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Hsiao V, Massoud E, Jensen C, Zhang Y, Hanlon BM, Hitchcock M, Arroyo N, Chiu AS, Fernandes-Taylor S, Alagoz O, Sundling K, LiVolsi V, Francis DO. Diagnostic Accuracy of Fine-Needle Biopsy in the Detection of Thyroid Malignancy: A Systematic Review and Meta-analysis. JAMA Surg 2022; 157:1105-1113. [PMID: 36223097 PMCID: PMC9558056 DOI: 10.1001/jamasurg.2022.4989] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/16/2022] [Indexed: 01/22/2023]
Abstract
Importance Fine-needle biopsy (FNB) became a critical part of thyroid nodule evaluation in the 1970s. It is not clear how diagnostic accuracy of FNB has changed over time. Objective To conduct a systematic review and meta-analysis estimating the accuracy of thyroid FNB for diagnosis of malignancy in adults with a newly diagnosed thyroid nodule and to characterize changes in accuracy over time. Data Sources PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials were searched from 1975 to 2020 using search terms related to FNB accuracy in the thyroid. Study Selection English-language reports of cohort studies or randomized trials of adult patients undergoing thyroid FNB with sample size of 20 or greater and using a reference standard of surgical histopathology or clinical follow-up were included. Articles that examined only patients with known thyroid disease or focused on accuracy of novel adjuncts, such as molecular tests, were excluded. Two investigators screened each article and resolved conflicts by consensus. A total of 36 of 1023 studies met selection criteria. Data Extraction and Synthesis The MOOSE guidelines were used for data abstraction and assessing data quality and validity. Two investigators abstracted data using a standard form. Studies were grouped into epochs by median data collection year (1975 to 1990, 1990 to 2000, 2000 to 2010, and 2010 to 2020). Data were pooled using a bivariate mixed-effects model. Main Outcomes and Measures The primary outcome was accuracy of FNB for diagnosis of malignancy. Accuracy was hypothesized to increase in later time periods, a hypothesis formulated prior to data collection. Results Of 16 597 included patients, 12 974 (79.2%) were female, and the mean (SD) age was 47.3 (12.9) years. The sensitivity of FNB was 85.6% (95% CI, 79.9-89.5), the specificity was 71.4% (95% CI, 61.1-79.8), the positive likelihood ratio was 3.0 (95% CI, 2.3-4.1), and the negative likelihood ratio was 0.2 (95% CI, 0.2-0.3). The area under the receiver operating characteristic curve was 86.1%. Epoch was not significantly associated with accuracy. None of the available covariates could explain observed heterogeneity. Conclusions and Relevance Accuracy of thyroid FNB has not significantly changed over time. Important developments in technique, preparation, and interpretation may have occurred too heterogeneously to capture a consistent uptrend over time. FNB remains a reliable test for thyroid cancer diagnosis.
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Affiliation(s)
- Vivian Hsiao
- University of Wisconsin–Madison School of Medicine and Public Health, Madison
- Department of Surgery, University of Wisconsin–Madison, Madison
| | - Elian Massoud
- University of Wisconsin–Madison School of Medicine and Public Health, Madison
- Department of Surgery, University of Wisconsin–Madison, Madison
| | - Catherine Jensen
- University of Wisconsin–Madison School of Medicine and Public Health, Madison
- Department of Surgery, University of Wisconsin–Madison, Madison
| | - Yanchen Zhang
- University of Wisconsin–Madison School of Medicine and Public Health, Madison
- Department of Otolaryngology, University of Wisconsin–Madison, Madison
| | - Bret M. Hanlon
- University of Wisconsin–Madison School of Medicine and Public Health, Madison
- Department of Biostatistics and Medical Informatics, University of Wisconsin–Madison, Madison
| | - Mary Hitchcock
- University of Wisconsin–Madison School of Medicine and Public Health, Madison
- Ebling Library for the Health Sciences, University of Wisconsin–Madison
| | - Natalia Arroyo
- University of Wisconsin–Madison School of Medicine and Public Health, Madison
- Department of Surgery, University of Wisconsin–Madison, Madison
| | - Alexander S. Chiu
- University of Wisconsin–Madison School of Medicine and Public Health, Madison
- Department of Surgery, University of Wisconsin–Madison, Madison
- Division of Endocrine Surgery, University of Wisconsin–Madison, Madison
| | - Sara Fernandes-Taylor
- University of Wisconsin–Madison School of Medicine and Public Health, Madison
- Department of Surgery, University of Wisconsin–Madison, Madison
| | - Oguzhan Alagoz
- Department of Industrial and Systems Engineering, University of Wisconsin–Madison, Madison
| | - Kaitlin Sundling
- University of Wisconsin–Madison School of Medicine and Public Health, Madison
- Department of Pathology, University of Wisconsin–Madison, Madison
- Wisconsin State Laboratory of Hygiene, University of Wisconsin–Madison, Madison
| | - Virginia LiVolsi
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia
| | - David O. Francis
- University of Wisconsin–Madison School of Medicine and Public Health, Madison
- Department of Surgery, University of Wisconsin–Madison, Madison
- Department of Otolaryngology, University of Wisconsin–Madison, Madison
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Daimary M, Chaubey RN, Nath J. Frozen Section in Diagnosis of Thyroid Swelling: Does It Still Have Role? Indian J Otolaryngol Head Neck Surg 2022; 74:383-393. [PMID: 36213482 PMCID: PMC9535071 DOI: 10.1007/s12070-021-02946-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/14/2021] [Indexed: 10/20/2022] Open
Abstract
Purpose The present study correlates the frozen section diagnosis of thyroid swelling with the histopathological diagnosis and assesses the expression of immunohistochemical markers in malignant thyroid tumours. Also, the study aims to analyse the accuracy and limitations of the frozen section as an intraoperative tool for the diagnosis of thyroid swellings. Method Fifty-three cases of thyroid swelling were included in the study. Frozen section reports were classified as benign, malignant and deferred. A correlation between frozen section and histopathology examination (HPE) reports has been evaluated. The malignant cases confirmed on HPE were subjected to Immunohistochemistry (IHC) with TTF-1, Thyroglobulin, and CK-7. Results Among the 53 patients, 45 (84.9%) were females, and the majority were younger than 40 years (60.37%). On frozen section majority, 42 (79.25%) were benign, while a definitive diagnosis of malignancy was made in six cases (11.32%). On the frozen section, there were no false-positive cases, six true-positive cases, one false-negative case and 46 true-negative cases, with a sensitivity of 85.71%, specificity of 100%, the positive predictive value of 100%, the negative predictive value of 97.87% and diagnostic accuracy of 98.11% respectively. All the six papillary carcinomas and one follicular carcinoma showed immunoreactivity of tumor cells to TTF 1, CK 7 and Thyroglobulin. Conclusion There was a strong correlation between the frozen section and histopathological diagnosis. Still, it is not recommended in routine use for intraoperative diagnosis of thyroid swelling because of various limitations and the high diagnostic accuracy of FNAC. Adequate histopathologic diagnosis of thyroid disease is based on extensive subsampling of the specimen, which is not possible during an intraoperative frozen section procedure. If the frozen section is used, its limitations must be recognized, preferably based on first-hand data.
