WW. The Journal of Surgical Research Editorial Board – 2011. J Surg Res 2011. [DOI: 10.1016/j.jss.2011.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Miller BS. Fine needle aspiration--is there a difference in indication for use based on gender? J Surg Res 2010; 162:165-7. [PMID: 20189587 DOI: 10.1016/j.jss.2009.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Revised: 10/03/2009] [Accepted: 10/15/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Barbra S Miller
- Division of Endocrine Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA.
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