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Petersen M, Schenke SA, Seifert P, Stahl AR, Görges R, Grunert M, Klemenz B, Kreissl MC, Zimny M. Correct and Incorrect Recommendations for or against Fine Needle Biopsies of Hypofunctioning Thyroid Nodules: Performance of Different Ultrasound-based Risk Stratification Systems. Nuklearmedizin 2024; 63:21-33. [PMID: 37871628 DOI: 10.1055/a-2178-6739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
PURPOSE To evaluate the recommendations for or against fine needle biopsy (FNB) of hypofunctioning thyroid nodules (TNs) using of five different Ultrasound (US) -based risk stratification systems (RSSs). METHODS German multicenter study with 563 TNs (≥ 10 mm) in 534 patients who underwent thyroid US and surgery. All TNs were evaluated with ACR TI-RADS, EU-TIRADS, ATA, K-TIRADS 2016 and modified K-TIRADS 2021. A correct recommendation was defined as: malignant TN with recommendation for FNB (appropriate) or benign TN without recommendation for FNB (avoided). An incorrect recommendation was defined as: malignant TN without recommendation for FNB (missed) or benign TN with recommendation for FNB (unnecessary). RESULTS ACR TI-RADS demonstrated the highest rate of correct (42.3 %) and lowest rate of incorrect recommendations (57.7 %). The other RRSs showed similar results for correct (26.5 %-35.7 %) and incorrect (64.3 %-73.5 %) recommendations. ACR TI-RADS demonstrated the lowest rate of unnecessary (73.4 %) and the highest rate of appropriate (26.6 %) FNB recommendation. For other RSSs, the rates of unnecessary and appropriate FNB were between 75.2 %-77.1 % and 22.9 %-24.8 %. The lowest rate of missed FNB (14.7 %) and the highest rate of avoided FNB (85.3 %) was found for ACR TI-RADS. For the other RSSs, the rates of missed and avoided FNB were between 17.8 %-26.9 % and 73.1 %-82.2 %. When the size cutoff was disregarded, an increase of correct recommendations and a decrease of incorrect recommendations was observed for all RSSs. CONCLUSION The RSSs vary in their ability to correctly recommend for or against FNB. An understanding of the impact of nodule size cutoffs seems necessary for the future of TIRADS.
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Affiliation(s)
- Manuela Petersen
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Germany
| | - Simone A Schenke
- Department and Institute of Nuclear Medicine, Hospital Bayreuth, Germany
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Germany
| | - Philipp Seifert
- Clinic of Nuclear Medicine, University Hospital Jena, Germany
| | | | - Rainer Görges
- Clinic for Nuclear Medicine, University Hospital Essen, Germany
| | - Michael Grunert
- Department of Nuclear Medicine, German Armed Forces Hospital Ulm, Germany
- Department of Nuclear Medicine, University Hospital Ulm, Germany
| | - Burkhard Klemenz
- Department of Nuclear Medicine, German Armed Forces Hospital Ulm, Germany
| | - Michael C Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
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Deniz MS, Dindar M. Examining the impact of several factors including COVID-19 on thyroid fine-needle aspiration biopsy. Diagn Cytopathol 2024; 52:42-49. [PMID: 37823334 DOI: 10.1002/dc.25239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/15/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE The study explores various factors, including coronavirus disease 2019 (COVID-19) history and vaccination status, that influence the classification value of ultrasonography-guided thyroid fine needle aspiration biopsy (TFNAB) by comparing non-diagnostic (Bethesda-I) and diagnostic (Bethesda II-VI) results. METHODS We conducted a retrospective observational study in a high-volume tertiary care center involving patients who underwent TFNAB from November 2022 to April 2023. The study retrospectively analyzed the cytopathology of 482 thyroid nodules. Patients were categorized into non-diagnostic (n = 136) and Diagnostic groups (n = 346) based on TFNAB. A comprehensive set of parameters was examined, including demographic, anthropometric and clinical data, thyroid ultrasonography findings, COVID-19 history and immunization status. RESULTS The mean age was 55.1 ± 12.1 years in the non-diagnostic group and 53.5 ± 13 years in the Diagnostic group (p = .223). 75.7% (n = 103) of the non-Diagnostic group and 82.9% (n = 287) of the Diagnostic group were male (p = .070). The mean nodule longitudinal diameter of the Diagnostic group was significantly higher than that of the non-diagnostic group (p = .015). The TIRADS score of the nodules showed a statistical difference between the groups (p = .048). The groups had no significant differences regarding other ultrasonographic parameters and COVID-19-related variables. CONCLUSION It can be assumed that when the longitudinal diameter of the thyroid nodule is small and in TIRADS categories other than the TIRADS3 category, TFNAB is less likely to be diagnostic. However, future research may be needed to confirm these findings and uncover any long-term effects of COVID-19 or vaccines on thyroid nodule diagnostics.
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Affiliation(s)
- Muzaffer Serdar Deniz
- Department of Endocrinology, Faculty of Medicine, Education and Research Hospital, Karabük University, Karabük, Turkey
| | - Merve Dindar
- Department of Internal Medicine, Faculty of Medicine, Education and Research Hospital, Karabük University, Karabük, Turkey
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Yucel S, Balci IG, Tomak L. Diagnostic Performance of Thyroid Nodule Risk Stratification Systems: Comparison of ACR-TIRADS, EU-TIRADS, K-TIRADS, and ATA Guidelines. Ultrasound Q 2023; 39:206-211. [PMID: 37918114 DOI: 10.1097/ruq.0000000000000653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
ABSTRACT The purpose of this study was to compare the diagnostic performance of 4 different ultrasound-based risk scoring systems for thyroid nodules (TNs). This study consecutively included 256 patients (mean age: 43.98 ± 12.94 years, min-max: 18-89 years; 225 females, 31 males) with 266 TNs. Each nodule was evaluated and classified according to the American Thyroid Association (ATA), American College of Radiology (ACR), European Thyroid Association, and Korean Thyroid Imaging Reporting and Data System (ACR-TIRADS, EU-TIRADS, and K-TIRADS, respectively) before performing ultrasound-guided fine-needle aspiration biopsy. Pathological results were reported according to the Bethesda system. Outcomes of the 4 classification systems were compared with respect to Bethesda results. Twenty-eight (10.5%) nodules had malignant cytology results. Diagnostic performances of the scoring systems were comparable with similar area under the curve values according to the reference standards of category 5 of each scoring system. The sensitivity and specificity values of these guidelines were as follows: ACR-TIRADS, 60.7% and 95.4%; EU-TIRADS, 71.4% and 93.3%; ATA-2015, 71.4% and 93.3%; and K-TIRADS, 67.9% and 93.3%. The biopsy rate of malignant nodules was 57.1% for K-TIRADS and ATA, whereas this value was 46.4% for ACR and EU-TIRADS. ACR-TIRADS had the lowest unnecessary biopsy rate (141 of 238 benign nodules, 46%). The diagnostic performance of 4 risk stratification systems appears to be comparable, as shown by similar sensitivity, specificity, and area under the curve values. However, the ACR-TIRADS had slightly higher accuracy and necessitated fewer unnecessary biopsies for benign nodules.
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Affiliation(s)
- Serap Yucel
- Radiology Section, Basaksehir Cam ve Sakura State Hospital, Istanbul
| | - Isa Gokturk Balci
- Department of Radiology, Baskent University School of Medicine, Adana
| | - Leman Tomak
- Department of Biostatistics and Medical Informatics, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Barcelos RN, Camacho CP, da Conceição de O C Mamone M, Ikejiri ES, Vanderlei FAB, Yang JH, Padovani RP, Martins LAL, Biscolla RPM, Macellaro D, Lindsey SC, Maciel RMB, Martins JRM. Risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy in thyroid nodules with diameters greater than 4 centimeters. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e000644. [PMID: 37364146 PMCID: PMC10661008 DOI: 10.20945/2359-3997000000644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/04/2023] [Indexed: 06/28/2023]
Abstract
Objective The risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy (FNAB) of thyroid nodules (TN) with diameters ≥ 3-4 cm remains controversial. However, some groups have indicated surgical treatment in these patients regardless of the FNAB results. We aimed to evaluate the diagnostic accuracy of the FNAB in systematically resected ≥4 cm TN and if the risk of malignancy is higher in these patients. Subjects and methods We retrospectively evaluated 138 patients (142 nodules) with TN with diameters ≥4 cm who underwent thyroidectomy. Results The FNAB results were nondiagnostic/unsatisfactory (ND/UNS) in 2.1% of the cases and benign in 51.4%. They indicated atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 23.9% of cases, follicular neoplasia/suspicious for a follicular neoplasm (FN/SFN) in 9.2%, suspicion of malignancy (SUS) in 8.5%, and malignant in 4.9%. The histopathological analysis after thyroidectomy revealed a thyroid cancer rate of 100% in the FNABs classified as malignant, 33.3% in SUS cases, 7.7% in FN/SFN, 17.6% in AUS/FLUS, and 4.1% in benign FNABs. None of the ND/UNS FNABs were malignant. The global malignancy diagnosis was 14.8% (n = 21). However, the rate of false negatives for FNAB was low (4.1%). Conclusion We showed that the risk of malignancy in nodules with diameters ≥4 cm was higher compared to the risk of thyroid cancer in TN in general. However, we found a low rate of false-negative cytological results; therefore, our data do not justify the orientation of routine resection for these larger nodules.
