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Arslan IE, Bostan H, Hepşen S, Akhanli P, Sencar ME, Cakal E. Evaluation of the Malignancy Risk in Nodules Expanding the Thyroid Gland Capsule. Horm Metab Res 2024. [PMID: 38942051 DOI: 10.1055/a-2356-8223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
There has been an increase in the diagnosis of thyroid nodules in recent years. In addition to the well-known criteria, features that are likely to increase the risk of malignancy are in the research process. In this study, we aimed to evaluate the malignant potential of nodules that expand the thyroid capsule ultrasonographically. A total of 109 patients with thyroid capsule-expanding nodules and 288 patients with non-expanding nodules were included in the study. Demographical data, ultrasonography features, and cytology results were noted, and histopathological findings were determined in operated patients. While malignant cytology was detected in 5.5% of capsule-expanding nodules in FNAB results, this rate was 0.7% in the non-capsule expanding group (p<0.001). According to the histopathological results, the incidence of malignancy was 15.6% in the capsule-expanding nodule group, while it was 3.1% in the other group (p=0.001). As a result of logistic regression analysis, it was determined that the risk of malignancy increased by 4.44-fold (95% CI 1.4-13.8, p=0.01) in patients with capsule-expanding nodules. Other features that increased the risk of malignancy were hypoechogenicity, microcalcification, and irregular margin presence. In this study, we found that the risk of malignancy increased in nodules expanding the thyroid capsule. Based on the increasing study data on this subject, monitoring thyroid capsule expansion in nodules may take its place among the criteria for malignancy in future evaluations.
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Affiliation(s)
- Ismail Emre Arslan
- Endocrinology and Metabolism, Ministry of Health Ankara Etlik City Hospital, Ankara, Turkey
| | - Hayri Bostan
- Endocrinology and Metabolism, Ministry of Health Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkey
| | - Sema Hepşen
- Endocrinology and Metabolism, Ministry of Health Ankara Etlik City Hospital, Ankara, Turkey
| | - Pinar Akhanli
- Endocrinology and Metabolism, Erzurum Bölge Eğitim ve Araştırma Hastanesi, Erzurum, Turkey
| | - Muhammed Erkam Sencar
- Endocrinology and Metabolism, Medicana International Ankara Hospital, Ankara, Turkey
| | - Erman Cakal
- Endocrinology and Metabolism, Ministry of Health Ankara Etlik City Hospital, Ankara, Turkey
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Fei M, Zhang F, Qin L, Zheng X, Zhang B, Ouyang X. Diagnostic Significance of Ultrasound-Guided Fine-Needle Aspiration Biopsy and on-Site Assessment by Pathologists for Thyroid Micronodules. Int J Gen Med 2024; 17:315-321. [PMID: 38314197 PMCID: PMC10838513 DOI: 10.2147/ijgm.s441480] [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: 09/21/2023] [Accepted: 01/06/2024] [Indexed: 02/06/2024] Open
Abstract
Objective Ultrasound-guided fine-needle aspiration biopsy (US-FNAB) is a safe and effective method for screening malignant thyroid nodules. The purpose of this study was to compare the diagnostic effectiveness of US-FNAB for nodules of different sizes. Methods A total of 1085 patients with thyroid nodules who underwent US-FNAB between January 2021 and July 2023 were included in the study. The patients were divided into three groups based on the maximum diameter of the nodules: there were 324 patients with thyroid nodules ≤5 mm in Group A, 537 patients with thyroid nodules between 6 mm and 10 mm in Group B, and 224 patients with thyroid nodules >10 mm in Group C. The US-FNAB satisfactory specimen rate, biopsy time and cytopathological results for the three groups were collected and compared with the postoperative pathological results. Results The US-FNAB satisfactory specimen rates for Groups A, B and C were 84.57% (274/324), 90.13% (484/537) and 94.64% (212/224), respectively. The average biopsy times for Groups A, B, and C were 100.84 ± 41.58 s, 91.20 ± 32.53 s, and 79.01 ± 29.62 s, respectively. In Groups A, B, and C, 103, 192 and 73 patients, respectively, underwent surgery, and the malignancy rates were 88.35%, 85.42% and 72.6%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of US-FNAB in Group A were 78.26%, 81.82%, 97.30%, 31.03%; respectively; those in Group B were 73.78%,85.71%,96.80%, and 35.82%, respectively; and those in Group C were 75.47%, 85.00%, 93.02% and 56.67%, respectively. Conclusion The US-FNAB satisfactory specimen rate for thyroid nodules ≤5 mm was relatively low, but the size of nodules had no effect on the diagnostic sensitivity of US-FNAB; additionally, nodules ≤5 mm had a higher probability of malignancy. Therefore, it is necessary to perform US-FNAB for thyroid nodules with a diameter ≤5 mm with malignant signs.
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Affiliation(s)
- Mingjian Fei
- Department of Pathology, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People's Republic of China
| | - Fenglan Zhang
- Clinical Genomics Center, DIAN Diagnostics, Hangzhou, Zhejiang, People's Republic of China
| | - Lan Qin
- Clinical Genomics Center, DIAN Diagnostics, Hangzhou, Zhejiang, People's Republic of China
| | - Xueyong Zheng
- Department of Thyroid Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People's Republic of China
| | - Bo Zhang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People's Republic of China
| | - Xuanyi Ouyang
- Department of Ultrasonic Diagnosis, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People's Republic of China
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Matei M, Vlad MM, Golu I, Dumitru CȘ, De Scisciolo G, Matei SC. Can Routine Laboratory Tests Be Suggestive in Determining Suspicions of Malignancy in the Case of Thyroid Nodules? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1488. [PMID: 37629778 PMCID: PMC10456539 DOI: 10.3390/medicina59081488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
Background and objectives: Thyroid nodules are a common finding in clinical practice and can be either benign or malignant. The aim of this study was to compare laboratory parameters between patients with malignant thyroid nodules and those with benign thyroid nodules. Materials and methods: A total of 845 patients were included, with 251 in the study group (malignant thyroid nodules) and 594 in the control group (benign thyroid nodules). Results: Our results show that there were statistically significant differences in several laboratory parameters, including FT3, FT4, ESR, fibrinogen, WBC, and lymphocyte percentage, between the two patient groups (p < 0.05). Conclusions: These findings suggest that certain laboratory parameters may be useful in differentiating between benign and malignant thyroid nodules and could aid in the diagnosis and treatment of thyroid cancer. However, further diagnostic tests such as fine-needle aspiration biopsy and imaging studies are typically required for an accurate diagnosis. Routine laboratory tests prove most effective when combined with other diagnostic methods to identify thyroid cancer. Although not conclusive on their own, these tests significantly suggest and guide physicians to suspect malignancy in thyroid nodules. This affirmative answer to our question, "Can routine laboratory tests be suggestive in determining suspicions of malignancy in the case of thyroid nodules?" aligns with the results of our study.
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Affiliation(s)
- Mervat Matei
- Department of Doctoral Studies, “Victor Babeș” University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania;
- Endocrinology Clinic, “Pius Brînzeu” Emergency Clinical Hospital Timișoara, Liviu Rebreanu Boulevard no. 156, 300723 Timișoara, Romania; (M.M.V.); (I.G.)
| | - Mihaela Maria Vlad
- Endocrinology Clinic, “Pius Brînzeu” Emergency Clinical Hospital Timișoara, Liviu Rebreanu Boulevard no. 156, 300723 Timișoara, Romania; (M.M.V.); (I.G.)
- Endocrinology Department, “Victor Babeș” University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania
| | - Ioana Golu
- Endocrinology Clinic, “Pius Brînzeu” Emergency Clinical Hospital Timișoara, Liviu Rebreanu Boulevard no. 156, 300723 Timișoara, Romania; (M.M.V.); (I.G.)
- Endocrinology Department, “Victor Babeș” University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania
| | - Cristina Ștefania Dumitru
- Department of Microscopic Morphology/Histology, Angiogenesis Research Center, “Victor Babeș” University of Medicine and Pharmacy, Sq. Eftimie Murgu no. 2, 300041 Timișoara, Romania
| | - Graziano De Scisciolo
- Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania;
| | - Sergiu-Ciprian Matei
- Abdominal Surgery and Phlebology Research Center, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania;
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Li J, Zhang YR, Ren JY, Li QL, Zhu PS, Du TT, Ge XY, Chen M, Cui XW. Association between diagnostic efficacy of acoustic radiation force impulse for benign and malignant thyroid nodules and the presence or absence of non-papillary thyroid cancer: A meta-analysis. Front Oncol 2023; 13:1007464. [PMID: 36776305 PMCID: PMC9915625 DOI: 10.3389/fonc.2023.1007464] [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] [Received: 07/30/2022] [Accepted: 01/09/2023] [Indexed: 01/30/2023] Open
Abstract
Purpose The aim of this study was to investigate the diagnostic efficacy of Acoustic Radiation Force Impulse (ARFI) for benign and malignant thyroid nodules in the presence and absence of non-papillary thyroid cancer (NPTC) and to determine the cut-off values of Shear Wave Velocity (SWV) for the highest diagnostic efficacy of Virtual Touch Quantification (VTQ) and Virtual Touch Tissue Imaging and Quantification (VTIQ). Methods The diagnostic accuracy of ARFI for benign and malignant thyroid nodules was assessed by pooling sensitivity, specificity and area under the curve (AUC) in each group in the presence and absence of both non-papillary thyroid glands, using histology and cytology as the gold standard. All included studies were divided into two groups according to VTQ and VTIQ, and each group was ranked according to the magnitude of the SWV cutoff value to determine the SWV cutoff interval with the highest diagnostic efficacy for VTQ and VTIQ. Results A total of 57 studies were collected on the evaluation of ARFI for the diagnosis of benign and malignant thyroid nodules. The results showed that the presence of non-papillary thyroid carcinoma led to differences in the specificity of VTIQ for the identification of benign and malignant thyroid nodules, and the differences were statistically significant. In addition, the diagnostic efficacy of VTQ was best when the cutoff value of SWV was in the interval of 2.48-2.55 m/s, and the diagnostic efficacy of VTIQ was best when the cutoff value of SWV was in the interval of 3.01-3.15 m/s. Conclusion VTQ and VTIQ have a high diagnostic value for benign and malignant thyroid nodules; however, when the malignant nodules in the study contain non-papillary thyroid carcinoma occupying the thyroid gland, the findings should be viewed in a comprehensive manner.