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Affiliation(s)
- Michimi Daimary
- Department of Pathology, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam 781301 India
| | - R. N. Chaubey
- Department of Pathology, Silchar Medical College, Silchar, Assam India
| | - Jyotiman Nath
- Department of Radiation Oncology, Dr B. Borooah Cancer Institute, Guwahati, Assam India
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Goemann IM, Paixão F, Migliavacca A, Guimarães JR, Scheffel RS, Maia AL. Intraoperative frozen section performance for thyroid cancer diagnosis. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:50-57. [PMID: 35263048 PMCID: PMC9991033 DOI: 10.20945/2359-3997000000445] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective A primary medical relevance of thyroid nodules consists of excluding thyroid cancer, present in approximately 5% of all thyroid nodules. Fine-needle aspiration biopsy (FNAB) has a paramount role in distinguishing benign from malignant thyroid nodules due to its availability and diagnostic performance. Nevertheless, intraoperative frozen section (iFS) is still advocated as a valuable tool for surgery planning, especially for indeterminate nodules. Methods To compare the FNAB and iFS performances in thyroid cancer diagnosis among nodules in Bethesda Categories (BC) I to VI. The performance of FNAB and iFS tests were calculated using final histopathology results as the gold standard. Results In total, 316 patients were included in the analysis. Both FNAB and iFS data were available for 272 patients (86.1%). The overall malignancy rate was 30.4%% (n = 96). The FNAB sensitivity, specificity, and accuracy for benign (BC II) and malignant (BC V and VI) were 89.5%, 97.1%, and 94.1%, respectively. For all nodules evaluated, the iFS sensitivity, specificity, and accuracy were 80.9%, 100%, and 94.9%, respectively. For indeterminate nodules and follicular lesions (BC III and IV), the iFS sensitivity, specificity, and accuracy were 25%, 100%, and 88.7%, respectively. For BC I nodules, iFS had 95.2% of accuracy. Conclusion Our results do not support routine iFS for indeterminate nodules or follicular neoplasms (BC III and IV) due to its low sensitivity. In these categories, iFS is not sufficiently accurate to guide the intraoperative management of thyroidectomies. iFS for BC I nodules could be an option and should be specifically investigated.
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Affiliation(s)
- Iuri Martin Goemann
- Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.,Faculdade de Medicina, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil
| | - Francisco Paixão
- Divisão de Cirurgia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Alceu Migliavacca
- Divisão de Cirurgia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - José Ricardo Guimarães
- Divisão de Cirurgia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Rafael Selbach Scheffel
- Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.,Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Ana Luiza Maia
- Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil,
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Gadermayr M, Siller M, Stangassinger L, Kreutzer C, Boor P, Bulow R, Kraus TF, von Stillfried S, Wolfl S, Couillard-Despres S, Oostingh G, Hittmair A. On the acceptance of “fake” histopathology: A study on frozen sections optimized with deep learning. J Pathol Inform 2022; 13:6. [PMID: 35136673 PMCID: PMC8794030 DOI: 10.4103/jpi.jpi_53_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/01/2021] [Accepted: 09/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The fast acquisition process of frozen sections allows surgeons to wait for histological findings during the interventions to base intrasurgical decisions on the outcome of the histology. Compared with paraffin sections, however, the quality of frozen sections is often strongly reduced, leading to a lower diagnostic accuracy. Deep neural networks are capable of modifying specific characteristics of digital histological images. Particularly, generative adversarial networks proved to be effective tools to learn about translation between two modalities, based on two unconnected data sets only. The positive effects of such deep learning-based image optimization on computer-aided diagnosis have already been shown. However, since fully automated diagnosis is controversial, the application of enhanced images for visual clinical assessment is currently probably of even higher relevance. Methods: Three different deep learning-based generative adversarial networks were investigated. The methods were used to translate frozen sections into virtual paraffin sections. Overall, 40 frozen sections were processed. For training, 40 further paraffin sections were available. We investigated how pathologists assess the quality of the different image translation approaches and whether experts are able to distinguish between virtual and real digital pathology. Results: Pathologists’ detection accuracy of virtual paraffin sections (from pairs consisting of a frozen and a paraffin section) was between 0.62 and 0.97. Overall, in 59% of images, the virtual section was assessed as more appropriate for a diagnosis. In 53% of images, the deep learning approach was preferred to conventional stain normalization (SN). Conclusion: Overall, expert assessment indicated slightly improved visual properties of converted images and a high similarity to real paraffin sections. The observed high variability showed clear differences in personal preferences.
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Grisales J, Sanabria A. Utility of Routine Frozen Section of Thyroid Nodules Classified as Follicular Neoplasm. Am J Clin Pathol 2020; 153:210-220. [PMID: 31732728 DOI: 10.1093/ajcp/aqz152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To evaluate the diagnostic performance of frozen section in thyroid nodules classified as follicular neoplasm. METHODS A diagnostic test meta-analysis was designed. Studies that assessed frozen section in patients with thyroid nodules and a fine-needle aspiration biopsy result of Bethesda IV were selected. The outcomes measured were the number of false- and true-positive and -negative results. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) instrument for methodological quality assessment and a bivariate mixed-effects regression framework and a likelihood-based estimation of the exact binomial approach. RESULTS Forty-six studies from 1991 to 2018 were included. Most studies had moderate methodological quality. The overall sensitivity and specificity were 43% (95% confidence internal [CI], 0.34-0.53) and 100% (95% CI, 0.99-1.00), respectively. The hierarchic summary receiver operating characteristic curve showed an area under the curve of 0.91 (95% CI, 0.80-0.97). CONCLUSIONS Frozen section demonstrates moderate diagnostic performance in patients with follicular neoplasm, and its utility for making intraoperative decisions is limited. Its routine use should be discouraged.