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Affiliation(s)
- Rafaela N Barcelos
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Cléber P Camacho
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Laboratório de Inovação Molecular e Biotecnologia, Programa de Pós-graduação em Medicina, Universidade Nove de Julho (Uninove), São Paulo, SP, Brasil
| | - Maria da Conceição de O C Mamone
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Elza S Ikejiri
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Felipe A B Vanderlei
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Ji H Yang
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rosália P Padovani
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Leandro A L Martins
- Laboratório de Anatomia Clínica e Patológica, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Rosa Paula M Biscolla
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Danielle Macellaro
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Susan C Lindsey
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rui M B Maciel
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - João Roberto M Martins
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil,
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Lopes SC, Shah B, Eloy C. Thyroid cytology: The reality before and after the introduction of ultrasound classification systems for thyroid nodules. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2023; 70:39-47. [PMID: 36764746 DOI: 10.1016/j.endien.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/30/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Several ultrasound-based systems for classification of thyroid nodules are available. They allow for a better triage of the nodules that require cytological assessment, and lead to standardized recommendations. Our aim was to compare patients and nodules referred to fine-needle aspiration (FNA) before and after the introduction of these systems. METHODS A retrospective study comparing two cohorts of patients referred for FNA was performed (386 patients and 463 nodules in 2015; 220 patients and 263 nodules in 2021). RESULTS The sex distribution (89.1% vs 85.9% females, p=0.243), number of nodules referred to FNA per patient (median of 1), and the distribution of the Bethesda categories (p=0.082) was similar in both years. In 2021, patients were older (53.4±14.5 years vs 57.8±13.2 years, p<0.001) and nodules over one centimetre were larger (median 17.0mm vs 19.0mm, p=0.002), especially the ones categorized as Bethesda III (median size 11mm vs 23mm, p=0.043). In 2021, at least 23.1% of the nodules referred to FNA did not have any criteria, and 38.8% of the nodules were not categorized by any system. CONCLUSION This analysis draws attention to the importance of systematically applying ultrasound-based classification systems. It seems that, by not being focused mainly on size thresholds, they allow for longer surveillance periods, without aggravating the cytology results when FNA becomes indicated. Nevertheless, greater efforts are needed to ensure more standardized reports, and to increase adherence to the resulting recommendations to reduce clinical uncertainty, unnecessary FNA, and overtreatment.
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Affiliation(s)
| | - Bijal Shah
- Histopathology Department, St. James's Hospital, Dublin, Ireland
| | - Catarina Eloy
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto, Porto, Portugal; Pathology Department of Medical Faculty, University of Porto, Porto, Portugal
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Lopes SC, Shah B, Eloy C. Thyroid cytology: The reality before and after the introduction of ultrasound classification systems for thyroid nodules. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Quaytman JA, Nikiforov YE, Nikiforova MN, Morariu E. Clinicopathologic features of thyroid nodules with PTEN mutations on preoperative testing. Endocr Relat Cancer 2022; 29:513-520. [PMID: 35723418 DOI: 10.1530/erc-22-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/16/2022] [Indexed: 11/08/2022]
Abstract
The incidence of cancer in thyroid nodules carrying germline or somatic phosphatase and tensin homolog (PTEN) mutations is not well-defined. This study characterizes the clinical and histopathologic features of thyroid nodules with preoperatively detected PTEN mutations and their impact on management. Thyroid nodules with PTEN mutations on molecular testing of fine-needle aspiration (FNA) specimens from November 2017 to July 2020 at our institution were included. Demographic and clinicopathologic data were obtained through retrospective chart review. We identified 49 PTEN mutation-positive nodules from 48 patients. Surveillance was pursued for 28 patients and surgery for 20 patients. There were 14 follicular adenomas (FA), 4 oncocytic adenomas, 1 oncocytic hyperplastic nodule, and 1 encapsulated follicular variant papillary thyroid carcinoma (EFVPTC). The EFVPTC had two somatic PTEN mutations, an NRAS mutation, and was a low-risk tumor with capsular but no angiolymphatic invasion. Four patients, all with multiple nodules, had PTEN hamartoma syndrome (PHTS) with germline mutations or a clinical diagnosis of Cowden syndrome (CS); two had surgery finding FAs, and one previously had follicular carcinoma removed. Among surveillance patients, 1/20 had a significant increase in the size of the thyroid nodule and underwent repeat FNA, and no thyroid malignancy was found with a mean of 1.77 years of follow-up (range 1.00-2.78). Thyroid nodules with isolated somatic PTEN mutations are primarily benign and unlikely to grow at a high rate, at least on short-term follow-up. About 8% of patients with PTEN mutations may have PHTS or CS, which should be suspected in younger patients with multiple thyroid nodules.
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Affiliation(s)
- Jacob A Quaytman
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, UPMC Montefiore Hospital, N715, Pittsburgh, PA, USA
| | - Yuri E Nikiforov
- Division of Molecular Genomic Pathology, Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marina N Nikiforova
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elena Morariu
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Association of Parathyroid and Differentiated Thyroid Carcinomas: A Narrative Up-To-Date Review of the Literature. Medicina (B Aires) 2022; 58:medicina58091184. [PMID: 36143862 PMCID: PMC9503363 DOI: 10.3390/medicina58091184] [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: 08/11/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Aim: Parathyroid carcinoma (PC) is a rare endocrine malignancy that represents 0.005% of all malignant tumors. Associated PC and differentiated thyroid carcinoma (DTC) is an exceptionally rare condition, and the preoperative diagnostics and proper treatment are challenging. Almost all PCs and the majority of DTCs are diagnosed postoperatively, making correct surgical treatment questionable. Specific guidelines for parathyroid and thyroid carcinomas association treatment are lacking. The purposes of our study were to identify the association between parathyroid and thyroid carcinomas, to analyze the available published data, and to evaluate the possible relationship between preoperative diagnostic and surgical decision-making, and outcome-related issues. Material and methods: We performed a literature review of several databases from the earliest records to March 2022, using controlled vocabulary and keywords to search for records on the topic of PC and WDTC pathological association. The reference lists from the initially identified articles were analyzed to obtain more references. Results: We identified 25 cases of PC and DTC association, 14 more than the latest review from 2021. The mean age of patients was 55, with a female to male ratio of about 3:1. Exposure to external radiation was identified in only one patient, although it is considered a risk factor the development of both PC and DTC. The preoperative suspicion of PC was stated by the authors in only 25% of cases, but suspicion based on clinical, laboratory, ultrasound (US), and fine needle aspiration (FNA) criteria could have been justified in more than 50% of them. With neck ultrasound, 40% of patients presented suspicious features both for PC and thyroid carcinoma. Intra-operatory descriptions of the lesions revealed the highest suspicion (83.3%) of PC, but en bloc resection was recommended and probably performed in only about 50% of the cases. Histopathological examinations of the thyroid revealed different forms of papillary thyroid carcinoma (PTC) in most cases. Postoperative normocalcemia was achieved in 72% of patients, but follow-up data was missing in about 25% of cases. Conclusion: Associated PC and DTC is an exceptionally rare condition, and the preoperative diagnostic and treatment of the patients is a challenge. However, in most cases pre- and intraoperative suspicious features are present for identification by a highly specialized multidisciplinary endocrine team, who can thus perform the optimal treatment to achieve curability.