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Affiliation(s)
- Jun Li
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China,*Correspondence: Jun Li, ; Xin Wu Cui,
| | - Yu-Rui Zhang
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Jia-Yu Ren
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiao-Li Li
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Pei-Shan Zhu
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Ting-Ting Du
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Xiao-Yan Ge
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Ming Chen
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Jun Li, ; Xin Wu Cui,
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Yildirim E, Akbas P, Erdogan KO, Bektas S, Gumuskaya PO, Er AM, Paltura C. The comparison of the histopathological results of the thyroid fine-needle aspiration biopsies in the 795 patients with thyroidectomy. Diagn Cytopathol 2021; 49:671-676. [PMID: 33560593 DOI: 10.1002/dc.24718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND We aimed to evaluate the effectiveness of preoperative fine-needle aspiration biopsies (FNAB) by the postthyroidectomy pathology results. METHOD Seven hundred and ninety-five patients with FNAB and following thyroid operations which have been performed between April 2008 and December 2019 were included in this study. By comparing the results of the FNAB and final pathologies, the specificity, sensitivity, FNR, false positivity ratio (FPR), accuracy and also the effect of nodule diameter on these have been evaluated. In Bethesda III subgroup according to FNAB, we investigated the malignancy rates and in whom this risk has been increased more. RESULTS In our study, the sensitivity of FNAB is 73.40%, the specificity is 95.33%, the accuracy is 91.81%, FNR is 26.60% and FPR is 4.67%. In the patients with nodules ≥4 cm and < 4 cm respectively, we calculated the sensitivity 20.0% vs 79.76%, specificity 95.73% vs 95.19%, accuracy 89.82% vs 92.78%, FNR 80.0% vs 20.24%, FPR 4.27% vs 4.8%. CONCLUSION Thyroid FNAB is an easy procedure with a high specificity and sensitivity. Nevertheless, when the nodule diameter was ≥4 cm, increased FNR and decreased sensitivity should be kept in mind while evaluating the patients.
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Affiliation(s)
- Emine Yildirim
- Department of General Surgery, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Pelin Akbas
- Department of Pathology, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Kivilcim Orhun Erdogan
- Department of General Surgery, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Sibel Bektas
- Department of Pathology, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Perihan Ozkan Gumuskaya
- Department of İnternal Medicine, University of Health Sciences Turkey, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ahmet Muzaffer Er
- Department of General Surgery, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Ceki Paltura
- Department of Otolaryngology, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
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Memiş U, Karadeniz E, Akçay MN, Öztürk N. Determination of galectin-3, hepsin and thyroid transcription factor-1 levels in thyroid cancer patients; A prospective case-control study. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2019. [DOI: 10.25000/acem.568773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
BACKGROUND Previous clinical studies have reported that ultrasound-guided fine needle aspiration cytology (UGFNAC) can be used for the diagnosis of thyroid nodules (TN) effectively. However, no study has systematically explored its diagnosis accuracy in patients with TN. Thus, this study will assess its diagnosis accuracy for TN. METHODS We will perform a comprehensive literature search from the following databases from their inceptions to the present without language restrictions: MEDILINE, EMBASE, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will consider all case-controlled studies investigating the impacts of UGFNAC diagnosis for patients with TN for inclusion. Two authors will independently carry out study selection, data collection, and methodological quality assessment. Quality Assessment of Diagnostic Accuracy Studies tool will be used for methodological quality evaluation. We will use RevMan V.5.3 and Stata V.12.0 software to perform statistical analysis. RESULTS We will apply sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio to judge the diagnostic accuracy of UGFNAC for TN. CONCLUSION The results of this study will provide latest evidence for the diagnostic accuracy of UGFNAC for TN. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019138805.
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Affiliation(s)
- Jing Wang
- Department of Endocrine and Metabolism
| | - Jing Liu
- Department of Laboratory, The First Hospital of Yulin, Yulin
| | - Zhe Liu
- Department of Cardiology, Yanan University Affiliated Hospital, Baota District, Yan’an, China
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Jat MA. Comparison of surgeon-performed ultrasound-guided fine needle aspiration cytology with histopathological diagnosis of thyroid nodules. Pak J Med Sci 2019; 35:1003-1007. [PMID: 31372132 PMCID: PMC6659049 DOI: 10.12669/pjms.35.4.537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To assess the Solitary thyroid nodules by surgeon- performed ultrasound-guided FNAC and evaluate with the histopathological findings. Methods: This study includes 100 Consecutive patients of a solitary thyroid nodule which were presented to the Outpatients Department of Surgery during the period of two years from September 2016 to August 2018. Exclusion criteria were patients with extra-thyroid swelling, diffuse goiter and multinodular goiter. All patients with a solitary thyroid nodule underwent Surgeon –performed ultrasound-guided FNAC in the department of Radiology. After thyroid surgery, thyroid specimens were sent for histopathology and evaluate with FNAC findings. Results: The study included hundred patients with solitary thyroid nodule, 75(75%) female and 25 (25%) male with a ratio of F 3:1M. The age of the patients ranged from 15-75 years with a mean age of 35 years. The result of 100 cases of Surgeon –performed Ultrasound –guide FNAC of a solitary thyroid nodule were inconclusive in 10 cases (10%), Non-neoplastic in 60 cases (60%) and Neoplastic lesions in 30 cases (30%). After evaluation of findings from FNAC and histopathology, four cases with benign FNAC (adenomatous/colloid Goiter) turnout as neoplastic (papillary carcinoma) on histopathology and six cases with neoplastic FNAC (papillary carcinoma), just two cases turnout as benign (nodular colloid goiter with cystic degeneration) on histopathology. In present study Surgeon – performed Us FNAC has found to be 87.5% sensitive, 95.3% specific and 92.0% diagnostic accuracy. Conclusion: Surgeon – performed Ultrasound-guided FNAC is a safe, simple and accurate technique in the diagnosis of solitary thyroid nodule.
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Affiliation(s)
- Muhammad Ayoob Jat
- Dr. Muhammad Ayoob Jat, Assistant Professor Surgery, Department of Surgery, College of Medicine, Northern Border University, Arar, KSA
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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.
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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
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Contributory Factors to Hemorrhage After Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules with an Emphasis on Patients Taking Antithrombotic or Anticoagulant Medications. IRANIAN JOURNAL OF RADIOLOGY 2018. [DOI: 10.5812/iranjradiol.57231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Nandedkar SS, Dixit M, Malukani K, Varma AV, Gambhir S. Evaluation of Thyroid Lesions by Fine-needle Aspiration Cytology According to Bethesda System and its Histopathological Correlation. Int J Appl Basic Med Res 2018; 8:76-82. [PMID: 29744318 PMCID: PMC5932928 DOI: 10.4103/ijabmr.ijabmr_169_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: The Bethesda system is a uniform reporting system for thyroid cytology that facilitates the clarity of communication among cytopathologists, radiologists, and surgeons and facilitates cytohistologic correlation for thyroid diseases. Objective: This study was carried out to evaluate thyroid lesions by fine-needle aspiration cytology (FNAC) based on Bethesda system of reporting and to correlate the cytological findings with histopathology. Materials and Methods: A total of 606 patients with thyroid lesions were studied by FNAC at our institute between January 1, 2006, and January 31, 2016, and results were compared with histopathology wherever possible. Results: Based on the Bethesda system of classification of thyroid lesions, out of 580 satisfactory samples; 501 lesions were diagnosed as benign (Group 1), five were in category of atypical follicular lesion of atypia undetermined significance (Group 2), 55 were diagnosed as suspicious for follicular neoplasm (Group 3), 7 as suspicious for malignancy (Group 4), and 12 cases were malignant (Group 5). 26 aspirates were nondiagnostic even after reaspiration. In the present study, cytohistopathological correlation was done in 148 benign and 18 malignant lesions. The sensitivity of FNAC was 85.7%, specificity 98.6%, and diagnostic accuracy 97.7%. Conclusion: Reviewing the thyroid FNAs with the Bethesda system for reporting allowed precise cytological diagnosis. It represents standardization and reproducibility in reporting thyroid cytology with improved clinical significance and greater predictive value. Nature of the disease, experience of cytopathologist, and understanding of certain limitations determine its diagnostic utility.
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Affiliation(s)
| | - Monal Dixit
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Kamal Malukani
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Amit V Varma
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Shankhini Gambhir
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
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Shi H, Bobanga I, McHenry CR. Are large thyroid nodules classified as benign on fine needle aspiration more likely to harbor cancer? Am J Surg 2017; 213:464-466. [DOI: 10.1016/j.amjsurg.2016.10.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/09/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
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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.