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Affiliation(s)
- Jhorman Grisales
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
- Centro de Excelencia en Cirugia de Cabeza y Cuello, CEXCA, Medellín, Colombia
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Najah H, Tresallet C. Role of frozen section in the surgical management of indeterminate thyroid nodules. Gland Surg 2019; 8:S112-S117. [PMID: 31475098 DOI: 10.21037/gs.2019.04.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Indeterminate thyroid nodules (ITNs) correspond to the categories III (atypia of undetermined significance or follicular lesion of undetermined significance) and IV (follicular neoplasm or suspicious for a follicular neoplasm) of the Bethesda system for reporting thyroid cytopathology. Their malignancy risk is 5-15% and 15-30% respectively, imposing surgical treatment for definitive diagnosis. Thus, they represent a diagnostic and therapeutic challenge given the risk of over or under treatment. Several teams continue to perform systematic intraoperative frozen sections (FS) in order to guide the initial extent of surgery and to avoid a two-stage thyroidectomy. FS have a very high specificity and positive predictive value for the diagnosis of malignancy allowing a one-stage total thyroidectomy if the result is positive. However, this attitude is highly controversial; and this review of the literature demonstrates that FS is of little contribution in this setting, due to low sensitivity and high false-negative rates. In fact, for these lesions, a careful and comprehensive evaluation of the tumor capsule is mandatory in order to visualize a capsular or a vascular invasion permitting to make the diagnosis of malignancy. However, this assessment is only possible on permanent section. Moreover, FS can jeopardize the detection of signs of capsular invasion on final pathologic examination. The recent development of molecular testing results in a better preoperative diagnosis, thus reducing even more the need for intraoperative FS. Contrasting with their limited role in Bethesda III and IV categories, FS are useful in guiding the preoperative management of Bethesda V category nodules, given their high negative and positive predictive values. Intraoperative FS of ITNs are of little use and are not recommended systematically. Their use should be restricted to elderly, high anesthetic risk, or poorly compliant patients for whom an eventual subsequent complementary surgery may be problematic.
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Affiliation(s)
- Haythem Najah
- Department of Digestive and Endocrine Surgery, CHU de Bordeaux, Groupe Hospitalier Sud, Hôpital Haut-Lévêque, Centre Magellan, 33604 Pessac cedex, Pessac, France
| | - Christophe Tresallet
- Department of Digestive and Endocrine Surgery, Hôpital de la Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, Sorbonne université (Pierre et Marie curie Paris 6), Paris, France.,Laboratoire d'imagerie biomédicale (LIB), INSERM U 678, Sorbonne université (Pierre et Marie Curie Paris 6), Paris, France
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Aghaghazvini L, Pirouzi P, Sharifian H, Yazdani N, Kooraki S, Ghadiri A, Assadi M. 3T magnetic resonance spectroscopy as a powerful diagnostic modality for assessment of thyroid nodules. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:501-505. [PMID: 30462802 PMCID: PMC10118653 DOI: 10.20945/2359-3997000000069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/03/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Magnetic resonance spectroscopy (MRS) is a powerful tool for structural studies of chemical compounds and biomolecules and also documented promising findings as a potential imaging technology in thyroid oncology. This prospective study was to ascertain the clinical significance of 3 Tesla MRS in the evaluation of patients with thyroid nodules (TNs) as an ancillary diagnostic technique for thyroid carcinoma. MATERIALS AND METHODS Magnetic resonance spectroscopy at 3T at echo- times (TEs) 136 and 270 ms was carried out on 15 patients with total number of 32 TNs larger than 1 cm3, which all were surgically resected. Choline (Chol) to creatine (Cr) ratio was assessed at 136 and 270 TEs on each nodule and a receiver operating characteristic (ROC) curve was used to determine optimal cut-off point. The findings were compared with histopathology of thyroid specimens. RESULTS There were 23 benign and 9 malignant lesions (7 papillary and 2 follicular thyroid carcinomas). The mean values of Chol/Cr at 136 and 270 TEs was 2.28 ± 3.65 and 1.52 ± 1.67 respectively and the difference between benign and malignant nodules was only significant at 136 TEs. The study revealed that Chol/ Cr ratio cut-off point of 2.5 best correlates with histopathology results (sensitivity = 75%; specificity = 100%; PPV = 100%; NPV= 92%). CONCLUSION This preliminary study showed that 3T magnetic resonance spectroscopy might be a specific modality for the evaluation of thyroid nodules in differentiation of benign from malignant thyroid tissue. However, a larger series would give much greater confidence that this state-of-the-art technology will worth pursuing in clinical practice.