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Baser OO, Koseoglu D, Cetin Z, Catak M, Kizilkaya H. Benign cytology does not rule out malignancy in thyroid nodules larger than 4 cm. Diagn Cytopathol 2022; 50:508-512. [DOI: 10.1002/dc.25024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/08/2022] [Accepted: 07/20/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Ozden Ozdemir Baser
- Department of Endocrinology and Metabolism Yozgat City Hospital Yozgat Turkey
| | - Derya Koseoglu
- Department of Endocrinology and Metabolism Hitit University Erol Olcok Education and Research Hospital Corum Turkey
| | - Zeynep Cetin
- Department of Endocrinology and Metabolism Amasya University Sabuncuğlu Serefeddin Education and Research Hospital Amasya Turkey
| | - Merve Catak
- Department of Endocrinology and Metabolism Gaziosmanpasa University Tokat Turkey
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Chen WH, Chen CY. Clinicopathologic characteristics of incidental thyroid carcinoma in euthyroid patients receiving total thyroidectomy for multinodular goiter: A retrospective cohort study. J Chin Med Assoc 2022; 85:839-844. [PMID: 35648159 DOI: 10.1097/jcma.0000000000000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Total thyroidectomy is the treatment of choice for multinodular goiter (MNG). In some of these cases, incidental thyroid cancer (ITC) is detected postoperatively. Papillary thyroid microcarcinoma (PTMC), the most common type of ITC, has clinical factors and pathologic similarities with ITC that have not been well clarified previously. We investigated the incidence and characteristics of ITC and PTMC in euthyroid patients undergoing total thyroidectomy for MNG. METHODS We retrospectively investigated the data of 151 euthyroid patients who underwent total thyroidectomy for MNG between January 2016 and December 2020. Patients with PTMC were then selected from among those with ITC for further data analysis. RESULTS The incidence rates of ITC and PTMC were 31.1% (47/151) and 21.1% (32/151), respectively. The mean age of patients with ITC was 52.8 ± 11.7 years, which was younger than that of patients with benign MNG (57.2 ± 12.5 years, p < 0.05). Bilateral cancer was observed in 17 patients with ITC (17/47, 36.2%) and nine with PTMC (9/32, 28.1%). The numbers of patients in the ITC and PTMC groups whose cancer was not on the side comprising the dominant tumor were 15 (15/47, 31.9%) and 13 (13/32, 40.6%), respectively. The multivariate analysis demonstrated that younger age was a clinical factor associated with ITC and PTMC. CONCLUSION Younger age is a clinical factor for ITC and PTMC. We recommend taking considering clinical factors and pathologic characteristics of ITC and PTC when considering total thyroidectomy in euthyroid patients with MNG.
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Affiliation(s)
- Wei-Hsin Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taichung Veterans General, Hospital, Taichung, Taiwan, ROC
| | - Chih-Yi Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
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Incidental Thyroid Nodule on Chest Computed Tomography: Application of Computed Tomography Texture Analysis in Prediction of Ultrasound Classification. J Comput Assist Tomogr 2022; 46:480-486. [PMID: 35405688 DOI: 10.1097/rct.0000000000001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the value of computed tomography (CT) texture analysis (CTTA) in predicting ultrasound (US) classification of incidentally detected thyroid nodule (ITN) on chest CT. METHODS A total of 117 ITNs (≥1 cm in the longest diameter) on chest CT scan of 107 patients was divided into 4 categories according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) classification on recent thyroid US within 3 months. Computed tomography texture features were extracted with or without filtration using commercial software. The texture features were compared between the benign (K-TIRADS 2; n = 21) and the suspicious (K-TIRADS 3, 4, 5; n = 96) nodules. Multivariate regression and area under the receiver operating characteristic curve analysis were performed to determine significant prediction factors of the suspicious nodules. RESULTS The mean value of positive pixels was significantly higher in the suspicious nodules except the unfiltered image (P < 0.05). Entropy of the suspicious nodules was significantly higher with unfiltered and fine filters (P < 0.05), and kurtosis of the suspicious nodules was significantly higher with medium and coarse filters (P < 0.05). A logistic regression model incorporating mean value of positive pixels and kurtosis with a medium filter using volumetric analysis demonstrated the best performance to predict the suspicious nodules with an area under the receiver operating characteristic curve of 0.842 (P < 0.001, sensitivity 82.3%, and specificity 81.0%). CONCLUSIONS Computed tomography texture analysis for ITN larger than 1 cm showed significant correlation with systematic thyroid US classification and presented excellent performance to predict the suspicious nodules.
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Steinmetz-Wood SN, Kennedy AG, Tompkins BJ, Gilbert MP. Navigating the Debate on Managing Large (≥4 cm) Thyroid Nodules. Int J Endocrinol 2022; 2022:6246150. [PMID: 35469125 PMCID: PMC9034904 DOI: 10.1155/2022/6246150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Discordant practice guidelines for managing large thyroid nodules may result in unnecessary surgeries and costs. Recent data suggest similar false-negative rates in fine needle aspiration (FNA) biopsies between small (<4 cm) and large (≥4 cm) nodules, indicating that monitoring rather than surgery may be appropriate for large biopsy-negative nodules. We investigated the management of thyroid nodules ≥4 cm to determine the proportion of surgeries not necessary for diagnostic purposes and examined for potential predictors. METHODS This was a retrospective cohort study of patients who received a FNA of nodule(s) ≥4 cm between 11/1/2014 and 10/31/2019 at the University of Vermont Medical Center. A surgery was considered unnecessary if the FNA result was benign in the absence of any of the following: compressive symptoms, family history of thyroid cancer in a first degree relative, history of neck irradiation, toxic nodule or toxic multinodular goiter, or substernal extension. Data were analyzed with Wilcoxon rank sum tests, chi square, or Fisher's exact tests. RESULTS 177 patients had a ≥4 cm nodule during the timeframe and half (54.2%) had surgery. Patients who underwent surgery were significantly younger (51.5 years vs. 62 years; P < 0.001), more likely to report obstructive symptoms (34.4% vs. 12.1%; P < 0.001) and had a larger nodule size (5.0 cm vs. 4.7 cm; P=0.26). Forty-one patients with benign (Bethesda II) FNA results had surgery, all with negative surgical pathology. Thirteen percentage (23/177) of surgeries were potentially not necessary for diagnostic purposes. CONCLUSION Approximately half of our patients with ≥4 cm nodules had surgery, with 13% having surgery not necessary for diagnostic purposes revealing opportunities for improving care and costs.
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Affiliation(s)
| | - Amanda G. Kennedy
- Department of Medicine Quality Program, The Larner College of Medicine at The University of Vermont, Burlington, VT, USA
| | - Bradley J. Tompkins
- Department of Medicine Quality Program, The Larner College of Medicine at The University of Vermont, Burlington, VT, USA
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13
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Ha EJ, Chung SR, Na DG, Ahn HS, Chung J, Lee JY, Park JS, Yoo RE, Baek JH, Baek SM, Cho SW, Choi YJ, Hahn SY, Jung SL, Kim JH, Kim SK, Kim SJ, Lee CY, Lee HK, Lee JH, Lee YH, Lim HK, Shin JH, Sim JS, Sung JY, Yoon JH, Choi M. 2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol 2021; 22:2094-2123. [PMID: 34719893 PMCID: PMC8628155 DOI: 10.3348/kjr.2021.0713] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1-2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.
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Affiliation(s)
- Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Chung
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Korea
| | - Seong Whi Cho
- Department of Radiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seul Kee Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Soo Jin Kim
- Department of Radiology, New Korea Hospital, Gimpo, Korea
| | - Chang Yoon Lee
- Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Ho Kyu Lee
- Department of Radiology, Jeju National University, Jeju, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
| | - Jin Young Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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Abstract
Thyroid nodules may be discovered in a variety of settings. Familiarity with their management is important for medical specialists. Workup should start with history and physical examination, proceed to laboratory studies, and then to imaging. Nodules are selected for fine needle aspiration (FNA) biopsy based on imaging criteria. Most nodules can be accurately diagnosed on cytopathology, but some may require additional molecular testing to evaluate risk of malignancy. Patients with malignant lesions require additional investigation before referral to an experienced thyroid surgeon. Those who have benign lesions may require monitoring by periodic ultrasound to identify nodules requiring reevaluation.
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Affiliation(s)
- Elizabeth H Holt
- Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, Yale Medical School, PO Box 208020, New Haven, CT 06520-8020, USA.