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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
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Yashaswini R, Suresh TN, Sagayaraj A. Cytological Evaluation of Thyroid Lesions by Nuclear Morphology and Nuclear Morphometry. J Cytol 2017; 34:197-202. [PMID: 29118474 PMCID: PMC5655656 DOI: 10.4103/joc.joc_87_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introduction: Fine needle aspiration (FNA) of the thyroid gland is an effective diagnostic method. The Bethesda system for reporting thyroid cytopathology classifies them into six categories and gives implied risk for malignancy and management protocol in each category. Though the system gives specific criteria, diagnostic dilemma still exists. Using nuclear morphometry, we can quantify the number of parameters, such as those related to nuclear size and shape. The evaluation of nuclear morphometry is not well established in thyroid cytology. Objective: To classify thyroid lesions on fine needle aspiration cytology (FNAC) using Bethesda system and to evaluate the significance of nuclear parameters in improving the prediction of thyroid malignancy. Materials and Methods: In the present study, 120 FNAC cases of thyroid lesions with histological diagnosis were included. Computerized nuclear morphometry was done on 81 cases which had confirmed cytohistological correlation, using Aperio computer software. One hundred nuclei from each case were outlined and eight nuclear parameters were analyzed. Results: In the present study, thyroid lesions were common in female with M: F ratio of 1:5 and most commonly in 40–60 yrs. Under Bethesda system, 73 (60.83%) were category II; 14 (11.6%) were category III, 3 (2.5%) were category IV, 8 (6.6%) were category V, and 22 (18.3%) were category VI, which were malignant on histopathological correlation. Sensitivity, specificity, and diagnostic accuracy of Bethesda reporting system are 62.5, 84.38, and 74.16%, respectively. Minimal nuclear diameter, maximal nuclear diameter, nuclear perimeter, and nuclear area were higher in malignant group compared to nonneoplastic and benign group. Conclusion: The Bethesda system is a useful standardized system of reporting thyroid cytopathology. It gives implied risk of malignancy. Nuclear morphometry by computerized image analysis can be utilized as an additional diagnostic tool.
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Affiliation(s)
- R Yashaswini
- Department of Pathology, Sri Devraj Urs Medical College SDUAHER, Kolar, Karnataka, India
| | - T N Suresh
- Department of Pathology, Sri Devraj Urs Medical College SDUAHER, Kolar, Karnataka, India
| | - A Sagayaraj
- Department of ENT, Sri Devraj Urs Medical College SDUAHER, Kolar, Karnataka, India
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Parisi MT, Eslamy H, Mankoff D. Management of Differentiated Thyroid Cancer in Children: Focus on the American Thyroid Association Pediatric Guidelines. Semin Nucl Med 2016; 46:147-64. [PMID: 26897719 DOI: 10.1053/j.semnuclmed.2015.10.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
First introduced in 1946, radioactive iodine (I-131) produces short-range beta radiation with a half-life of 8 days. The physical properties of I-131 combined with the high degree of uptake in the differentiated thyroid cancers (DTCs) led to the use of I-131 as a therapeutic agent for DTC in adults. There are two indications for the potential use of I-131 therapy in pediatric thyroid disorders: nonsurgical treatment of hyperthyroidism owing to Graves' disease and the treatment of children with intermediate- and high-risk DTC. However, children are not just miniature adults. Not only are children and the pediatric thyroid gland more sensitive to radiation than adults but also the biologic behavior of DTC differs between children and adults as well. As opposed to adults, children with DTC typically present with advanced disease at diagnosis; yet, they respond rapidly to therapy and have an excellent prognosis that is significantly better than that in adult counterparts with advanced disease. Unfortunately, there are also higher rates of local and distant disease recurrence in children with DTC compared with adults, mandating lifelong surveillance. Further, children have a longer life expectancy during which the adverse effects of I-131 therapy may become manifest. Recognizing the differences between adults and children with DTC, the American Thyroid Association commissioned a task force of experts who developed and recently published a guideline to address the unique issues related to the management of thyroid nodules and DTC in children. This article reviews the epidemiology, diagnosis, staging, treatment, therapy-related effects, and suggestions for surveillance in children with DTC, focusing not only on the differences between adults and children with this disease but also on the latest recommendations from the inaugural pediatric management guidelines of the American Thyroid Association.
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Affiliation(s)
- Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA; Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
| | - Hedieh Eslamy
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - David Mankoff
- Department of Nuclear Medicine, University of Pennsylvania, Philadelphia, PA
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Cesareo R, Naciu A, Barberi A, Pasqualini V, Pelle G, Manfrini S, Tabacco G, Pantano AL, Campagna G, Cianni R, Palermo A. A Rare and Severe Complication Following Thyroid Fine Needle Aspiration: Retropharyngeal Cellulitis. Int J Endocrinol Metab 2016; 14:e39174. [PMID: 28123438 PMCID: PMC5236985 DOI: 10.5812/ijem.39174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/08/2016] [Accepted: 08/15/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Fine needle aspiration (FNA) is the most accurate and cost-effective method for evaluating thyroid nodules. We have reported a rare complication related to the procedure: severe retropharyngeal cellulitis. CASE PRESENTATION A thirty-five-year-old female was admitted to hospital with hoarseness, laryngeal stridor and dyspnea without fever that emerged about 3 days after a first diagnostic FNA. After the procedure, the patient felt her voice became hoarse and 1 day before presentation began to have dyspnea, without fever. It had become difficult for her to swallow solids, and she felt as if food was sticking in her throat. In the emergency room, hematochemical tests and CT scan of the neck/mediastinum had been performed. This showed leukocytosis with neutrophilia and a severe cellulitis framework with involvement of the laterocervical neck area and in particular, the invasion of the retropharynx and the upper part of the mediastinum. The patient was admitted in hospital for an anti-inflammatory therapy with cortisone and antibiotic therapy. CONCLUSIONS For the first time to our knowledge, we have reported a severe retropharyngeal and upper mediastinum cellulitis, probably due to the FNA procedure in an immunocompetent young woman.
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Affiliation(s)
- Roberto Cesareo
- Department of Internal Medicine, S. M. Goretti Hospital, Latina, Italy
| | - Anda Naciu
- Department of Endocrinology, University Campus Bio-Medico, Rome, Italy
| | - Antonio Barberi
- Department of Radiology, S. M. Goretti Hospital, Latina, Italy
| | | | - Giuseppe Pelle
- Department of Radiology, S. M. Goretti Hospital, Latina, Italy
| | - Silvia Manfrini
- Department of Endocrinology, University Campus Bio-Medico, Rome, Italy
| | - Gaia Tabacco
- Department of Endocrinology, University Campus Bio-Medico, Rome, Italy
| | | | - Giuseppe Campagna
- Department of Internal Medicine, S. M. Goretti Hospital, Latina, Italy
| | - Roberto Cianni
- Department of Radiology, S. M. Goretti Hospital, Latina, Italy
| | - Andrea Palermo
- Department of Endocrinology, University Campus Bio-Medico, Rome, Italy
- Corresponding author: Andrea Palermo, Department of Endocrinology, University Campus Bio-Medico, Rome, Italy. Tel: +39-6225419184, Fax: +39-622541698, E-mail:
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Manuel DC, Betancourt JL, Puthanveedu ND, Kachur S, Williams SF, Cabral JM, Villabona CV, Jose TC. SHOULD FNA BE PERFORMED IN PATIENTS WITH A MULTINODULAR GOITER AND COMPRESSIVE SYMPTOMS? Endocr Pract 2016; 22:970-3. [PMID: 27042747 DOI: 10.4158/ep151149.or] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In this study, we aimed to determine whether preoperative thyroid fine-needle aspiration (FNA) in patients with multinodular goiter (MNG) and compressive symptoms influences the type of thyroid surgery performed, the incidence of recurrent thyroid cancer, or the need for successive surgery. METHODS We retrospectively reviewed the charts of 431 patients who underwent thyroidectomy at our institution from 2008 to 2011. Patients who presented with compressive symptoms and no prior FNA at initial presentation were included in this study. RESULTS Eighty patients met the criteria for our study, of which 46 (57.5%) underwent FNA prior to surgery and 34 (42.5%) were referred to surgery without FNA. The prevalence rates of malignancy (>1 cm) on surgical pathology in the FNA and non-FNA groups were 41% (n = 19) and 38% (n = 13), respectively. There was no statistically significant difference between the rate of total/subtotal thyroidectomies (71.7% in FNA vs. 79.4% in non-FNA, P = .31), lobectomies/partial thyroidectomies (28.3% in FNA vs. 20.5% in non-FNA, P = .43), neck lymph node dissections (P = .89) or subsequent surgeries (P = .72) between the 2 groups. CONCLUSION Our findings show that preoperative FNA in patients with an MNG and compressive symptoms does not influence the type of surgery performed, short-term outcomes, or the need for subsequent surgeries. Further studies are needed to validate the need for preoperative FNA in such patients. ABBREVIATIONS FNA = fine-needle aspiration MNG = multinodular goiter WHO = World Health Organization.