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Affiliation(s)
- Leila Aghaghazvini
- Department of Radiology, Shariati General Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pirouz Pirouzi
- Advanced Diagnostic and Interventional Radiology Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hashem Sharifian
- Department of Radiology, Amir Alam General Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Yazdani
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Kooraki
- Advanced Diagnostic and Interventional Radiology Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsoon Ghadiri
- Advanced Diagnostic and Interventional Radiology Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Assadi
- The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
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Cohen MA, Patel KR, Gromis J, Kutler DI, Kuhel WI, Stater BJ, Schulman A, Hoda RS, Scognamiglio T. Retrospective evaluation of frozen section use for thyroid nodules with a prior fine needle aspiration diagnosis of Bethesda II-VI: The Weill Cornell Medical College experience. World J Otorhinolaryngol Head Neck Surg 2015; 1:5-10. [PMID: 29204534 PMCID: PMC5698504 DOI: 10.1016/j.wjorl.2015.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the Weill Cornell Medical College (WCMC)/New York Presbyterian Hospital (NYPH) experience with intraoperative frozen (IOF) section in the management of thyroid nodules with a fine needle aspiration (FNA) diagnosis of Bethesda II–VI and to analyze the cost and pathology benefit it provides. Methods The surgical and cytopathology files at WCMC/NYPH were searched within the time period of January 2008 to May 2013. A total of 435 thyroid specimens were identified for which both an FNA and subsequent IOF section was performed. The FNA was correlated with the locations of the resected nodule and the nodule frozen for intraoperative diagnosis. The results of the FNA were compared to the IOF section diagnosis and final diagnosis (FD). Results Among 435 cases, the FNA diagnosis was Bethesda II: 149 cases, Bethesda III: 170 cases, Bethesda IV: 91 cases, Bethesda V: 19 cases, and Bethesda VI: 6 cases. There were a total of 83 carcinomas identified on FD, which included 69 papillary thyroid carcinomas (PTCs), 12 follicular carcinomas, and 2 poorly differentiated carcinomas. The preoperative FNA diagnosis for these carcinomas was as follows: Bethesda II, 11/149 (7.4%), Bethesda III, 24/170 (14%), Bethesda IV, 26/91 (29%), Bethesda V, 16/19 (84%), and Bethesda VI, 6/6 (100%). IOF section contributed to the diagnosis of malignancy in 16/429 (4%) cases: 1/149 (0.7%) Bethesda II, 5/170 (3%) Bethesda III, 2/91 (1.1%) Bethesda IV, and 8/19 (42%) Bethesda V. The diagnosis of malignancy was confirmed in the 6 Bethesda VI cases by IOF section. There were no false positives on IOF section. IOF had a sensitivity and specificity of 26% and 100%, respectively. Conclusion The role of IOF section is limited in the evaluation of thyroid nodules. IOF section is most useful for nodules with an FNA diagnosis of Bethesda V lesions. The diagnosis of follicular variant of PTC remains difficult on frozen section.
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Affiliation(s)
- Marc A. Cohen
- Department of Otolaryngology—Head and Neck Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
- Corresponding author. Tel.: +1 646 962 2286; fax: +1 646 962 0030.
| | | | | | - David I. Kutler
- Department of Otolaryngology—Head and Neck Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - William I. Kuhel
- Department of Otolaryngology—Head and Neck Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Brian J. Stater
- Department of Otolaryngology—Head and Neck Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Aaron Schulman
- Department of Endocrinology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Rana S. Hoda
- Department of Pathology & Laboratory Medicine, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Theresa Scognamiglio
- Department of Pathology & Laboratory Medicine, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
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Seo JY, Choi JR, Moon HJ, Kim EK, Han KH, Kim H, Kwak JY. Clinical Implication of Highly Sensitive Detection of the BRAFV600E Mutation in Fine-Needle Aspirations According to the Thyroid Bethesda System in Patients With Conventional Papillary Thyroid Carcinoma. Ann Otol Rhinol Laryngol 2014; 124:392-9. [PMID: 25404749 DOI: 10.1177/0003489414560433] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND We investigated the additional diagnostic yield of the mutation test and evaluated the frequency of the BRAF mutation in conventional PTC (cPTC) according to ultrasound (US) features and the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) based on the BRAFV600E mutation status. MATERIALS AND METHODS During the study period, 279 patients who underwent FNA with an additional BRAFV600E mutation test were diagnosed as cPTC after surgery. We analyzed the association between the mutation and several clinical factors. RESULTS Of the 279 cPTCs, 250 (89.6%) had the BRAFV600E mutation. The BRAF mutation test was helpful in diagnosing an additional 19% (53/279) of cPTCs. The frequency of the BRAF mutation in cPTCs with suspicious US features was higher than that of cPTCs with negative US features regardless of the BSRTC. CONCLUSIONS Suspicious US features may be helpful in deciding whether an additional BRAFV600E mutation test should be done in thyroid nodules with indeterminate cytology.
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Affiliation(s)
- Jae Young Seo
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Department of Radiology, Konyang University Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jong Rak Choi
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hwa Han
- Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunki Kim
- Department of Pathology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Technetium-99m methoxyisobutylisonitrile scintigraphy in the assessment of cold thyroid nodules: is it time to change the approach to the management of cold thyroid nodules? Nucl Med Commun 2014; 35:51-7. [PMID: 24128898 DOI: 10.1097/mnm.0000000000000013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Scanning with technetium-99m methoxyisobutylisonitrile (Tc-MIBI) is recommended for evaluating thyroid nodule metabolism. In addition, it may help differentiate between benign and malignant nodules; however, the efficacy of this technique has not been fully elucidated. Therefore, it is not currently performed for routine clinical application. This prospective study was conducted to investigate the clinical significance of Tc-MIBI scintigraphy in the assessment of patients with cold thyroid nodules. PATIENTS AND METHODS This prospective study was conducted on 104 patients with cold thyroid nodules greater than 1 cm in diameter as detected on Tc-pertechnetate scintigraphy. Uptake of MIBI in thyroid nodules was compared with that in the surrounding normal thyroid tissue for both early and delayed images, and a score of 0-3 was assigned to each nodule as follows: 0, cold; 1, decreased; 2, equal; 3, increased. The thyroid scan was performed 20 and 40 min after intravenous injection of 555 MBq of Tc-MIBI. The patients underwent fine-needle aspiration cytology (FNAC). Detailed statistical parameters were determined on a per-nodule basis for each qualitative and quantitative scan analysis, as defined by histology. RESULTS A total of 104 patients (93 women and 11 men; mean age 40.76±11.40 years, range 20-73) with a total number of 167 cold nodules were included in this study. When Tc-MIBI uptake was regarded as the criterion of malignancy in Tc-MIBI scintigraphy, the accuracy was between 69.46 and 92.21% on using seven different methods. In addition, FNAC findings indicated a sensitivity of 66.66%, a specificity of 100%, a negative predictive value of 95.72%, a positive predictive value of 100%, and an accuracy of 96.06%. Six malignant cold nodules were detected on a positive Tc-MIBI scan, which were determined as benign nodules on FNAC examinations. CONCLUSION The study demonstrated that Tc-MIBI scanning can be complementary to other diagnostic techniques in patients with cold thyroid nodules. In addition, because of its availability, rather low cost, simple protocol, and objective semiquantitative information, Tc-MIBI scanning seems to hold promise in routine imaging of cold thyroid nodules.