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15
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Hamour AF, Yang W, Lee JJW, Wu V, Ziai H, Singh P, Eskander A, Sahovaler A, Higgins K, Witterick IJ, Vescan A, Freeman J, de Almeida JR, Goldstein D, Gilbert R, Chepeha D, Irish J, Enepekides D, Monteiro E. Association of the Implementation of a Standardized Thyroid Ultrasonography Reporting Program With Documentation of Nodule Characteristics. JAMA Otolaryngol Head Neck Surg 2021; 147:343-349. [PMID: 33570552 DOI: 10.1001/jamaoto.2020.5233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Although most thyroid nodules are benign, the potential for malignant neoplasms is associated with unnecessary workup in the form of imaging, fine-needle aspiration, and diagnostic surgery. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is commonly used to assess the malignant neoplasm risk potential of thyroid nodules imaged by ultrasonography. However, standardized reporting of ACR TI-RADS descriptors is inconsistent. Objective To increase the documentation rate of ACR TI-RADS thyroid nodule characteristics to 80% in 18 months. Design, Setting, and Participants This prospective interrupted time series quality improvement study was conducted from December 1, 2018, to March 31, 2020, at a tertiary outpatient head and neck clinic among 229 patients who had at least 1 documented thyroid nodule identified on bedside clinic ultrasonography. Data analysis was performed throughout the entire study period because this was a quality improvement study with iterative small cycle changes; final analysis of the data was performed in April 2020. Main Outcomes and Measures The primary outcome was the documentation rates of 6 ACR TI-RADS ultrasonographic descriptors. Secondary outcomes included nodule fine-needle aspiration biopsy rate and physician-reported clinic flow efficiency. Results A total of 229 patients had at least 1 documented thyroid nodule and were included in the analysis. Size was the most frequently documented nodule characteristic (72 of 74 [97.3%]) at baseline, followed by echogenic foci (31 of 74 [41.9%]), composition (23 of 74 [31.1%]), echogenicity (17 of 74 [23.0%]), margin (6 of 74 [8.1%]), and shape (1 of 74 [1.4%]). After 3 Plan, Do, Study, Act (PDSA) cycles, the final intervention consisted of a standardized ultrasonography reporting form and educational initiatives for surgical trainees. After the third PDSA cycle (n = 36), reporting of nodule size, echogenic foci, and composition increased to 100%. Similarly, reporting of echogenicity (34 of 36 [94.4%]), shape (28 of 36 [77.8%]), and margin (25 of 36 [69.4%]) all increased. This represented a cumulative 90.3% documentation rate (195 of 216), a 56.5% increase from baseline (95% CI, 50.0%-61.9%). The standardized reporting form was used in 83.3% of eligible thyroid ultrasonography cases (30 of 36) after PDSA cycle 3, demonstrating good fidelity of implementation. There were no unintended consequences associated with clinic workflow, as a balancing measure, reported by staff surgeons. Conclusions and Relevance This study suggests that implementation of an ACR TI-RADS-based reporting form in conjunction with educational initiatives improved documentation of ultrasonographic thyroid nodule characteristics, potentially allowing for improved bedside risk stratification and communication among clinicians.
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Affiliation(s)
- Amr F Hamour
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Weining Yang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John J W Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Praby Singh
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Scarborough Hospital, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Allan Vescan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Jeremy Freeman
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - David Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Douglas Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
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16
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CENGİZ H, DEMİRCİ T, AYDIN A, VARIM C. Does fine needle aspiration from a different nodule other than the dominant nodule provide additional benefit in thyroid diseases with nodules? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.950773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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17
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Bernet VJ, Chindris AM. Update on the Evaluation of Thyroid Nodules. J Nucl Med 2021; 62:13S-19S. [PMID: 34230067 DOI: 10.2967/jnumed.120.246025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/29/2020] [Indexed: 12/18/2022] Open
Abstract
Thyroid nodules (TN) are prevalent in the general population and represent a common complaint in clinical practice. Most are asymptomatic and are associated with a 7%-15% risk of malignancy (1). Methods: PubMed and Medline were searched for articles with a focus on the epidemiology, diagnosis, and management of TN over the past 5 y. Results: The increase in frequency of imaging has led to a rise in the incidence of incidentally diagnosed TN. The initial evaluation of a TN includes assessing thyroid function, clinical risk factors, and neck imaging. Ultrasound remains the gold standard for assessing TN morphology, and biopsy is the standard method for determining whether a TN is benign. Recently published risk stratification systems using morphologic characteristics on ultrasonography have been effective in reducing the number of unnecessary biopsies. Advances in molecular testing have reduced the number of surgical procedures performed for diagnostic purposes on asymptomatic TN with indeterminate cytology. Scintigraphy is the first-line study for assessing a hyperfunctioning nodule. Many TN can be followed clinically or with serial ultrasound after the initial diagnosis. Surgical intervention is warranted when local symptoms are present, in patients with clinical risk factors, as well as in most situations with malignant cytology. Active surveillance is an option in cases of micropapillary thyroid cancer. Emerging nonsurgical approaches for treating TN include ethanol ablation for TN; sclerotherapy for thyroid cysts; and thermal techniques, such as radiofrequency ablation, laser ablation, microwaves, and high-intensity focused ultrasound. Conclusion: Most TN are benign and can be safely monitored. The indications for biopsy and frequency of imaging should be tailored on the basis of risk stratification. Treatment options should be individualized for each patient's particular situation. Active surveillance should be considered in certain cases of papillary microcarcinoma.
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Affiliation(s)
- Victor J Bernet
- Division of Endocrinology, Department of Medicine, Mayo Clinic in Florida, Jacksonville, Florida
| | - Ana-Maria Chindris
- Division of Endocrinology, Department of Medicine, Mayo Clinic in Florida, Jacksonville, Florida
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18
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Wang M, Sun P, Zhao X, Sun Y. Ultrasound Parameters of Thyroid Nodules and the Risk of Malignancy: A Retrospective Analysis. Cancer Control 2021; 27:1073274820945976. [PMID: 33035078 PMCID: PMC7791455 DOI: 10.1177/1073274820945976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Ultrasonography-guided fine-needle aspiration biopsy is the common choice for
diagnosis of the suspected thyroid nodule. An algorithm(s) that finds the
malignant potential of a nodule preoperatively, to overcome unnecessary
diagnostic methods, does not exist. The objective of the study was to correlate
thyroid nodule sizes measured by ultrasonography and risk of malignancy assessed
by cytologic and histologic examinations. Data regarding fine-needle aspiration
cytology and the results of histologic examinations of surgical specimens of 260
nodules were collected and analyzed. The macro or multiple calcifications, the
complex echo pattern, and posterior region homogeneity were considered
suspicious in ultrasonography. Bethesda system for classification of thyroid
nodules was used for cytopathology. Histopathology performed as per the 2004
World Health Organization classification system. The benefit score analysis was
performed for determination of clinical usefulness. Twenty-eight of 49 malignant
nodules and 46 of 68 malignant nodules detected through ultrasound following
fine-needle aspiration cytopathology and histopathology were <2 cm in size. A
correlation was found for malignancy rate detected by ultrasonography-guided
fine-needle aspiration cytology and those of the surgical specimen
(r = 0.945, P = .015, R2 = 0.894). Ultrasonography-guided fine-needle aspiration cytology
had 0.994 sensitivities, 0.721 accuracies, and 0.08 to 0.945 diagnostic
confidence for the detection of malignant nodules. Nodule size less than 2 mm
(P = .011) was associated with the malignancy potential of
thyroid nodules. Ultrasonography-guided fine-needle aspiration cytology had 19
(7%) results as a false negative and 1 (1%) results were false positive.
Ultrasound-guided fine-needle aspiration cytopathology reported oversize of
thyroid nodule than original but can predict the risk of malignancy. Level of
Evidence: III.
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Affiliation(s)
- Minxin Wang
- Department of Ultrasound, Weihai Central Hospital, Weihai, Shandong, China
| | - Ping Sun
- Department of Ultrasound, Weihai Central Hospital, Weihai, Shandong, China
| | - Xiaodong Zhao
- Department of Gastroenterology, Weihai Central Hospital, Weihai, Shandong, China
| | - Yongmei Sun
- Department of Ultrasound, 12593The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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19
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Avior G, Dagan O, Shochat I, Frenkel Y, Tessler I, Meir A, Jaffe A, Cohen O. Outcomes of the Bethesda system for reporting thyroid cytopathology: Real-life experience. Clin Endocrinol (Oxf) 2021; 94:521-527. [PMID: 32981060 DOI: 10.1111/cen.14341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The 2017 revised Bethesda System for Reporting Thyroid Cytopathology (BSRTC) included new malignancy rates for each category as well as new management recommendations. Here, we evaluate the malignancy rate and test performance for BSRTC categories in a middle-sized institution outside the United States (US). DESIGN Retrospective single centre case series with chart review. PATIENTS All patients who underwent thyroid surgery with a preoperative BSRTC between the years 2010 and 2018 at our institution. MEASUREMENTS In order to assess the malignancy rate for each BSRTC, all medical records were reviewed to collect demographics, nodule's size, BSRTC and final pathology. RESULTS Three hundred and sixty-four patients were included, with an overall malignancy rate of 34.3%. The malignancy rate for BSRTC categories I-VI was as follows: 13.3%, 5.1%, 25.0%, 24.4%, 91.3% and 95.2%, respectively. The most sensitive test was when BSRTC III-VI were evaluated (91%). Overall best performance (sensitivity, specificity, PPV, NPV and accuracy) was obtained when BSRTC V-VI were grouped together with a substantial decrease when adding BSRTC III-IV (90%, 97%, 94%, 95%, 95% vs, respectively, 91%, 73%, 62%, 95%, 79%, respectively). CONCLUSIONS Despite differences from the reported 2017 BSRTC malignancy rates, we demonstrated that the revised 2017 BSRTC management recommendations for thyroid nodules are also valid in smaller non-US centre, supporting its use globally.