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Gill KS, Tassone P, Hamilton J, Hjelm N, Luginbuhl A, Cognetti D, Tuluc M, Martinez-Outschoorn U, Johnson JM, Curry JM. Thyroid Cancer Metabolism: A Review. JOURNAL OF THYROID DISORDERS & THERAPY 2016; 5:200. [PMID: 27213120 PMCID: PMC4874252 DOI: 10.4172/2167-7948.1000200] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Metabolic dysregulation within the tumor microenvironment (TME) is critical to the process of tumorigenesis in various cancer types. Thyrocyte metabolism in papillary and anaplastic thyroid cancer, however, remains poorly characterized, and studies analyzing the role of multicompartment metabolism in thyrocyte oncogenesis are sparse. We present a review of the current knowledge on cellular metabolism in non-cancerous and cancerous thyroid tissues, focusing on the monocarboxylate transporters MCT1 and MCT4, and on a transporter of the outer mitochondrial membrane TOMM20. Understanding the metabolic phenotype of tumor cells and associated stromal cells in thyroid cancer can have profound implications on the use of biomarker staining in detecting subclinical cancer, imaging as it relates to expression of various transport proteins, and therapeutic interventions that manipulate this dysregulated tumor metabolism to halt tumorigenesis and eradicate the cancer. Future studies are required to confirm the prognostic significance of these biomarkers and their correlation with existing staging schemas such as the AGES, AMES, ATA and MACIS scoring systems.
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Affiliation(s)
- Kurren S Gill
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, USA
| | - Patrick Tassone
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, USA
| | - James Hamilton
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, USA
| | - Nikolaus Hjelm
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, USA
| | - Adam Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, USA
| | - David Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, USA
| | - Madalina Tuluc
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, USA
| | | | - Jennifer M Johnson
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, USA
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, USA
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Kim SJ, Chang S. Predictive value of intratumoral heterogeneity of F-18 FDG uptake for characterization of thyroid nodules according to Bethesda categories of fine needle aspiration biopsy results. Endocrine 2015; 50:681-8. [PMID: 25948075 DOI: 10.1007/s12020-015-0620-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/27/2015] [Indexed: 01/21/2023]
Abstract
The current study was aimed to investigate the clinical value of intratumoral heterogeneity of F-18 FDG uptake for characterization of thyroid nodule (TN) with inconclusive fine-needle aspiration biopsy (FNAB) results. The current study enrolled 200 patients who showed F-18 FDG incidentaloma and were performed FNAB. The intratumoral heterogeneity of F-18 FDG uptake was represented as the heterogeneity factor (HF), defined as the derivative (dV/dT) of a volume-threshold function for a primary tumor. The diagnostic and predictive values of HF and F-18 FDG PET/CT parameters were evaluated for characterization of inconclusive FNAB results. Among F-18 FDG PET/CT parameters, SUVmax, MTV, and TLG of malignant group were statistically higher than those of Bethesda category of suspicious malignant group. However, HF values were not statistically different between the groups of Bethesda categories (Kruskal-Wallis statistics, 9.924; p = 0.0774). In ROC analysis, when HF > 2.751 was used as cut-off value, the sensitivity and specificity for prediction of malignant TN were 100 % (95 % CI 69.2-100 %) and 60 % (95 % CI 42.1-76.1 %), respectively. The AUC was 0.826 (95 % CI 0.684-0.922) and standard error was 0.0648 (p < 0.0001). In conclusion, the intratumoral heterogeneity of F-18 FDG uptake represented by HF could be a predictor for characterization of TN with inconclusive FNAB results. Additional large population-based prospective studies are needed to validate the diagnostic utility of HF of F-18 FDG PET/CT.
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Affiliation(s)
- Seong-Jang Kim
- Department of Nuclear Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739, Republic of Korea.
- Biomedical Research Institute, Pusan National University Hospital, Busan, 602-739, Republic of Korea.
| | - Samuel Chang
- Department of Radiology, University of Colorado School of Medicine, 12401, 17th Ave, Aurora, CO, 80045, USA
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20
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Lai SW, Roberts DJ, Rabi DM, Winston KY. Diagnostic accuracy of fine needle aspiration biopsy for detection of malignancy in pediatric thyroid nodules: protocol for a systematic review and meta-analysis. Syst Rev 2015; 4:120. [PMID: 26399232 PMCID: PMC4581518 DOI: 10.1186/s13643-015-0109-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 09/04/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Fine needle aspiration biopsy (FNAB) is an accurate test commonly used to determine whether thyroid nodules are malignant in adults. However, less is known about its diagnostic accuracy for this purpose in children, where conduct of FNAB is less frequent, more technically challenging, and pre-test probabilities of malignancy are often higher. The purpose of this systematic review is to evaluate the diagnostic accuracy of FNAB for the detection of malignancy in pediatric thyroid nodules. METHODS We will search electronic bibliographic databases (MEDLINE, EMBASE, the Cochrane Library, and Evidence-Based Medicine) from their date of inception, reference lists of included articles, proceedings from relevant conferences, and the table of contents of the Journal of Pediatric Surgery (January 2007-present). Two reviewers will independently screen titles and abstracts and identify diagnostic accuracy studies involving FNAB of the thyroid in children. We will include studies comparing FNAB to a reference standard of surgical histopathology or clinical follow-up for detection of malignancy in pediatric thyroid nodules. Two investigators will independently extract data and assess risk of bias using the Quality of Diagnostic Accuracy Studies-II tool. Pooled estimates of sensitivity, specificity, and positive and negative likelihood ratios will be calculated using bivariate random-effects and hierarchical summary receiver operating characteristic models. In the presence of between-study heterogeneity, we will conduct stratified meta-analyses and meta-regression to determine whether diagnostic accuracy estimates vary by country of origin, use of ultrasound guidance during FNAB, qualifications of the individuals performing/interpreting FNAB, adherence to the Bethesda criteria for cytology classification, length of clinical follow-up, timing of data collection, patient selection methods, and presence of verification bias. DISCUSSION This meta-analysis will determine the diagnostic accuracy of FNAB for detection of malignancy in pediatric thyroid nodules and explore whether heterogeneity observed across studies may be explained by variations in patient population, FNAB technique or interpretation, and/or study-level risks of bias. This will be the first study to determine the accuracy of Bethesda cytological classification levels of FNAB (benign, atypical, follicular, suspicious, malignant). We expect that our results will help in guiding clinical decision-making in children with thyroid nodules. SYSTEMATIC REVIEW REGISTRATION PROSPERO No. CRD42014007140.
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Affiliation(s)
- Sarah W Lai
- Department of Surgery, University of Calgary, Calgary, AB, Canada. .,Department of Gastrointestinal Sciences, University of Calgary, Calgary, AB, Canada. .,Department of Pediatric Surgery, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB, Canada, T3B 6A8.
| | - Derek J Roberts
- Department of Surgery, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. .,Intensive Care Unit Administration, Ground Floor McCaig Tower, Foothills Medical Centre, 3134 Hospital Drive NW, Calgary, AB, Canada, T2N 5A1.
| | - Doreen M Rabi
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Karin Y Winston
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. .,Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
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Gandhi A, Ranganathan B, Thiryayi S, Rowland M, Yap B. Variations in single/two stage thyroidectomies for cancer may be due to differences in thyroid fine needle cytology provision. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2015; 41:1033-8. [DOI: 10.1016/j.ejso.2015.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 04/06/2015] [Accepted: 04/18/2015] [Indexed: 10/23/2022]
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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.
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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.
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Deniwar A, Hambleton C, Thethi T, Moroz K, Kandil E. Examining the Bethesda criteria risk stratification of thyroid nodules. Pathol Res Pract 2015; 211:345-8. [PMID: 25796296 DOI: 10.1016/j.prp.2015.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 01/05/2015] [Accepted: 02/04/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND The Bethesda criteria are proposed for appropriate stratification of malignancy risk in thyroid nodules, but controversy exists regarding their accuracy and reliability in decision making. Additionally, previous studies have suggested higher rates of both malignancy and false negative fine needle aspiration biopsy (FNA) associated with increasing nodule size. This study aims to determine the accuracy of ultrasound (US)-guided FNA using the current Bethesda criteria in surgical practice. We also aimed to investigate the relationship between nodule size and malignancy. METHODS A retrospective analysis of US-guided FNAs by a single surgeon during a 4.5 year period. FNA results using Bethesda criteria were compared to final surgical pathology. RESULTS 611 patients with thyroid nodules underwent US-guided FNA. FNA results in 375 subsequently excised thyroid nodules were recorded according to the Bethesda criteria: 192 (51%) benign, 65 (17%) atypia of unknown significance/follicular lesion of undetermined significance (AUS/FLUS), 42 (11%), suspicious for follicular neoplasm (SFN), 17 (5%) suspicious for malignancy (SM), 28 (8%) malignancy, and 31 (8%) non-diagnostic. Malignancy was confirmed by surgical pathology in 15%, 34%, 50%, 88%, 100%, and 39% of the above groups respectively. Sensitivity, specificity, and false-negative rate were 61%, 99%, and 15% respectively. No correlation existed between the size of nodules with indeterminate FNA results and malignancy rate (p=0.89), or size of nodules with non-diagnostic FNA and malignancy rate (p=0.50). CONCLUSION The current Bethesda risk stratification system underestimated malignancy rates in benign, indeterminate and non-diagnostic cytopathologic categories in our experience. There was no positive linear correlation between nodule size and malignancy rate in these cytopathologic categories.
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Affiliation(s)
- Ahmed Deniwar
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States.
| | - Catherine Hambleton
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States.
| | - Tina Thethi
- Division of Endocrinology and Metabolism, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States.
| | - Krzysztof Moroz
- Department of Pathology, Tulane University School of Medicine, New Orleans, LA, United States.
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States.