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Kim HC, Yoon DY, Seo YL, Namkung S, Hong MS, Baek S, Lim KJ, Yun EJ, Choi CS, Bae SH, Chung EJ, Kwon KH, Rho YS. Incidental thyroid lesions identified by ultrasound in patients with non-thyroidal head and neck cancer. Acta Radiol 2013; 54:1153-8. [PMID: 23858508 DOI: 10.1177/0284185113491091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Thyroid cancer is one of the common head and neck malignancies and may be found incidentally with other head and neck cancers. PURPOSE To evaluate the prevalence and risk of malignancy in incidental thyroid lesions identified by ultrasound (US) in patients with head and neck cancer. MATERIAL AND METHODS We retrospectively reviewed medical records of all patients with head and neck cancer other than of thyroid origin between January 2004 and December 2011. A total of 690 patients (537 men and 153 women; mean age, 58.9 ± 12.9 years) underwent US of the neck for the evaluation of cervical lymph node status (including thyroid gland). We evaluated the prevalence of patients with incidental thyroid lesions identified by US and the risk of malignancy in these patients. RESULTS Of the 690 patients with head and neck cancer, 234 (33.9%) had incidental thyroid lesions on US. Based on US findings, 61 patients underwent fine-needle aspiration, with 39 eventually undergoing thyroidectomy. Among these thyroid lesions, 24 incidental thyroid lesions of 22 patients were histologically proven to be malignant (23 papillary and 1 follicular carcinomas). The risk of malignancy was 9.4% on a patient-by-patient basis. CONCLUSION Screening of the thyroid gland should be included in the preoperative US examination for cervical lymph node metastases in patients with non-thyroidal head and neck cancer.
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Affiliation(s)
- Heung Cheol Kim
- Department of Radiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Kangwon-do, Republic of Korea
| | - Dae Young Yoon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young Lan Seo
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sook Namkung
- Department of Radiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Kangwon-do, Republic of Korea
| | - Myung Sun Hong
- Department of Radiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Kangwon-do, Republic of Korea
| | - Sora Baek
- Department of Nuclear Medicine, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Ja Lim
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Eun Joo Yun
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Chul Soon Choi
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Bae
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology, Ilsong Memorial Institute of Head and Neck Cancer, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Kee Hwan Kwon
- Department of Otorhinolaryngology, Ilsong Memorial Institute of Head and Neck Cancer, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Ilsong Memorial Institute of Head and Neck Cancer, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
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Utility of Intraoperative Frozen Sections during Thyroid Surgery. Int J Otolaryngol 2013; 2013:496138. [PMID: 23401692 PMCID: PMC3563233 DOI: 10.1155/2013/496138] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 01/03/2013] [Accepted: 01/03/2013] [Indexed: 11/18/2022] Open
Abstract
Objective. To describe the usefulness of intraoperative frozen section in the diagnosis and treatment of thyroid nodules where fine needle aspirate biopsies have evidence of follicular neoplasm. Study Design. Retrospective case series. Methods. All patients have a fine needle aspirate biopsy, an intraoperative frozen section, and final pathology performed on a thyroid nodule after initiation of the Bethesda System for Reporting Thyroid Cytopathology in 2009 at a single tertiary referral center. Sensitivity, specificity, positive predictive value, and negative predictive value are calculated in order to determine added benefit of frozen section to original fine needle aspirate data. Results. The sensitivity and specificity of the frozen section were 76.9% and 67.9%, respectively, while for the fine needle aspirate were 53.8% and 74.1%, respectively. The positive and negative predictive values for the fine needle aspirates were 25% and 90.9%, respectively, while for the frozen sections were 27.8% and 94.8%, respectively. There were no changes in the operative course as a consequence of the frozen sections. Conclusion. Our data does not support the clinical usefulness of intraoperative frozen section when the fine needle aspirate yields a Bethesda Criteria diagnosis of follicular neoplasm, suspicious for follicular neoplasm, or suspicious for malignancy at our institution.
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Grannan K, Snyder J, Mcdonough S, Engel A, Farnum J. Operative Decision-Making for Follicular Thyroid Lesions: A Community Hospital System Experience. Am Surg 2011. [DOI: 10.1177/000313481107700420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Follicular neoplasms of the thyroid are a frequent indication for surgery of the thyroid gland. We evaluated the use of frozen sections on intraoperative decision-making, possible avoidance of reoperative surgery, and histologic findings in a retrospective cohort. A database was created of all thyroid operations from 2001 to 2007. Data collected included age, gender, preoperative cytology, indication for surgery, surgeon, intraoperative decision-making, and histologic findings. Of the 723 thyroidectomies, 203 were performed for follicular neoplasms diagnosed by fine needle aspiration. Of these, 135 had cytology reports available within our electronic medical record; 44 per cent (59 of 135) of these patients had an intraoperative frozen section. Only two of 59 (3.4%) were positive for carcinoma, both of which were papillary carcinomas. One was interpreted as “suspicious” for carcinoma by the pathologist. In these three cases, the surgeon proceeded with total thyroidectomy at the time of initial surgery. The results of frozen section altered the operation in only three of 59 cases (5.1%). Intraoperative frozen section rarely impacts the conduct of thyroidectomy for follicular neoplasms.
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Affiliation(s)
- Kevin Grannan
- Departments of Surgery, Good Samaritan Hospital, Cincinnati, Ohio
| | - Jonathan Snyder
- Departments of Surgery, Good Samaritan Hospital, Cincinnati, Ohio
| | - Sarah Mcdonough
- E. Kenneth Hatton, MD, Institute for Research and Education, Cincinnati, Ohio
| | - Amy Engel
- E. Kenneth Hatton, MD, Institute for Research and Education, Cincinnati, Ohio
| | - James Farnum
- Departments of Pathology, Good Samaritan Hospital, Cincinnati, Ohio
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14
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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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15
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Bargren AE, Meyer-Rochow GY, Sywak MS, Delbridge LW, Chen H, Sidhu SB. Diagnostic utility of fine-needle aspiration cytology in pediatric differentiated thyroid cancer. World J Surg 2010; 34:1254-60. [PMID: 20091309 DOI: 10.1007/s00268-010-0391-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pediatric patients present with thyroid nodules less often than adults, but the rate of malignancy is much higher. This study was designed to determine the ability of fine-needle aspiration cytology (FNA) to diagnose accurately and facilitate management of thyroid neoplasms in pediatric patients. METHODS A retrospective study revealed 110 patients <19 years old who had undergone thyroid surgery and FNA biopsy at two academic institutions over the last 28 years. FNA sensitivity for diagnosing papillary thyroid cancer (PC) and follicular neoplasm (FN) was investigated. RESULTS Of 110 patients who presented for surgery, 27 had PC and 33 had a FN: 4 follicular carcinomas (FCs) and 29 follicular adenomas (FAs). Among the PCs patients, the FNA results were as follows: 1 (4%) nondiagnostic, 6 (22%) atypical, 2 (7%) benign, and 18 (67%) malignant lesions. The sensitivity of a malignant FNA was 90% for diagnosing a PC. Sensitivity of an atypical FNA was 75% for FCs and 69% for FAs, giving an overall FN sensitivity of 70%. Of the atypical FNA readings, 60% had confirmed histological atypical features, and 19% were malignant. In 95% of the malignant FNA reports, final histology confirmed PC, resulting in a positive predictive value of 95%. CONCLUSIONS FNA biopsy can reliably diagnose malignancy in pediatric thyroid patients and should be used as a standard technique to indicate surgical treatment. Atypical or suspicious FNA results do not predict cancer effectively, confirming the current accepted practice for adults that diagnostic excision is required to exclude malignancy in pediatric patients.