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Affiliation(s)
- Galit Avior
- Otorhinolaryngology and Head & Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel
- Faculty of Medicine, Technion, Haifa, Israel
| | - Or Dagan
- Otorhinolaryngology and Head & Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Isaac Shochat
- Otorhinolaryngology and Head & Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yulia Frenkel
- Otorhinolaryngology and Head & Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Idit Tessler
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Alona Meir
- Department of Pathology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Anat Jaffe
- Endocrinology and Diabetes Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Oded Cohen
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
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20
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He X, Soleimanpour SA, Clines GA. Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer. Clin Diabetes Endocrinol 2020; 6:19. [PMID: 33292836 PMCID: PMC7640618 DOI: 10.1186/s40842-020-00109-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/25/2020] [Indexed: 01/25/2023] Open
Abstract
Background Differentiated thyroid cancer uncommonly presents with distant metastases. Adrenal metastasis from differentiated thyroid cancer presenting as the initial finding is even less common. Case Presentation A 71-year-old male was incidentally found on chest CT to have bilateral thyroid nodules, which were confirmed on ultrasound. Fine needle aspiration of the dominant right 3.3 cm nodule contained histologic features most consistent with Bethesda classification III, and repeat fine needle aspiration revealed pathology consistent with Bethesda classification II. Follow-up thyroid ultrasound showed 1% increase and 14% increase in nodule volume at one and two years, respectively, compared to baseline. Prior to the second annual thyroid ultrasound, the patient was incidentally found to have a 4.1 cm heterogeneously enhancing mass in the right adrenal gland on CT of the abdomen and pelvis. Biochemical evaluation was unremarkable with the exception of morning cortisol of 3.2 µg/dL after dexamethasone suppression. The patient then underwent laparoscopic right adrenal gland excision, which revealed metastatic follicular thyroid carcinoma. Total thyroidectomy was then performed, with pathology showing a 4.8 cm well-differentiated follicular thyroid carcinoma of the right lobe, a 0.5 cm noninvasive follicular thyroid neoplasm with papillary-like nuclear features of the left lobe, and a 0.1 cm papillary microcarcinoma of the left lobe. Thyrotropin-stimulated whole body scan showed normal physiologic uptake of the remnant thyroid tissue without evidence of other iodine avid disease. The patient then received radioactive iodine. At follow-up 14 months after total thyroidectomy, he remains free of recurrent disease. Conclusion Despite following the recommended protocol for evaluation and surveillance of thyroid nodules, thyroid cancer can be challenging to diagnose, and may not be diagnosed until distant metastases are identified.
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Affiliation(s)
- Xin He
- Department of Internal MedicineDivision of MetabolismEndocrinology & Diabetes, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Scott A Soleimanpour
- Department of Internal MedicineDivision of MetabolismEndocrinology & Diabetes, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.,Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Gregory A Clines
- Department of Internal MedicineDivision of MetabolismEndocrinology & Diabetes, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.,Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
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21
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Kornelius E, Lo SC, Huang CN, Yang YS. The Risk of Thyroid Cancer in Patients with Thyroid Nodule 3 Cm Or Larger. Endocr Pract 2020; 26:1286-1290. [PMID: 33471658 DOI: 10.4158/ep-2020-0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/02/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There are conflicting data on the risk of thyroid cancer in thyroid nodules 3 cm or larger, and few such studies on this issue have been conducted in Asia. This study aimed to examine the risk of thyroid cancer in patients with thyroid nodules 3 cm or larger. METHODS This was a 7-year retrospective study conducted in a tertiary referral hospital in Taiwan. All patients with a thyroid nodule measuring ≥3 cm who underwent thyroid operation with or without fine-needle aspiration biopsy (FNAB) were included. The prevalence rate of thyroid cancer, as well as the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and false-negative rate of FNAB for thyroid nodule ≥3 cm were also examined. RESULTS A total of 132 patients were included in this study. Thyroid cancer was detected in 19 of 132 (14.4%) thyroid nodules measuring ≥3 cm. The performance of FNAB for detecting cancer in nodules 3 cm or larger without considering other ultrasonography parameters was relatively poor with a sensitivity of 50%, but the specificity (100%), PPV (100 %), and NPV (93.4 %) were excellent. CONCLUSION The risk of thyroid cancer for thyroid nodules ≥3 cm in this study was low. The PPV and NPV of FNAB were high for the detection of cancer in large nodules. The decision to perform thyroidectomy should not be solely based on nodule size and should include other factors, such as ultrasound characteristics and surgical risk.
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Affiliation(s)
- Edy Kornelius
- From the Chung Shan Medical University Hospital, Department of Internal Medicine, Division of Endocrinology and Metabolism, Institute of Medicine, Taichung, Taiwan; The Chung Shan Medical University, School of Medicine, Institute of Medicine, Taichung, Taiwan; Chung Shan Medical University, Institute of Medicine, Taichung, Taiwan
| | - Shih-Chang Lo
- From the Chung Shan Medical University Hospital, Department of Internal Medicine, Division of Endocrinology and Metabolism, Institute of Medicine, Taichung, Taiwan; Chung Shan Medical University, Institute of Medicine, Taichung, Taiwan
| | - Chien-Ning Huang
- From the Chung Shan Medical University Hospital, Department of Internal Medicine, Division of Endocrinology and Metabolism, Institute of Medicine, Taichung, Taiwan; The Chung Shan Medical University, School of Medicine, Institute of Medicine, Taichung, Taiwan; Chung Shan Medical University, Institute of Medicine, Taichung, Taiwan
| | - Yi-Sun Yang
- From the Chung Shan Medical University Hospital, Department of Internal Medicine, Division of Endocrinology and Metabolism, Institute of Medicine, Taichung, Taiwan; The Chung Shan Medical University, School of Medicine, Institute of Medicine, Taichung, Taiwan; Chung Shan Medical University, Institute of Medicine, Taichung, Taiwan..
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22
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Görgülü O, Görgülü FF, Koç AS. Can the unnecessary operations for suspected thyroid nodules be avoided by the combined use of the strain ratio and elastography score? Braz J Otorhinolaryngol 2020; 87:338-345. [PMID: 32653346 PMCID: PMC9422504 DOI: 10.1016/j.bjorl.2020.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Only 5%–15% of thyroid surgical specimens are reported as malignant. Most of the operations are performed due to suspicion of malignancy as a result of fine needle aspiration biopsy but invasiveness, non-diagnostic results and potential repeat biopsies are disadvantages of fine needle aspiration biopsy. Objective The aim of this study was to investigate the effectiveness of simultaneously using both the strain ratio and elasticity score in the differential diagnosis of thyroid nodules, as well as to assess the compatibility of these two methods. Methods A total of 144 nodules were included in the study. The final histopathologic diagnosis was used as the reference standard. The area under the curve sensitivity, specificity, and cut-off values of the strain ratio and elasticity score were determined using receiver operating characteristic curve analysis. The compatibility and comparison of strain ratio and elasticity score were also performed. Results Twenty eight nodules (19.4%) were malignant. The strain ratio and elasticity score results were found to be significantly successful in predicting thyroid malignancy (p < 0.001 for both). Moreover, the area under the curve for the strain ratio and elasticity score were found to be 0.944 and 0.960, respectively. The diagnostic accuracy of the elasticity score was found to be superior to that of the strain ratio, but this difference was not statistically significant (p = 0.456). When the compatibility of the strain ratio and elasticity score was examined, the two evaluations were revealed to be statistically consistent with each other (Kappa = 0.767; p < 0.001). When the strain ratio and the elasticity score were used together, the specificity of capturing the correct diagnosis increased from 84.5% to 93.1%. Conclusion When the strain ratio an elasticity score were used together for the differential diagnosis of thyroid nodules, more accurate results were obtained. Thus, combining both methods may be a promising alternative to fine needle aspiration biopsy in order to prevent unnecessary surgical interventions for suspected thyroid nodules.