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Elsharkawy SL, AbdEl-Aal WE, Esmal RS, Ali HH, Mahfouz SM, El-Habashi A. Preoperative Evaluation of Thyroid Epithelial Lesions by DNA Ploidy and Galectin-3 Expression in FNAC. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.105] [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
AIM: This study aimed to investigate the value of DNA ploidy and galectins-3 immunostain in the preoperative evaluation of thyroid epithelial lesions.MATERIAL AND METHODS: Sixty patients presenting with thyroid enlargement were included in this study and referred by clinicians for FNA. Routine cytological evaluation was done on PAP  stained slides according to the WHO criteria and at least three slides were prepared for routine cytological examinations. The nuclear DNA analysis was performed at the Pathology Department, National Research Center using the Leica Qwin 500 Image Analyzer (LEICA Imaging Systems Ltd, Cambridge, England). Galectin-3 expression was investigated in all tissues using streptavidin-biotin technique.RESULTS: Conventional Fine needle aspiration cytology (FNAC) of 60 cases could diagnose malignancy with a sensitivity of 60%, negative predictive value (NPV) 71.4%, and overall diagnostic accuracy of 80%. The aneuploidy was significantly associated with malignancy, with sensitivity 90.9%, specificity 83.3% and accuracy 88.3%. On using galectin-3 immunocytochemichal stain on cell blocks prepared from FNA the values were improved, sensitivity 93.3% specificity 86.7% and overall accuracy 90% and it was noticed that galectin-3 over expression was significantly associated with malignancy.CONCLUSIONS: From the results of this study we can consider that DNA ploidy and Galectin-3 could refine the FNA results and increase its sensitivity as a screening test from sensitivity(60%) to reach sensitivity (93.3%), thus decreasing the false negative cases. From this study, it is concluded that the application of ancillary techniques as galectin-3 immunocytochemical markers may become a reliable indicator for surgical intervention, DNA ploidy measurements on the other hand may be of value in galectin-3 negative cases to determine the behavior of the lesion in such cases & refine the preoperative assessment by out ruling false negative cases.
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Isaac A, Jeffery CC, Seikaly H, Al-Marzouki H, Harris JR, O'Connell DA. Predictors of non-diagnostic cytology in surgeon-performed ultrasound guided fine needle aspiration of thyroid nodules. J Otolaryngol Head Neck Surg 2014; 43:48. [PMID: 25466726 PMCID: PMC4260212 DOI: 10.1186/s40463-014-0048-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 11/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fine needle aspiration (FNA) is the standard of care for the diagnostic work-up of thyroid nodules but despite its proven utility, the non-diagnostic rate for thyroid FNA ranges from 6-36%. A non-diagnostic FNA is problematic for the clinician and patient because it can result in repeated procedures, multiple physician visits, and a delay in definitive treatment. Surgeon-performed FNA has been shown to be safe, cost-effective, as accurate as those performed by other clinicians, and has the added benefit of decreasing wait times to surgery. Several studies have examined rates and factors that may be predictive of a non-diagnostic cytology in non-surgeon FNA, but none have evaluated this in surgeon-performed thyroid FNA. If these factors are unique in surgeon-performed vs. non-surgeon performed thyroid FNA, then patients may be more appropriately triaged to FNA by alternate clinicians. OBJECTIVES The purpose of this study was to determine the rate and factors predictive of a non-diagnostic FNA in surgeon performed ultrasound-guided FNA of thyroid nodules. METHODS We conducted a retrospective review of all adult patients who underwent thyroid FNA by a staff, fellow, or resident Otolaryngologist at the University of Alberta between January 2011 and June 2013. Factors analyzed included patient factors, thyroid characteristics, nodule characteristics, and surgeon level of training and experience. Univariate and multivariate binary logistic regression analysis were performed. RESULTS 131 patients (180 nodules) were reviewed. The non-diagnostic rate was 23%. Nodules with predominant cystic component, those less than 1 cm, and resident-performed FNA were associated with non-diagnostic cytology (p = 0.001, p = 0.02, p = 0.04 respectively). A cystic nodule was the only independent predictor of non-diagnostic FNA on multivariate analysis (OR = 4.441, 95% CI [1.785-11.045], p = 0.001). CONCLUSIONS The rate of non-diagnostic thyroid FNA performed by a surgeon with ultrasound guidance is similar to other clinicians. A cystic nodule is a strong independent predictor of non-diagnostic cytology. Non-cystic nodules may particularly benefit from surgeon-performed thyroid FNA due to the high diagnostic rate and potential for earlier definitive management.
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Affiliation(s)
- Andre Isaac
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, #603-10649 Saskatchewan Drive, Edmonton, AB T6E 6S8 Canada
| | - Caroline C Jeffery
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, #603-10649 Saskatchewan Drive, Edmonton, AB T6E 6S8 Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, #603-10649 Saskatchewan Drive, Edmonton, AB T6E 6S8 Canada
| | - Hani Al-Marzouki
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, #603-10649 Saskatchewan Drive, Edmonton, AB T6E 6S8 Canada
| | - Jeffrey R Harris
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, #603-10649 Saskatchewan Drive, Edmonton, AB T6E 6S8 Canada
| | - Daniel A O'Connell
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, #603-10649 Saskatchewan Drive, Edmonton, AB T6E 6S8 Canada
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Giles WH, Maclellan RA, Gawande AA, Ruan DT, Alexander EK, Moore FD, Cho NL. False negative cytology in large thyroid nodules. Ann Surg Oncol 2014; 22:152-7. [PMID: 25074665 DOI: 10.1245/s10434-014-3952-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Controversy exists regarding the accuracy of fine-needle aspiration (FNA) in large thyroid nodules. Recent surgical series have documented false-negative rates ranging from 0.7 to 13 %. We examined the accuracy of benign FNA cytology in patients with thyroid nodules ≥3 cm who underwent surgical resection and identified features characteristic of false-negative results. METHODS We retrospectively studied all thyroidectomy specimens between January 2009 and October 2011 and identified nodules ≥3 cm with corresponding benign preoperative FNA cytology. We collected clinical information regarding patient demographics, nodule size, symptoms, sonographic features, FNA results, and final surgical pathology. For comparison, we analyzed nodules <3 cm from this cohort also with benign FNA cytology. RESULTS A total of 323 nodules with benign preoperative cytology were identified. Eighty-three nodules were <3 cm, 94 nodules were 3-3.9 cm, and 146 nodules were ≥4 cm in size. The false-negative rate was 11.7 % for all nodules ≥3 cm and 4.8 % for nodules <3 cm (p = 0.03). Subgroup analysis of nodules ≥3 cm revealed a false-negative rate of 12.8 % for nodules 3-3.9 cm and 11 % for nodules ≥4 cm. Age ≥55 years and asymptomatic clinical status were the only patient characteristics that reached statistical significance as risk factors. Final pathology of the false-negative specimens consisted mainly of follicular variant of papillary thyroid cancer and follicular thyroid cancer. CONCLUSIONS When referred for thyroidectomy, patients with large thyroid nodules demonstrate a modest, yet significant, false-negative rate despite initial benign aspiration cytology. Therefore, thyroid nodules ≥3 cm may be considered for removal even when referred with benign preoperative cytology.
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Affiliation(s)
- Wesley H Giles
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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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.
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Affiliation(s)
- Agnese Proietti
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Pathological Anatomy, University of Pisa, Pisa, Italy
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Deng J, Zhou P, Tian SM, Zhang L, Li JL, Qian Y. Comparison of diagnostic efficacy of contrast-enhanced ultrasound, acoustic radiation force impulse imaging, and their combined use in differentiating focal solid thyroid nodules. PLoS One 2014; 9:e90674. [PMID: 24594879 PMCID: PMC3940946 DOI: 10.1371/journal.pone.0090674] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 02/04/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A key limitation of conventional ultrasound (US) includes poor differentiation of benign from malignant thyroid nodules. Contrast-enhanced US (CEUS) and acoustic radiation force impulse (ARFI) could provide better characterization of focal thyroid nodules; however, no studies have compared their efficacies. OBJECTIVE To evaluate the diagnostic efficacy of conventional US,CEUS, ARFI, and their combined use in differentiating focal solid thyroid nodules. METHODS One-hundred-forty-six Chinese patients with 175 thyroid nodules (119 benign and 56 malignant) were prospectively enrolled. Each patients underwent conventional US, CEUS and ARFI, respectively. The diagnostic performance of the conventional US, CEUS, ARFI, combined use of either CEUS or ARFI and combined use of the three modalities were assessed and compared using Pathological diagnosis (histological/cytological) as the reference method. RESULTS There were no significant differences between individual groups (CEUS vs US, P = 0.279, ARFI vs US, P = 0.372, CEUS vs ARFI, P = 0.849), combined use of US and CEUS or combined use of US and ARFI yielded significant difference compared to US. (combination of US & CEUS vs US, P = 0.021; combination of US & ARFI vs US, P = 0.036). The combination of three modalities significantly improved the diagnostic accuracy compared with either combination of conventional US and CEUS or combination of conventional US and ARFI (P = 0.045 and P = 0.027, respectively). CONCLUSIONS CEUS and ARFI can be used as an additional tool in the diagnostic work up of thyroid nodules. The combination of CEUS with ARFI can significantly improve the diagnostic accuracy.