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Affiliation(s)
- Anna E Bargren
- Section of Endocrine Surgery, Department of Surgery, H4/722 Clinical Science Center, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA.
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16
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Reeves WA, DeMay RM. Frozen Section of Thyroid? Just Say No, Again. AJSP-REVIEWS AND REPORTS 2010. [DOI: 10.1097/pcr.0b013e3181f67efc] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Zhang X, Xu Y, Zhang Y, Wang L, Hou C, Zhou X, Ling X, Xu Z. Intraoperative detection of thyroid carcinoma by fourier transform infrared spectrometry. J Surg Res 2010; 171:650-6. [PMID: 20828740 DOI: 10.1016/j.jss.2010.05.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 04/14/2010] [Accepted: 05/13/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fourier transform infrared (FTIR) spectroscopy is a powerful tool for distinguishing cancerous tissue from normal one. Our aim in this study was to establish tissue discriminant analysis for thyroid malignancy and benign samples intraoperatively using FTIR spectroscopy. METHODS Seventeen papillary thyroid cancer and 43 nodular goiter tissues were obtained and underwent FTIR spectroscopy scanning intraoperatively. Nine peak positions were identified and assigned. Peak position values and wave intensity ratios were measured in every single spectrum. Data of malignant and benign groups were compared and equations of canonical discriminant analysis were established. RESULTS Peak positions of P1640, P1240, P1550, and peak intensity ratios of I3375/I1460, I1640/I1460, I1400/I1460, I1550/I1080, I1080/I1460, and I1640/I1550 of thyroid papillary carcinoma group are significantly different from nodular goiter group. The sensitivity, specificity, and accuracy rate of the discriminants are 83.3%, 95.2%, and 91.67%, respectively. CONCLUSION FTIR spectroscopy technique in combination with canonical discriminant analysis method can achieve fast and accurate discrimination for malignant and benign thyroid nodules during operation.
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Affiliation(s)
- Xiaoqing Zhang
- General Surgery, Peking University Third Hospital, College of Chemistry and Molecular Engineering, Peking University, Beijing, China
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18
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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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19
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Peng Y, Wang HH. A meta-analysis of comparing fine-needle aspiration and frozen section for evaluating thyroid nodules. Diagn Cytopathol 2009; 36:916-20. [PMID: 18855886 DOI: 10.1002/dc.20943] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The literature on comparing fine-needle aspiration (FNA) and frozen section for evaluating thyroid nodules was reviewed. Publications on this subject were divided into three groups (follicular lesions, non-follicular lesions and thyroid lesions, not otherwise specified). A meta-analysis was done to compare sensitivity, specificity, and positive and negative predictive values between FNA and frozen section diagnoses. For follicular lesions, FNA was much more sensitive but less specific, with lower positive predictive value than frozen section. FNA and frozen section are virtually identical in all parameters of accuracy in evaluating thyroid nodules that are not follicular lesions. The third group of publications that did not separate/specify follicular lesions from non-follicular lesions was non-contributory.
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Affiliation(s)
- Yan Peng
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9073, USA.
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20
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Eloy JA, Brett EM, Fatterpekar GM, Kostakoglu L, Som PM, Desai SC, Genden EM. The significance and management of incidental [18F]fluorodeoxyglucose-positron-emission tomography uptake in the thyroid gland in patients with cancer. AJNR Am J Neuroradiol 2009; 30:1431-4. [PMID: 19342543 DOI: 10.3174/ajnr.a1559] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Incidental positron-emission tomography (PET) uptake in the thyroid bed represents a diagnostic dilemma. Currently, there is no consensus regarding the significance of this finding or the most appropriate approach to management. The purpose of this study was to determine the significance of incidental fluorodeoxyglucose (FDG) uptake in the thyroid gland on [(18)F]FDG-positron-emission tomography (FDG-PET/CT) in patients being initially staged for lymphomas and/or cancers other than of thyroid origin. MATERIALS AND METHODS A retrospective review was conducted on patients who were incidentally found to have focal FDG uptake in the thyroid bed on initial staging for cancer. Patient records were assessed for age, sex, clinical presentation, standard uptake values (SUV(max)), on FDG-PET/CT, and CT findings in those patients undergoing FDG-PET/CT, fine-needle aspiration (FNA) cytology, and surgical pathologic examination. RESULTS Thirty patients were identified with incidental FDG-PET uptake in the thyroid bed from 630 studies performed for evaluation of cancer between March 2004 and June 2006. Complete records were available for 18 patients (6 men, 12 women). Five (27.8%) of 18 patients with incidental focal FDG-PET/CT uptake in the thyroid gland demonstrated papillary thyroid carcinoma on final pathologic findings. The mean and SD of SUV(max) was 3.0 +/- 1.8 (range, 1.1-7.4) overall, 2.9 +/- 1.6 (range, 1.1-6.8) in the patients without malignant growth, and 3.4 +/- 2.6 (range, 1.1-7.4) in the 5 patients with papillary thyroid carcinoma. No statistical difference in SUV(max) was noted between patients with papillary thyroid carcinoma and patients with benign pathologic findings (P = .63). CONCLUSIONS Incidental FDG-PET uptake in the thyroid gland in patients with cancer of nonthyroidal origin is associated with a 27.8% risk for well-differentiated thyroid carcinoma; however, there seems to be no correlation between intensity of FDG uptake and the risk for a malignant process.