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Affiliation(s)
- Orhan Görgülü
- University of Health Sciences, Adana Health Practice and Research Center, Department of Otorhinolaryngology, Adana, Turkey.
| | - Feride Fatma Görgülü
- University of Health Sciences, Adana Health Practice and Research Center, Radiology Department, Adana, Turkey
| | - Ayşe Selcan Koç
- University of Health Sciences, Adana Health Practice and Research Center, Radiology Department, Adana, Turkey
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赵 美, 杨 炜, 李 金, 王 自, 邵 国. [Positive rate and accuracy of ultrasound-guided fine-needle aspiration cytology for detecting suspected thyroid carcinoma nodules of different sizes]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:693-697. [PMID: 32897217 PMCID: PMC7277305 DOI: 10.12122/j.issn.1673-4254.2020.05.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To analyze the accuracy and positive rate of ultrasound-guided fine-needle aspiration (US-FNA) cytology for detecting suspected thyroid cancer nodules of different sizes. METHODS A total of 591 patients with 594 suspected malignant thyroid nodules received examinations with US-FNA cytology. Based on their size, the nodules were divided into group I (4-5 mm), group II (6-10 mm), group III (>10 mm). With the results of pathology as the standard, we analyzed the results of US-FNA cytology for detecting thyroid carcinoma in terms of its accuracy, indeterminate rate, positive predictive value and negative predictive value for nodules of different sizes. RESULTS The positive rates in group I, group II and group III were 39.2% (40/102), 48.2% (172/357) and 65.2% (88/135), respectively, similar between groups I and II (P=0.107) and differed significantly between groups I and III (P=0.000) and between groups II and III (P=0.001). The accuracy, indeterminate rate, positive predictive value and negative predictive value in the 3 groups were 95.5% (21/22), 97.1% (100/103), and 94.4% (51/54); 2.9% (3/102), 2.8% (10/357), and 1.5% (2/135); 100%, 100%, and 98%; 66.7%, 57.1%, and 33.3%, respectively, showing no significant differences among the 3 groups. CONCLUSIONS The size of the thyroid nodules can affect the positive rate but does not have significant effects on the accuracy, indeterminate rate, positive predictive value or negative predictive value of US-FNA cytology.
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Affiliation(s)
- 美丽 赵
- 南京医科大学附属南京医院//南京市第一医院 功能检查科, 江苏 南京 210006Department of Functional Examination, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - 炜 杨
- 南京医科大学附属南京医院//南京市第一医院 功能检查科, 江苏 南京 210006Department of Functional Examination, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - 金凤 李
- 南京医科大学附属南京医院//南京市第一医院 功能检查科, 江苏 南京 210006Department of Functional Examination, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - 自正 王
- 南京医科大学附属南京医院//南京市第一医院 核医学科, 江苏 南京 210006Department of Nuclear Medicine, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
| | - 国强 邵
- 南京医科大学附属南京医院//南京市第一医院 核医学科, 江苏 南京 210006Department of Nuclear Medicine, Nanjing Hospital Affiliated to Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 236] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
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Chung SR, Baek JH, Choi YJ, Sung TY, Song DE, Kim TY, Lee JH. The relationship of thyroid nodule size on malignancy risk according to histological type of thyroid cancer. Acta Radiol 2020; 61:620-628. [PMID: 31554409 DOI: 10.1177/0284185119875642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Although several studies have examined the value of thyroid nodule size as a malignancy predictor, the results are conflicting. Purpose To investigate the relationship between nodule size and malignancy risk and to evaluate the impact of nodule size on the false-negative rate of fine needle aspiration or core needle biopsy according to the histological type of thyroid cancer. Material and Methods From January 2013 to December 2013, 3970 thyroid nodules that underwent ultrasound-guided fine needle aspiration or core needle biopsy were retrospectively reviewed. We assessed the relationship between nodule size and malignancy risk according to histological type of thyroid cancer. In addition, we compared the false-negative rate by thyroid nodule size category. Results Of 3970 thyroid nodules, 1170 nodules were malignant. For papillary thyroid carcinoma, nodule size was inversely related to malignancy risk, whereas in nodules of follicular carcinoma and follicular variant papillary thyroid carcinoma, nodule size was positively related to malignancy risk ( P < 0.001). The false-negative rate tended to increase as nodule size increased ( P = 0.002) for all nodules and the overall false-negative rate was 2.3%. Conclusion Overall, nodule size does not correlate with risk of malignancy, but the relationship between nodule size and malignancy risk depends on the histological type of thyroid cancer.
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Affiliation(s)
- Sae Rom Chung
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Tae-Yon Sung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Tae Yong Kim
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Hu F, Yan Z, Ma B, Jiang Y, Huang H. The impact of concurrent Hashimoto thyroiditis on thyroid nodule cytopathology assessed by ultrasound-guided fine-needle aspiration cytology. Postgrad Med 2020; 132:506-511. [PMID: 32133896 DOI: 10.1080/00325481.2020.1739462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: Thyroid nodules are highly prevalent and a common clinical problem worldwide. How to identify the nature of a nodule is a major concern of clinicians. Fine needle aspiration cytology (FNAC) has an established role and is well-utilized in nodule management. However, the unsatisfactory nondiagnostic and indeterminate rates limit its usage and lead to some unnecessary surgery. Hashimoto thyroiditis (HT) is prevalently found concurrent with thyroid nodules. Whether HT can influence the accuracy of cytopathological diagnosis of nodules is still controversial. Methods: We collected medical records of 1,063 patients with thyroid nodules who had done FNAC in our hospital from 2015 to 2016. Thyroid function, anti-thyroid autoantibody levels, thyroid ultrasound records, and cytological and histopathological results of nodules were reviewed to analyze the impact of HT on FNAC outcome. Results: A total of 1,063 patients with an average age of 44 ± 13 years old were retrospectively reviewed for pathological and clinical data. Patients with different cytological diagnoses had comparable positive rates of anti-thyroid autoantibodies. One hundred patients were confirmed to have concurrent HT by histopathology after surgery. The overall nondiagnostic and indeterminate cytology rates were 11.9% and 25% respectively. No statistical difference was found either in the rate of a nondiagnostic cytology results or in the rate of indeterminate cytology results between patients with positive anti-thyroid autoantibodies and patients with negative test for anti-thyroid autoantibodies (P > 0.05). The same was true between patients with histopathologically confirmed HT and HT-negative ones (P > 0.05). Conclusions: The presence of concurrent HT, whether clinically implied with positive anti-thyroid autoantibodies or pathologically confirmed, is unlikely to predispose an FNAC diagnosis of thyroid nodules to be non-diagnostic or indeterminate.
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Affiliation(s)
- Fengqiu Hu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University , Chengdu, China
| | - Zhe Yan
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University , Chengdu, China
| | - Buyun Ma
- Department of Ultrasound, West China Hospital, Sichuan University , Chengdu, China
| | - Yong Jiang
- Department of Pathology, West China Hospital, Sichuan University , Chengdu, China
| | - Hui Huang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University , Chengdu, China
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Suh J, Choi HS, Kwon A, Chae HW, Kim HS. Adolescents with thyroid nodules: retrospective analysis of factors predicting malignancy. Eur J Pediatr 2020; 179:317-325. [PMID: 31741093 DOI: 10.1007/s00431-019-03507-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 01/10/2023]
Abstract
Thyroid nodules are less common in children than in adults. However, pediatric thyroid nodules have a higher rate of malignancy compared to those in adults, and increased risk of metastasis and recurrence. In the present study, we analyzed the clinical features as well as laboratory and thyroid ultrasound (US) findings of children and adolescents with thyroid nodules to identify predictive factors of thyroid cancer. We retrospectively analyzed 275 patients with thyroid nodules under 18 years of age who visited Severance Children's Hospital between January 2005 and May 2017. Among them, 141 patients who underwent ultrasonography-guided fine needle aspiration biopsy (FNAB), and four patients without FNAB who underwent surgical resection, were included in this study. The remaining 125 patients without FNAB and five patients with follow-up loss after FNAB were excluded. Clinical, laboratory, and US data were evaluated in 145 patients to establish the potential predictive factors of thyroid cancer. Thyroid malignancies were observed in 101 patients. Grade 2 goiters were seen more often in benign nodule group. Hypoechoic nodules, nodules with microcalcifications, abnormal lymph nodes, and irregular margins were findings significantly associated with thyroid cancer. The findings of hypoechoic nodule, nodule with microcalcifications, and abnormal lymph nodes showed statistical significance in predicting thyroid cancer.Conclusion: Hypoechoic nodules, nodules with microcalcifications, and abnormal lymph nodes are predictive factors for thyroid cancer in children. Therefore, further diagnostic evaluations, including FNAB, should be considered in patients with such findings.What is Known:• Thyroid nodules are less common in children than in adults, but pediatric thyroid nodules have a higher rate of malignancy, and also have increased risk of metastasis and recurrence.• Research on ways to predict thyroid cancer have mostly been accomplished in adult patients, and the application of risk stratification system has not been fully satisfactory in children, which requires further studies in pediatric thyroid nodules.What is New:• Hypoechoic nodules, nodules with microcalcifications, and abnormal lymph nodes are predictive factors for thyroid cancer in Korean children.