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Affiliation(s)
- Jin Deng
- Department of Ultrasound, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ping Zhou
- Department of Ultrasound, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- * E-mail:
| | - Shuang-ming Tian
- Department of Ultrasound, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lu Zhang
- Department of Ultrasound, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jia-le Li
- Department of Ultrasound, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ying Qian
- Department of Ultrasound, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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Sex variability of fine-needle aspiration reliability in the diagnosis of malignancy in thyroid nodules ≥4 cm. Am J Surg 2013; 206:778-82. [DOI: 10.1016/j.amjsurg.2013.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/09/2013] [Accepted: 04/12/2013] [Indexed: 11/18/2022]
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Sengupta A, Pal R, Kar S, Zaman FA, Sengupta S, Pal S. Fine needle aspiration cytology as the primary diagnostic tool in thyroid enlargement. J Nat Sci Biol Med 2012; 2:113-8. [PMID: 22470244 PMCID: PMC3312690 DOI: 10.4103/0976-9668.82308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: In the preoperative decision-making of the thyroid swellings, fine needle aspiration cytology (FNAC) is becoming an ever more vital tool. Objectives: To compare the advantage of preoperative FNAC of thyroid swellings with postoperative histopathology to reach a consensus protocol as a simple procedure for diagnosis and optimal management of thyroid swellings. Materials and Methods: A prospective study of preoperative FNAC was carried out on 178 incidental thyroid swellings attending a tertiary care centre in Kishanganj, Bihar. Evidence-based surgical interventions were done, irrespective of FNAC findings and diagnosis was confirmed by histopathological examination (HPE) postoperatively in all the cases. Results: In the FNAC, preponderance of the cases (75.84%) was colloid goitre followed by granulomatous thyroiditis; follicular carcinoma was noted in 7.30 percent and anaplastic carcinoma in 3.37 percent of cases. Histopathological examination showed colloid goitre predominantly (76.97%), followed by follicular carcinoma (8.99%). The overall prevalence of malignancy was 11.24 percent diagnosed by HPE and 9.55 percent by FNAC. In our FNAC series sensitivity of was 90 percent while specificity was 100 percent; accuracy was 98.88 percent. Predictive value of a positive test and negative tests was 100 percent and 98.75 percent respectively. Conclusion: The study highlights that FNAC should be treated as a first-line diagnostic test for thyroid swellings to guide the management though this is not a substitute for HPE as a need to improve primary healthcare in India.
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Affiliation(s)
- Arup Sengupta
- Department of Otorhinolaryngology, M.G.M. Medical College, Kisanganj, Bihar, India
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Reliability of fine-needle aspiration for thyroid nodules greater than or equal to 4 cm. J Surg Res 2012; 181:6-10. [PMID: 23428179 DOI: 10.1016/j.jss.2012.06.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 05/25/2012] [Accepted: 06/15/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) is considered the diagnostic test of choice in the evaluation of thyroid nodules. Some practice recommendations, however, suggest surgical resection of larger thyroid nodules due to concerns of FNA unreliability in the diagnosis of thyroid malignancy. The purpose of this study was to determine the reliability of FNA in thyroid nodules ≥4 cm. METHODS Retrospective review of prospectively collected data of 1068 consecutive patients who underwent FNA and thyroidectomy at a single tertiary medical center from 2003 to 2010 was performed. Patients were divided into two groups: those patients with a dominant thyroid nodule ≥4 cm (n = 212) and those patients with a dominant thyroid nodule <4 cm (n = 856). Sensitivity, specificity, and negative and positive predictive values were calculated for FNA results and final histopathology after thyroidectomy. RESULTS Of 212 patients with lesions ≥4 cm, 35% had thyroid malignancy on final pathology. Conversely, 54% of 856 patients with dominant thyroid nodules <4 cm had a final diagnosis of thyroid cancer after thyroidectomy. FNA demonstrated similar test characteristics among patients with lesions ≥4 cm and <4 cm, with a specificity of 99% (CI: 96%-100%) and 98% (CI: 96%-99.0%), respectively, and a sensitivity of 35% (CI: 23%-49%) and 42% (CI: 37%-46%), respectively. The positive predictive value of FNA was 82% (CI: 75%-100%) for nodules ≥4 cm and 96% (CI: 92%-98%) for nodules <4 cm. Negative predictive value was significantly different, with a value of 82% (CI: 75%-87%) for lesions ≥4 cm and only 59% (CI: 55%-63%) for lesions <4 cm. CONCLUSIONS The reliability of FNA as a diagnostic test is not affected by the size of thyroid nodules. Routine surgical resection for all thyroid nodules ≥4 cm should not be used as the only independent factor in determining need for surgical resection.
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Ceratti S, Giannini P, Souza RADSE, Rodrigues Junior OF. Ultrasound-guided fine-needle aspiration of thyroid nodules: assessment of the ideal number of punctures. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000300005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE: To determine the number of punctures in fine-needle aspiration biopsies required for a safe cytological analysis of thyroid nodules. MATERIALS AND METHODS: Cross-sectional study with focus on diagnosis. The study population included 94 patients. RESULTS: The mean age of the patients participating in the study was 52 years (standard-deviation = 13.7) and 90.4% of them were women. Considering each puncture as an independent event, the first puncture has showed conclusive results in 78.7% of cases, the second, in 81.6%, and the third, in 71.8% of cases. With a view to the increasing chance of a conclusive diagnosis at each new puncture, two punctures have showed conclusive results in 89.5% of cases, and three punctures, in 90.6% of cases with at least one conclusive result. CONCLUSION: Two punctures in fine-needle aspiration biopsies of thyroid nodules have lead to diagnosis in 89.5% of cases in the study sample, suggesting that there is no need for multiple punctures to safely obtain the diagnosis of thyroid nodules.
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Image cytometry of fine needle aspiration of thyroid epithelial lesions. Appl Immunohistochem Mol Morphol 2012; 20:25-30. [PMID: 21691199 DOI: 10.1097/pai.0b013e31821ffa6a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fine needle aspiration (FNA) biopsy has been documented as a reliable, cost-effective test, diagnosing different thyroid lesions. However, its sensitivity declines much in some settings. This study aimed to investigate the value of computerized morphometry and DNA ploidy in differential diagnosis of different thyroid epithelial follicular lesions diagnosed on FNA smears. In this study, 68 cases of thyroid FNA were cytologically examined, and classified according to their postthyroidectomy histopathologic diagnosis as follow: 10 cases of nodular goiter, 14 cases of adenomas, 10 cases of follicular carcinoma, 20 cases of papillary carcinoma, 10 cases of anaplastic carcinoma, and 4 cases of poorly differentiated carcinoma. Using Leica Qwin 500 image analysis system, nuclear area as a morphologic variable, and the DNA ploidy, DNA index, and proliferation indices were measured for each case. Sensitivity of FNA in the studied cases was optimum (100%) in papillary carcinomas and anaplastic carcinomas. However, the sensitivity declined sharply in discriminating nodular goiter and follicular adenoma from well-differentiated follicular carcinoma, thus, most of these cases were diagnosed as follicular lesions. A significant difference in mean values of nuclear area was found between benign and malignant lesions, with no statistical differences within the benign group. Aneuploidy was significantly associated with malignancy. Therefore, image analysis may become an important ancillary test in the initial evaluation of patients with thyroid epithelial lesions.
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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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Are there predictors of malignancy in patients with multinodular goiter? J Surg Res 2011; 174:207-10. [PMID: 22341348 DOI: 10.1016/j.jss.2011.11.1035] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 11/03/2011] [Accepted: 11/29/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multinodular goiters (MNG) have recently been shown to have an incidence of cancer that approaches that of solitary thyroid nodule. However, fine needle aspiration (FNA) of a MNG is limited due to the presence of multiple nodules. Therefore we sought to identify risk factors for malignancy in patients with MNG. METHODS A total of 1791 consecutive patients underwent thyroidectomy at a single academic institution between May 1994 and December 2009. Of these, 838 patients had a MNG, which we defined as ≥ 2 nodules on preoperative ultrasound. The medical records of these patients were reviewed and analyzed. RESULTS A final pathologic diagnosis of malignancy was found in 260 of 838 (31%) of MNG patients. Of the 260 patients with malignancy, 113 (44%) had a focus of cancer <1 cm. Of the patients with malignancy on final pathology, preoperative FNA detected only 46% (n = 120). Of the 140 cancers not recognized preoperatively, 61 (44%) were >1 cm in size. On univariate analysis risk factors for malignancy were younger age and male gender. Patients with malignant nodules also had smaller nodules, smaller thyroids, and fewer nodules than those patients with benign findings on pathology. On multivariate analysis all predictors remained independently associated with malignancy with the exception of thyroid weight. CONCLUSION Risk factors for malignancy in a MNG included male gender, younger age, fewer nodules, and smaller nodule size. The low predictive value of FNA in our population suggests there needs to be better ways to predict malignancy in patients with MNG. Therefore, these clinical risk factors should be considered when consulting patients with MNG in regards to their risk of malignancy.
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Paksoy N, Yazal K, Corak S. Malignancy rate in nondominant nodules in patients with multinodular goiter: Experience with 1,606 cases evaluated by ultrasound-guided fine needle aspiration cytology. Cytojournal 2011; 8:19. [PMID: 22114619 PMCID: PMC3221080 DOI: 10.4103/1742-6413.86970] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 09/27/2011] [Indexed: 01/21/2023] Open
Abstract
Background: Conventional medical sources recommend the use of fine needle aspiration cytology (FNAC) for single thyroid nodules and the dominant nodule in multinodular goiter (MNG). The purpose of the present study was to analyze the utility of FNAC for multiple thyroid nodules in patients with MNG and to determine the rate of malignancy in teh nondominant nodules. Materials and Methods: Our private practice performed ultrasound-guided FNAC on 1,606 patients between February 2001 and February 1, 2010. In the MNG cases, samples were taken from the dominant nodule and from trhee suspicious / nonsuspicious nodules larger than 1 cm on ultrasound. Ninety-four cases were diagnosed as ‘suspiciously malignant’(SUS) or ‘malignant’ (POS) based on FNAC.