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Affiliation(s)
- J A Eloy
- Head and Neck Cancer Center, Mount Sinai School of Medicine, New York, NY 10029, USA
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21
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Moon HJ, Kwak JY, Kim EK, Kim MJ, Park CS, Chung WY, Son EJ. The Combined Role of Ultrasound and Frozen Section in Surgical Management of Thyroid Nodules Read as Suspicious for Papillary Thyroid Carcinoma on Fine Needle Aspiration Biopsy: A Retrospective Study. World J Surg 2009; 33:950-7. [DOI: 10.1007/s00268-009-9984-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Hemithyroidectomy: When it Is Necessary an Intraoperative Frozen-Section Biopsy? ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s2173-5735(08)70214-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Fine-needle aspiration may miss a third of all malignancy in palpable thyroid nodules: a comprehensive literature review. Ann Surg 2007; 246:714-20. [PMID: 17968160 DOI: 10.1097/sla.0b013e3180f61adc] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Fine-needle aspiration (FNA) is currently the primary diagnostic procedure in diagnosing thyroid malignancy and guides surgeons on patient selection for thyroidectomy for thyroid nodules. Diagnostic sensitivity is reported to be approximately 80%; however, patients with negative FNA results do not necessarily undergo surgery and are often not considered in statistical analysis. This may lead to bias in previous reported sensitivity of FNA. The aim of this study was to assess the diagnostic performance attributes of FNA based on a comprehensive review and summary of previous literature. METHODS A comprehensive review of published literature from 1966 to 2005 was performed, using structured selection and appraisal methods to include all studies that have assessed the sensitivity of FNA for detecting thyroid malignancy in palpable thyroid nodules. A statistical modeling study was designed to estimate the possible true sensitivity and specificity of FNA. RESULTS Twelve studies fulfilled inclusion criteria and were included in the review. Only 1 study had greater than 25% of patients with negative FNA results who proceeded to thyroidectomy. Statistical modeling indicated that the sensitivity of FNA is highly dependent on the risk of malignancy in the patients with negative FNA results who did not undergo thyroidectomy; in the "same risk" scenario, where the risk of malignancy in the whole group with negative FNA result was assumed to be the same as that in patients with negative FNA results who underwent surgical biopsy; sensitivity could be as low as 66% (confidence interval [CI]: 65-68%). CONCLUSION Based on existing reports, the true diagnostic attributes of FNA for thyroid malignancy in palpable nodules are uncertain and FNA could miss up to a third of all thyroid malignancy. Further research is required to investigate the incidence of malignancy in FNA negative cases and to determine the additive effect of clinical judgment.
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Miller MC, Rubin CJ, Cunnane M, Bibbo M, Miller JL, Keane WM, Pribitkin EA. Intraoperative pathologic examination: cost effectiveness and clinical value in patients with cytologic diagnosis of cellular follicular thyroid lesion. Thyroid 2007; 17:557-65. [PMID: 17614777 DOI: 10.1089/thy.2006.0166] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Routine use of intraoperative pathologic examination (IOPE), including frozen section (FS) and scrape preparation cytology (SPC), during diagnostic thyroid lobectomy continues to be a source of controversy. We sought to better delineate the usefulness and cost-benefit ratio of IOPE in the context of cytologically diagnosed cellular follicular lesion (CFL) or follicular neoplasm (FN). DESIGN Records of 205 patients who underwent thyroidectomy for cytologically diagnosed FN or CFL between 1997 and 2005 were retrospectively reviewed. IOPE results, patient demographics, and tumor characteristics were correlated to final histopathologic diagnoses. Sensitivity, specificity, predictive values, accuracy, and costs of IOPE were calculated. MAIN OUTCOME IOPE correctly identified 3 of 16 follicular carcinomas and 9 of 36 papillary carcinomas. Sensitivity, specificity, and accuracy were 23%, 99%, and 78%, respectively. On univariate analysis, malignancy risk among follicular nodules did not correlate with age, gender, or nodule size. On multivariate analysis, nodule size was predictive of malignancy (p < 0.05). Over the entire patient series, routine IOPE resulted in a net cost savings of $74,304.33. CONCLUSIONS IOPE reduced costs and limited the number of completion thyroidectomies necessary. IOPE is specific, cost effective, and of minimal additional risk when performed routinely for patients with CFL or FN.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/surgery
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary, Follicular/diagnosis
- Carcinoma, Papillary, Follicular/pathology
- Carcinoma, Papillary, Follicular/surgery
- Cost-Benefit Analysis
- Cytological Techniques/economics
- Female
- Frozen Sections/economics
- Humans
- Intraoperative Period
- Male
- Middle Aged
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
- Thyroidectomy/methods
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Affiliation(s)
- Matthew C Miller
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA
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Campillo-Soto A, Flores-Pastor B, Candel-Arenas M, Soria-Aledo V, Giménez-Bascuñana A, Miquel Perelló J, Aguayo-Albasini JL. Utilidad de la biopsia intraoperatoria en el tratamiento quirúrgico del nódulo tiroideo. Cir Esp 2006; 79:176-9. [PMID: 16545284 DOI: 10.1016/s0009-739x(06)70845-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To present our experience of the use of frozen section (FS) in the operative management of thyroid nodules and determine the utility of this procedure when deciding the extent of thyroidectomy. PATIENTS AND METHOD We performed a prospective and comparative study. The FS of patients who underwent surgery for thyroid nodules between 1995 and 2002 were evaluated. The results were compared with those of fine-needle aspiration cytology (FNA) and definitive biopsy. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of both FNA and FS were calculated. RESULTS There were 469 thyroidectomies and 179 FS were performed. The results obtained for FNA and FS were, respectively: PPV: 100%/100%; NPV: 89%/90%; diagnostic accuracy: 89.5%/91%. When only "follicular hyperplasia" was included as the cytologic diagnosis, the PPV and NPV for FS were 100% and 86.7%, respectively. CONCLUSION The diagnostic accuracy of FNAC and FS is similar. In cases of follicular hyperplasia, the sensitivity of FS is too low to rule out malignancy.