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Affiliation(s)
- Junghwan Suh
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Han Saem Choi
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Ahreum Kwon
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
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Zhu Y, Song Y, Xu G, Fan Z, Ren W. Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review. Diagn Pathol 2020; 15:1. [PMID: 31900180 PMCID: PMC6942345 DOI: 10.1186/s13000-019-0924-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/27/2019] [Indexed: 12/16/2022] Open
Abstract
Objective FNA is a simple, safe, cost-effective and accurate diagnostic tool for the initial screening of patients with thyroid nodules. The aims of this study were to determine the diagnostic utility of FNAC performed in our institution, assess the cytomorphologic features that contribute to diagnostic errors and propose improvement measures. Methods A total of 2781 FNACs were included in the study, and 1122 cases were compared with their histological diagnoses. We retrospectively reexamined our discordant (both false-negative and false-positive) cases and performed a systematic review of previous studies on causes of misdiagnoses. Results When DC V and DC VI were both considered cytologic-positive, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 98.3, 30.9, 94.9, 58.3 and 93.5%, respectively. If DC VI was considered cytologic-positive, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC were 98.0, 84.0, 99.4, 58.3, and 97.5% respectively. The main cause of false-negative diagnoses was sampling error (13/15, 86.7%), while interpretation error led to the majority of the false-positive diagnoses (38/47, 80.9%). Overlapping cytological features in adenomatous hyperplasia, thyroiditis and cystic lesions were the major factors contributing to interpretation errors, while the size and number of nodules may have led to false-negative diagnoses because of heterogeneity and unsampled areas. Conclusions The sensitivity and PPV of thyroid FNAC in our institution were higher than those in the published data, while the specificity and NPV were lower. Regarding the FNA category DC V, a frozen section analysis during diagnostic lobectomy is necessary. Multiple passes should be performed in various parts of a large nodule or from different nodules to reduce the risk of false-negative findings. Cytopathologists should strengthen their criteria for the identification of adenomatous hyperplasia, thyroiditis and cystic lesions to avoid false-positive diagnoses. NIFTP has little effect on diagnostic accuracy and the distribution of diagnostic errors.
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Affiliation(s)
- Yanli Zhu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Yuntao Song
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Guohui Xu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Zhihui Fan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Wenhao Ren
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
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Jinih M, Faisal F, Abdalla K, Majeed M, Achakzai AA, Heffron C, McCarthy J, Redmond HP. Association between thyroid nodule size and malignancy rate. Ann R Coll Surg Engl 2020; 102:43-48. [PMID: 31865760 PMCID: PMC6937614 DOI: 10.1308/rcsann.2019.0156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2019] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The diagnostic performance of ultrasound-fine needle aspiration to identify thyroid nodules harbouring malignancy remains variable. The aim of this study was to determine thyroid nodule size and cytological classification as predictors of malignancy risk. MATERIALS AND METHODS We conducted a retrospective cohort analysis at an academic hospital involving 499 consecutive patients who underwent thyroid surgery between 2004 and 2015. RESULTS A total of 503 thyroid nodules (499 patients, 84% female; mean age 50.8 years, standard deviation, SD, 15.4 years) were analysed. Of these, 19.5% were malignant. The mean (± SD) nodule size was 3.28 ± 1.63 cm and 3.27 ± 1.54 cm for benign and malignant nodules, respectively. The odds of malignancy for thyroid nodules less than 3.0 cm was similar to those for nodules of 3.0 cm or greater (0.26 compared with 0.29; p=0.77). Overall, the sensitivity and specificity of fine-needle aspiration in this cohort were 71.4% and 100%, respectively. The overall false negative rate was 5.4%. When the cut-off of 3.0 cm was used, the false negative rate in thyroid nodules less than 3.0 cm was 0% compared with 7.0% in nodules of 3.0 cm or greater. Thus, class (p<0.01) but not nodule size (p=0.49), was associated with higher malignancy risk. CONCLUSIONS Our results suggest that thyroid nodule size did not accurately predict the risk of thyroid malignancy irrespective of fine-needle aspiration cytology. Routine diagnostic thyroid lobectomy solely owing to thyroid nodule size of 3.0 cm or greater is currently not justified.
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Affiliation(s)
- M Jinih
- Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - F Faisal
- School of Medicine, University College Cork, Cork, Ireland
| | - K Abdalla
- Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - M Majeed
- Department of ENDOCRINE SURGERY, Cork University Hospital, Wilton, Cork, Ireland
| | - AA Achakzai
- Department of ENDOCRINE SURGERY, Cork University Hospital, Wilton, Cork, Ireland
| | - C Heffron
- Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland
| | - J McCarthy
- Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland
| | - HP Redmond
- Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland
- Department of ENDOCRINE SURGERY, Cork University Hospital, Wilton, Cork, Ireland
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Li Y, Yu JH, Du PJ, Xie Y, Das SK, Li B, Zhang C. High-Score US-Suspicious Subcentimeter Thyroid Nodules: What Factors Affect Adequate Sampling of US-Guided Fine-Needle Aspiration Biopsy? Int J Endocrinol 2020; 2020:8464623. [PMID: 32377188 PMCID: PMC7191365 DOI: 10.1155/2020/8464623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/20/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Fine-needle aspiration biopsy (FNAB) is diagnostic standard for thyroid nodules. However, the influence of adequate sample rate of US-guided FNAB for subcentimeter thyroid nodules is not known well. OBJECTIVES To assess the factors affecting adequate sample rate of US-guided FNAB for subcentimeter thyroid nodules. METHODS Three hundred and forty-nine consecutive US-guided FNAB procedures were performed in 344 patients with subcentimeter thyroid nodules. The adequate sample rate was analyzed for all nodules on the basis of nodule-related and technical factors. The factors affecting adequate sample rate of US-guided FNAB for subcentimeter thyroid nodules were determined by multivariate logistic regression. RESULTS The adequate sample rate increased with larger nodules (72.7% for 3-6 mm nodules and 84.9% for 7-10 mm nodules (P=0.007)). The adequate sample rate was 63.9%, 81.3%, and 90.6% in nodules with macrocalcifcation, microcalcification, and no calcification, respectively (P < 0.001). The adequate sample rate was 71.8% for biopsies performed with a perpendicular needle path and 85.0% with a parallel needle path (P=0.004). The significant factors affecting adequate sample rate of US-guided FNAB for subcentimeter thyroid nodules were nodule size (P < 0.001; odds ratio (OR) for 7-10 mm nodules was approximately 3.0 times higher than that for 3-6 mm nodules), calcification (P < 0.001; OR for nodules without calcification was approximately 5.3 times higher than that for the nodules with macrocalcification), and needle path (P=0.044; OR for the use of the parallel needle path was about 1.8 times higher than that for the perpendicular needle path). CONCLUSION Nodule size, calcification, and needle path were the determinants of sample adequacy. The adequate sample rate was higher in larger nodules, in nodules without calcification, and upon using a parallel needle path for biopsy.