Results: The rate of an SUS / POS diagnosis was 5.7% in the dominant nodules; 2.3% of the nondominant nodules had a SUS / POS diagnosis in FNAC (p = 0.0003). Follow-up revealed malignancy in 15 (35.7%) nondominant nodules and in 27 (64.2%) dominant nodules, with 42 MNG cases undergoing surgery. X test showed a ‘p-level of 0.0003’ between the percentages of SUS / POS diagnosis in dominanat and nondominanat nodules. It was less than the significance level of 0.05. Therefore, the result was regarded to be statistically significant. Conclusions: Nondominant nodules could harbor malignancy. The risk of malignancy in nondominant nodules in MNG should not be underestimated. We have shown that the dominant nodule in patients with MNG was in fact about 2.5 times more likely to be malignant than a nondominant nodule. The use of FNAC for nondominant nodules could enhance the likelihood of detecting malignancy in an MNG.
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Affiliation(s)
- Nadir Paksoy
- Private Cyto-Pathology Practice and Department of Pathology, Kocaeli University Medical School, İzmit, Turkey
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Bohacek L, Milas M, Mitchell J, Siperstein A, Berber E. Diagnostic accuracy of surgeon-performed ultrasound-guided fine-needle aspiration of thyroid nodules. Ann Surg Oncol 2011; 19:45-51. [PMID: 21633868 DOI: 10.1245/s10434-011-1807-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is scant data concerning surgeon-performed thyroid fine-needle aspiration (FNA), and controversy regarding its accuracy in larger nodules. This study aimed to specifically assess accuracy of surgeon-performed ultrasound (US)-guided FNA on a per-nodule basis, with a subanalysis of nodule size. METHODS Data of 1,000 surgeon-performed US-guided thyroid FNAs at a single institution from 2000 to 2010 were prospectively collected. Standard clinical information, FNA results using the Bethesda criteria, and final histology were recorded. RESULTS Fine-needle aspiration results were reported as: cancer (7%), suspicious for cancer (2%), suspicious for follicular neoplasm (17%), atypia of unknown significance (AUS) (1%), benign (67%), and insufficient (6%). Of nodules with FNA results of cancer, suspicious for cancer, suspicious for follicular neoplasm, and atypia of unknown significance, 94% were operated on, with malignancy rates of 97%, 58%, 21%, and 12%, respectively. Of nodules with benign FNA, 26% underwent surgery for associated symptoms, concerning features, or other remote pathology. A total of 56% were followed, and 18% were lost to follow-up. Of nodules with insufficient FNA, 46% had repeat FNA (yielding a diagnosis in 81%), 23% underwent surgery, 21% with hypocellular features were followed, and 9% were lost to follow-up. In size subanalysis, there was no statistically significant difference in risk of malignancy or increased rate of falsely negative FNA with increasing nodule size. CONCLUSIONS The Bethesda system appropriately stratified lesions for risk of malignancy, and repeat FNA had high diagnostic yield in lesions with inadequate FNA. The results suggest no trend toward larger lesions harboring thyroid malignancy nor an increased likelihood of false-negative benign FNA.
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Affiliation(s)
- Linda Bohacek
- Division of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA
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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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Yoon JH, Moon HJ, Kim EK, Kwak JY. Inadequate cytology in thyroid nodules: should we repeat aspiration or follow-up? Ann Surg Oncol 2011; 18:1282-9. [PMID: 21331807 DOI: 10.1245/s10434-011-1605-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND To evaluate how to correctly manage thyroid nodules showing inadequate cytology after ultrasound (US)-guided fine-needle aspiration biopsy (US-FNAB). MATERIALS AND METHODS A total of 393 thyroid nodules with inadequate cytology in 351 patients (M:F = 40:311, mean age: 49.3 years) with surgery or follow-up US-FNAB for at least 1 year were included in this study. Among them, 293 (74.6%) were benign and 100 (25.4%) were malignant on final reference results. Clinical characteristics and US features were reviewed and compared. RESULTS Malignancy rates (39.5%) of nodules having suspicious US feature were significantly higher than those (10.9%) of nodules without any suspicious US feature (P < .001). Malignancy rates of solid nodules, mainly solid nodules, and mainly cystic nodules were 29.2, 16.7, and 9.5%, respectively, with significant differences (P = .016). Malignancy rates of nodules assessed as suspicious malignant to probably benign in composition are: 39.1-12.8% (P < .001) in solid nodules, 42.1-9.2% (P = .001) in mainly solid nodules, and 50.0-5.3% (P = .04) in mainly cystic nodules. CONCLUSIONS In nodules with inadequate cytology, follow-up US can be considered over repeat aspiration if there are no suspicious US features present, especially in mainly cystic nodules.
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Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
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Sakorafas GH. Thyroid nodules; interpretation and importance of fine-needle aspiration (FNA) for the clinician - practical considerations. Surg Oncol 2011; 19:e130-9. [PMID: 20620044 DOI: 10.1016/j.suronc.2010.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 06/10/2010] [Accepted: 06/12/2010] [Indexed: 01/21/2023]
Abstract
Thyroid nodules are very common lesions. Despite that the great majority is benign, in a significant percentage of them there is an underlying malignancy. Malignant thyroid nodules should be managed surgically, while the more common benign thyroid nodules may be managed conservatively. A systemic and careful diagnostic evaluation is needed to recognize nodules (overtly malignant or with malignant potential), and to avoid unnecessary surgery in a large percentage of patients with benign disease. Fine-needle aspiration (FNA) has a central role in the diagnostic investigation of the patient with thyroid nodules. FNA is a safe, useful, and cost-effective procedure. To increase accuracy, FNA can be performed under ultrasonographic guidance (if needed). Its results may be particularly helpful in determining the indication for surgery. In contrast, the role of FNA in selecting the extent of surgery is limited today. This is due to the fact that during the last decade there is a clear trend toward radical surgical management of thyroid nodular disease (both benign and malignant) by total/near-total thyroidectomy.
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Affiliation(s)
- George H Sakorafas
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, Athens, Greece.
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Faquin WC, Baloch ZW. Fine-needle aspiration of follicular patterned lesions of the thyroid: Diagnosis, management, and follow-up according to National Cancer Institute (NCI) recommendations. Diagn Cytopathol 2011; 38:731-9. [PMID: 20049964 DOI: 10.1002/dc.21292] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The National Cancer Institute (NCI) State of the Science Conference on thyroid fine-needle aspiration (FNA) proposed that follicular patterned lesions can be divided into two diagnostic categories; follicular lesion of undetermined significance/Atypia of undetermined significance (FLUS/AUS) and suspicious for follicular neoplasm/follicular neoplasm (SFON/FON). The former group can benefit from repeat FNA (RFNA) to achieve a more definitive diagnosis and the latter should undergo surgical excision for histologic characterization (adenoma vs. carcinoma). In this study, we report the combined experience from our institutions with thyroid FNA cases that can be placed into NCI-designated thyroid FNA diagnostic categories for follicular patterned lesions.The case cohort comprised of 857 cases in 645 females and 212 males; 509 cases could be classified as FLUS/AUS and 348 as SFON/FON. Histologic follow-up was available in 273/509 (54%) cases diagnosed as FLUS/AUS and 251/348 (72%) cases diagnosed as SFON/FON.RFNA was performed in 203/509 (40%) patients classified as FLUS/AUS. RFNA diagnoses were: benign (125 cases), FLUS (46 cases), SFON/FON (20 cases), suspicious for papillary carcinoma (7 cases), papillary carcinoma (3 cases) and non-diagnostic (2 cases). The malignancy rate on surgical excision in the FLUS/AUS group was 27 and 15% with and without RFNA, respectively; and 25% in cases diagnosed as SFON/FON.RFNA is effective in managing thyroid nodules diagnosed as FLUS/AUS since the malignancy rates are different in cases with or without RFNA (27% vs. 15%). The malignancy rate (25%) in cases diagnosed as SFON/FON is similar to reported by other authors.
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Affiliation(s)
- William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, USA
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Seningen JL, Nassar A, Henry MR. Correlation of thyroid nodule fine-needle aspiration cytology with corresponding histology at Mayo Clinic, 2001-2007: An institutional experience of 1,945 cases. Diagn Cytopathol 2010; 40 Suppl 1:E27-32. [PMID: 22619156 DOI: 10.1002/dc.21566] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 09/03/2010] [Indexed: 01/21/2023]
Affiliation(s)
- Justin L Seningen
- Mayo Clinic Foundation and Mayo Medical School, College of Medicine, Rochester, Minnesota, USA
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43
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Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope 2010; 121:487-91. [PMID: 21344423 DOI: 10.1002/lary.21227] [Citation(s) in RCA: 234] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 08/03/2010] [Indexed: 01/09/2023]
Abstract
OBJECTIVES/HYPOTHESIS This study was performed to assess the diagnostic accuracy of surgeon-performed preoperative neck ultrasound (US) in the detection of both central and lateral cervical lymph node metastases from thyroid cancer. STUDY DESIGN Prospective cohort study. METHODS Data for all patients with thyroid cancers and follicular thyroid lesions who were evaluated by means of preoperative neck US were reviewed. The cervical lymph nodes were assessed for suspicion of metastasis based on US characteristics. The diagnostic accuracy of US was determined according to whether histologically confirmed cancer was present in surgical cervical lymph node specimens. RESULTS The sensitivity and specificity of US in predicting papillary thyroid carcinoma (PTC) metastasis in the central neck were 30.0% and 86.8%, respectively. The sensitivity and specificity of US in predicting metastasis in the lateral neck were 93.8% and 80.0%, respectively. A subset of patients underwent US followed by revision neck dissection for PTC, and the sensitivity and specificity of US in predicting metastasis in the lateral neck were 100% and 100%, respectively. CONCLUSIONS Preoperative neck US is a valuable tool in assessing patients with thyroid cancers. The highly sensitive and specific nature of US in predicting cervical lymph node metastasis in the lateral neck, especially in the setting of recurrent disease, can provide reliable information to assist in surgical management. Although US for central compartment lymphadenopathy in the presence of the thyroid gland is less sensitive and specific than US for the lateral neck, it still provides useful information that can be obtained at the same time the primary thyroid pathology is assessed.