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Abstract
Reporting schemes for thyroid fine-needle aspirations in the literature were reviewed and classified according to the number of categories in the scheme and the significance of each category. The sensitivity, specificity, and positive predictive and negative values were determined for each scheme, if possible. A reporting scheme based on the probability of finding carcinoma on histology is proposed.
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Affiliation(s)
- Helen H Wang
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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Furlan JC, Bedard YC, Rosen IB. Role of Fine-needle Aspiration Biopsy and Frozen Section in the Management of Papillary Thyroid Carcinoma Subtypes. World J Surg 2004; 28:880-5. [PMID: 15593461 DOI: 10.1007/s00268-004-6953-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Since fine-needle aspiration biopsy (FNAB) was introduced, the value of frozen section (FS) has been questioned. This study compares FNAB and FS sensitivities among the usual form of papillary thyroid cancer (uPTC) and variants of PTC such as tall cell (tcPTC), follicular (fPTC), and Hurthle cell (HcPTC). A total of 257 patients who underwent preoperative FNAB, intraoperative FS, and thyroidectomy for PTC were, randomly selected from a database of a university teaching hospital in Toronto. There were 218 females (84.8%) and 39 males (15.2%), from 19 to 89 years of age (mean of 44 years), having uPTC (n = 212), fPTC (n = 24), HcPTC (n = 14), and tcPTC (n = 7). Data were analyzed using chi2 test. Sensitivities were calculated by division of true positives and by the sum of true positives and false negatives. True positives had to reflect a conclusive diagnosis of cancer. The FNAB sensitivities were uPTC (39.2%), fPTC (25%), HcPTC (42.9%), tcPTC (85.7%), similar to FS sensitivities (p = 0.497) for uPTC (44.3%), fPTC (16.7%), HcPTC (42.9%), and tcPTC (71.4%). Use of FS following FNAB increased sensitivities for uPTC to 56.1%, fPTC to 29.2%, and tcPTC to 100%. In addition, FS did not increase FNAB sensitivity in HcPTC. Combination FNAB plus FS failed in 43.9% of uPTC, 70.8% of fPTC, and 57.1% of HcPTC. We concluded that FNAB and FS sensitivity vary with PTC subtype and are still necessary for selection and treatment. The recognition of morphologic subtypes of PTC from the FNAB could optimize the selection of patients for intraoperative FS, enhance the preoperative assessment of prognosis, facilitate the surgical planning, and simplify the preparation of postoperative adjuvant therapy.
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Affiliation(s)
- Julio C Furlan
- Department of Surgery, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Suite 1521, Toronto, Ontario M5G 1X5, Canada.
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Callcut RA, Selvaggi SM, Mack E, Ozgul O, Warner T, Chen H. The utility of frozen section evaluation for follicular thyroid lesions. Ann Surg Oncol 2004; 11:94-8. [PMID: 14699040 DOI: 10.1007/bf02524352] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Because fine-needle aspiration cannot reliably discriminate between benign and malignant follicular thyroid lesions, some surgeons use intraoperative frozen section (FS) to guide operative management. To determine the utility of FS for these lesions, we reviewed our institutional experience. METHODS Between 1994 and 2001, 152 patients underwent surgical resection for follicular neoplasms. RESULTS The mean age of the patients was 47 years, and 76% were female. Forty-one (32%) FSs were reported as benign, 5 (4%) as malignant, and 3 (2%) as indeterminate, and in 80 (62%), the diagnosis was "follicular lesion, deferred to permanent histology." On paraffin section, all patients with malignant FSs had thyroid cancer, and all 41 patients with benign FSs had benign lesions. Thus, FS for diagnosis of follicular thyroid cancer had a sensitivity, specificity, positive predictive value, and accuracy of 67%, 100%, 100%, and 96%, respectively. In most cases (64%), FS rendered no additional information at the time of operation. Therefore, the cost per useful FS was $7800, which is higher than the charge of a completion thyroidectomy (approximately $6000). CONCLUSIONS FS analysis for follicular lesions seems to be highly specific and accurate. However, because of the low sensitivity, routine use of FS is not cost-effective in patients with follicular thyroid lesions.
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Affiliation(s)
- Rachael A Callcut
- Departments of Surgery, University of Wisconsin, Madison, Wisconsin 53792, USA
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Lumachi F, Borsato S, Tregnaghi A, Marino F, Poletti A, Iacobone M, Favia G. Accuracy of fine-needle aspiration cytology and frozen-section examination in patients with thyroid cancer. Biomed Pharmacother 2004; 58:56-60. [PMID: 14739062 DOI: 10.1016/j.biopha.2003.08.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In patients with solitary thyroid nodules (TN) undergoing surgery both fine-needle aspiration (FNA) and frozen-section examination (FSE) are currently performed, but their role is still controversial. We retrospectively analyzed a series of 606 patients with a nontoxic solitary thyroid nodule who underwent both FNAB and FSE prior to thyroidectomy. There were 118 (19.5%) men and 488 (80.5%) women, with a median age of 44 years (range 16-81 years). The results of both FNAB and FSE were compared against the final pathological examination. Definitive histology showed 500 (82.5%) benign nodules, including 239 (39.4%) follicular adenomas, and 106 (17.5%) carcinomas, of which 18 (17.0%) were follicular cancer. In differentiating between benign TN and thyroid tumors the sensitivity, specificity, and accuracy of FNAB were 93.6%, 98.9% and 95.9%, while in the detection of malignancy were 81.1%, 99.4% and 96.2% for FNAB, and 83.0%, 100% and 97.0% for FSE (P = NS), respectively. The combination of both techniques did not improve significantly (P = NS) the results. Both medullary and undifferentiated cancer, and 76 of 80 (95.0%) papillary carcinomas were correctly detected by FNAB. Three (0.5%) false-positive smears suggesting cancer were found. In conclusion, in patients with FNAB revealing thyroid cancer or a benign TN, the extent of thyroidectomy should be established by performing FSE. When FNAB suggests the presence of a follicular tumor, FSE may affect rarely the final intraoperative decision-making, and should be considered unnecessary. However, in patients with FNA revealing thyroid cancer, FSE is useful in confirming malignancy, and may avoid surgical overtreatments.
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Affiliation(s)
- F Lumachi
- Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, School of Medicine, University of Padua, Via Giustiniani 2, 35128, Padova, Italy.
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