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Affiliation(s)
- Harry S Hwang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
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Chae SW, Kim SH, Park HD, Park WS, Cho YH, Kang SH, Kim DH, Sohn JH. Comparison of Liquid-based (SurePath™ and Conventional Preparations in Thyroid Fine Needle Aspiration. KOREAN JOURNAL OF PATHOLOGY 2010. [DOI: 10.4132/koreanjpathol.2010.44.6.651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Seoung Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Hee Kim
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Dae Park
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woon Sun Park
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hye Cho
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hee Kang
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hoon Kim
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Hee Sohn
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hwang HS, Perez DA, Orloff LA. Comparison of positron emission tomography/computed tomography imaging and ultrasound in staging and surveillance of head and neck and thyroid cancer. Laryngoscope 2009; 119:1958-65. [DOI: 10.1002/lary.20594] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Saleh HA, Feng J, Tabassum F, Al-Zohaili O, Husain M, Giorgadze T. Differential expression of galectin-3, CK19, HBME1, and Ret oncoprotein in the diagnosis of thyroid neoplasms by fine needle aspiration biopsy. Cytojournal 2009; 6:18. [PMID: 19826479 PMCID: PMC2758025 DOI: 10.4103/1742-6413.55894] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Accepted: 06/19/2009] [Indexed: 12/30/2022] Open
Abstract
Background: Fine needle aspiration biopsy (FNAB) is a common and excellent procedure for the evaluation of thyroid lesions that require surgical resection. At times, the FNAB diagnosis can be difficult, particularly of follicular-patterned lesions. Previous studies have shown that some immunohistochemical (IHC) markers may be helpful in establishing more accurate diagnosis. In this study, our goal was to evaluate four of the recently investigated markers in differentiating benign from malignant thyroid nodules on FNABs. Materials and Methods: We performed IHC staining of galectin-3, Ret oncoprotein (Ret), HBME-1, and cytokeratin 19 (CK19), on cell block sections of thyroid FNAB cases that had corresponding surgical resections. They included 44 benign lesions (37 hyperplastic or cellular nodules, HN; and 7 follicular adenomas, FA) and 27 malignant tumors (6 follicular carcinoma, FC; 19 classic papillary carcinoma, PTC; and 2 follicular variant of papillary carcinoma, FVPC). The stains were done according to the standard avidin–biotin–peroxidase method. Results: Statistical analysis showed that immunoexpression was significantly higher in the malignant group for all four markers. The sensitivity for positive expression for all benign lesions versus malignant tumors was as follows: 10/44 (22.7%) versus 25/27 (92.6%) for galectin-3; 14/44 (31.8%) versus 23/27 (85%) for Ret; 12/44 (27.3%) versus 24/27 (88.8%) for HBME-1; and 13/44 (29.5%) versus 23/27 (85%) for CK19. The sensitivity and specificity was highest for galectin-3 (92.6% and 77.3%, respectively) followed by HMBE-1 (88.9% and 72.7%, respectively). When combining the markers' expressions, the panel of galectin-3 + HBME-1 showed the highest sensitivity and specificity (90.7% and 75%, respectively), but this was, however, lower than galectin-3 alone (92.3% and 77.3%, respectively). Conclusion: We conclude that galectin-3 is the best single marker in differentiating benign from malignant thyroid lesions with the highest sensitivity and specificity. The galectin-3 + HBME-1 was the best combination for distinguishing benign from malignant lesions. Because they were the best two independent and combined markers, we recommend the use of the galectin-3 + HBME-1 panel to enhance the diagnostic accuracy of follicular-patterned thyroid lesions on FNABs.
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Affiliation(s)
- Husain A Saleh
- Department of Pathology, Wayne State University, Sinai-Grace Hospital, Detroit, MI, USA.
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Schiro AJ, Pinchot SN, Chen H, Sippel RS. Clinical efficacy of fine-needle aspiration biopsy of thyroid nodules in males. J Surg Res 2009; 159:645-50. [PMID: 19932905 DOI: 10.1016/j.jss.2009.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 08/01/2009] [Accepted: 08/11/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND It has recently been suggested that the use of fine-needle aspiration (FNA) biopsy of thyroid nodules in male patients is associated with an unacceptably high false-negative rate in the detection of thyroid malignancy. We hypothesize that FNA biopsy is an accurate preoperative tool for detecting thyroid cancer in men, and that false negative rates are significantly lower than recently reported. MATERIALS AND METHODS A retrospective database analysis was performed on all male patients who underwent thyroid surgery from May 1994 through January 2007 at a single institution. The results of preoperative FNA biopsies were compared with final surgical pathologic results. FNA biopsy results were reported as benign, malignant, inconclusive (i.e., follicular neoplasm), or nondiagnostic; final surgical pathology was reported as benign or malignant. RESULTS Of 1205 patients who underwent thyroidectomy, 273 (23%) were male. Preoperative FNA biopsy results were obtained in 60% of these male patients and were read as benign in 45/165 (27%) patients, malignant in 47/165 (28%) patients, inconclusive in 66/165 (40%) patients, and nondiagnostic in 7/165 (4%) patients. In male patients with cytology reported as benign, 3/45 (6.7%) FNAs were determined to be malignant on final pathology. CONCLUSIONS Our study determined that FNA biopsy of thyroid nodules in male patients has an acceptably low false-negative rate of 6.7% and is, therefore, an accurate and useful diagnostic tool. We recommend preoperative FNA biopsy for all male patients presenting with thyroid nodules as a standard of practice.
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Affiliation(s)
- Adam J Schiro
- Department of Surgery, University of Wisconsin, Madison, Wisconsin 53792, USA
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Kuru B, Gulcelik NE, Gulcelik MA, Dincer H. Predictive index for carcinoma of thyroid nodules and its integration with fine-needle aspiration cytology. Head Neck 2009; 31:856-66. [DOI: 10.1002/hed.21049] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Predictive value of sonographic features in preoperative evaluation of malignant thyroid nodules in a multinodular goiter. World J Surg 2009; 32:1948-54. [PMID: 18443853 DOI: 10.1007/s00268-008-9600-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The primary goal of ultrasonography (US) in the evaluation of a thyroid nodule is to determine its malignancy, although the diagnosis of a malignant nodule on the basis of US alone is nearly impossible. The aim of this prospective study was to evaluate the predictive value of sonographic features in the preoperative diagnosis of malignant thyroid nodules, and to determine the important features of sonography. METHODS This prospective study included 550 consecutive patients with , thyroid nodules. Nodules were divided into two groups on the basis of pathological diagnosis: group 1 consisted of 1,633 nodules with a benign pathology, and group 2 consisted of 293 nodules with a malignant pathology. RESULTS Microcalcifications, blurred nodular margins, and solid and hypoechoic appearance were more common in malignant nodules compared to benign nodules (89.1% versus 5%; 64.5% versus 4.7%; 81.6% versus 30.6% ; and 62.5% versus 43.1%, respectively; p < 0.001). There was a positive correlation between the detection of malignant thyroid nodules and microcalcification (rs = 0.791, p = 0.0001), blurred nodular margin (rs = 0.625, p = 0.0001), solid appearance (rs = 0.376, p = 0.0001), and hypoechoic appearance (rs = 0.141, p = 0.0001). Microcalcifications, blurred nodular margins, and solid and hypoechoic appearance were independent determinants of malignancy upon US examination of thyroid nodules (OR: 159, OR: 37, OR: 9.9, and OR: 2.2, respectively). CONCLUSION Although we did not identify a single feature indicative of malignancy in the sonographic examination of nodules, microcalcification and blurred margin were the strongest correlates for malignancy.
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Baloch ZW, LiVolsi VA, Asa SL, Rosai J, Merino MJ, Randolph G, Vielh P, DeMay RM, Sidawy MK, Frable WJ. Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol 2008; 36:425-37. [PMID: 18478609 DOI: 10.1002/dc.20830] [Citation(s) in RCA: 537] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine-needle Aspiration (FNA) State of the Science Conference on October 22-23, 2007 in Bethesda, MD. The two-day meeting was accompanied by a permanent informational website and several on-line discussion periods between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document summarizes matters regarding diagnostic terminology/classification scheme for thyroid FNA interpretation and cytomorphologic criteria for the diagnosis of various benign and malignant thyroid lesions. (http://thyroidfna.cancer.gov/pages/info/agenda/).
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Affiliation(s)
- Zubair W Baloch
- Department of Pathology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA.
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