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Affiliation(s)
- Yang Li
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong 637000, Sichuan, China
| | - Jin Hong Yu
- Department of Ultrasound, The Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong 637000, Sichuan, China
| | - Ping Jie Du
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong 637000, Sichuan, China
| | - Yu Xie
- Department of Ultrasound, The Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong 637000, Sichuan, China
| | - Sushant Kumar Das
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong 637000, Sichuan, China
| | - Bing Li
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong 637000, Sichuan, China
| | - Chuan Zhang
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong 637000, Sichuan, China
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Freesmeyer M, Kühnel C, Gühne F, Seifert P. Standard Needle Magnetization for Ultrasound Needle Guidance: First Clinical Experiences in Fine-Needle Aspiration Cytology of Thyroid Nodules. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3311-3319. [PMID: 31190439 DOI: 10.1002/jum.15066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/21/2019] [Accepted: 05/26/2019] [Indexed: 06/09/2023]
Abstract
Fine-needle aspiration cytology using a novel ultrasound needle guidance system on the basis of standard needle magnetization was consecutively performed in 30 (15 in-plane and 15 out-of-plane) suspicious thyroid nodules. Nondedicated, commercially available needles were used. The technical effectiveness and safety of the system were satisfying; system failures were observed in 2 cases. The needle tip could be (at least occasionally) visualized inside the thyroid nodule in 96%, and the subjective procedure ratings were excellent in 57%. The out-of-plane technique was significantly superior in both respects (P = .021 and .027, respectively). Standard needle magnetization ultrasound needle guidance was easy to apply and cost-effective and has the potential to improve fine-needle aspiration cytology performance.
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Affiliation(s)
| | - Christian Kühnel
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Falk Gühne
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Philipp Seifert
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
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Tao W, Qingjun Z, Wei Z, Fang Z, Lei Z, Yuanyuan N, Kefu H. Computed tomography versus ultrasound/fine needle aspiration biopsy in differential diagnosis of thyroid nodules: a retrospective analysis. Braz J Otorhinolaryngol 2019; 87:402-409. [PMID: 31874829 PMCID: PMC9422654 DOI: 10.1016/j.bjorl.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/02/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction Ultrasound sonography provides a quick method for determining which nodule to sample for fine needle aspiration biopsy in thyroid nodules. On the other hand, the computed tomography examination is not restricted by echo attenuation and distinguishes between benign and malignant nodules. Objective To compare computed tomography examinations against ultrasound/fine needle aspiration biopsy in the differential diagnosis of thyroid nodules. Methods Data regarding computed tomography examinations, sonographic finding following fine needle aspiration biopsy, and tumor histology of 953 nodules from 698 patients who underwent thyroidectomy were collected and analyzed. The beneficial score for detection of the malignant tumor for each adopted modality was evaluated. Results Ultrasound images did not show a well-circumscribed solid mass in 89 nodules, and ultimately did not detect nodules in fine needle aspiration biopsies (false positive non-malignant nodules). Ultrasound images showed parenchymatous disease (false positive malignant nodules) in several nodules. Computed tomography examinations demonstrated higher difficulty in detection of malignant nodules of 1.0–2.0 cm size than ultrasound examination following fine needle aspiration biopsies; compared to tumor histological data, computed tomography examinations had a sensitivity of 0.879. Conclusion Computed tomography examinations are a more reliable method for differential diagnosis of thyroid nodules than ultrasound examinations followed by fine needle aspiration biopsy. Level of Evidence III.
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Affiliation(s)
- Wang Tao
- Gong'an County People's Hospital, Department of Ultrasound, Gong'an County, Hubei Province, China
| | - Zhu Qingjun
- The People's Hospital of Jinshi, Department of Ultrasound, Jinshi, Hunan Province, China
| | - Zheng Wei
- Gong'an County People's Hospital, Department of Ultrasound, Gong'an County, Hubei Province, China
| | - Zhou Fang
- Gong'an County People's Hospital, Department of Ultrasound, Gong'an County, Hubei Province, China
| | - Zhou Lei
- Gong'an County People's Hospital, Department of Medical Cosmetology, Gong'an County, Hubei Province, China
| | - Ni Yuanyuan
- Gong'an County People's Hospital, Department of Emergency, Gong'an County, Hubei Province, China
| | - Hu Kefu
- Gong'an County People's Hospital, Department of Medical Administration, Gong'an County, Hubei Province, China.
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Kizilgul M, Shrestha R, Radulescu A, Evasovich MR, Burmeister LA. Thyroid nodules over 4 cm do not have higher malignancy or benign cytology false-negative rates. Endocrine 2019; 66:249-253. [PMID: 31144224 DOI: 10.1007/s12020-019-01964-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/20/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Whether thyroid nodules 4 cm or larger with benign cytology carry a higher risk of malignancy, and should be managed differently than smaller nodules remains controversial. We aimed to evaluate the malignancy rate and benign cytology false-negative rate in thyroid nodules ≥4 cm compared with those <4 cm. METHODS All thyroidectomies between January 2010 and December 2014 were reviewed. Patient demographics, preoperative sonographic nodule size, fine needle aspiration cytology (FNAC), and final surgical pathology results were compared for index nodules ≥4 vs. <4 cm. RESULTS A total of 490 index nodules with preoperative FNAC were identified. A total of 137 nodules were ≥4 cm and 353 nodules were <4 cm. The prevalence of carcinoma was lower (23 vs. 53%) in nodules ≥4 vs. <4 cm (p < 0.0001). The false-negative rate of benign FNAC for ≥4 and <4 cm index nodule was 5.2% and 5.9%, respectively (p = 1.000). CONCLUSIONS This study shows that thyroid nodules ≥4 cm do not have a higher malignancy rate at surgery nor higher benign cytology false-negative rate than smaller nodules. Thyroid nodules over 4 cm do not require resection, to rule out malignancy, based on size alone.
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Affiliation(s)
- Muhammed Kizilgul
- Department of Medicine, Surgery University of Minnesota, Minneapolis, MN, USA
- Department of Endocrinology and Metabolism, UHS Diskapi Training and Research Hospital, Ankara, Turkey
| | - Rupendra Shrestha
- Department of Medicine, Surgery University of Minnesota, Minneapolis, MN, USA
| | - Angela Radulescu
- Department of Medicine, Surgery University of Minnesota, Minneapolis, MN, USA
| | - Maria R Evasovich
- Department of Medicine, Surgery University of Minnesota, Minneapolis, MN, USA
| | - Lynn A Burmeister
- Department of Medicine, Surgery University of Minnesota, Minneapolis, MN, USA.
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Ding J, Jiang L, Fang J, Jiang Y, Zhu Y, Hua T, Yuan Y, Wu W. Predictors for malignancy risk in subcentimeter thyroid nodules categorized as atypia/follicular lesion of undetermined significance by fine needle aspiration. Sci Rep 2019; 9:14973. [PMID: 31628340 PMCID: PMC6802379 DOI: 10.1038/s41598-019-50597-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 08/30/2019] [Indexed: 02/08/2023] Open
Abstract
Little work has been done on the prediction of malignancy risk in patients with subcentimeter thyroid nodule (TN) categorized as atypia/follicular lesion of undetermined significance (AUS/FLUS). We performed a retrospective analysis on the medical records of subcentimeter TNs whose initial fine-needle aspiration (FNA) diagnosis was AUS/FLUS at our center between November 2013 and August 2018. Univariate analysis and multivariate logistic regression analysis were used to select independent factors associated with malignancy. Of the 324 patients who were classified as AUS/FLUS on initial FNA, 153 patients underwent surgical procedures and showed an associated malignancy rate of 45.10% (69/153). The malignancy rates in AUS/FLUS settings with and without repeat FNA were 38.30% (18/47), and 48.11% (51/106), respectively, p = 0.260. Multivariate logistic regression analysis revealed that age < 55 (OR 3.015, 95% CI 1.196-7.596), microcalcification (OR 9.162, 95% CI 3.332-25.916) and taller than wide shape (OR 10.785, 95% CI 4.108-28.319) were three independent predictors for malignancy. The malignancy rates in the patients with one or none of predictor and patients with two or three above predictors were 20.5% (17/83) and 74.3% (52/70), respectively, p < 0.001 (OR 11.216, 95% CI 5.266-23.885). In conclusion, our study showed that for subcentimeter TNs with AUS/FLUS category, patient's age, taller than wide shape and microcalcification were three independent predictive factors for malignancy, which was helpful for decision-making of surgery or observation in such patient population.
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Affiliation(s)
- Jinhua Ding
- Department of Breast and Thyroid Surgery, Ningbo Medical Center Lihuili Eastern Hospital/Taipei Medical, University Ningbo Medical Center, Ningbo, 315000, China
| | - Li Jiang
- Department of Emergency, Ningbo Medical Center Lihuili Eastern Hospital/Taipei Medical University Ningbo Medical Center, Ningbo, 315000, China
| | - Jianjiang Fang
- Department of Emergency, Ningbo Medical Center Lihuili Eastern Hospital/Taipei Medical University Ningbo Medical Center, Ningbo, 315000, China
| | - Yan Jiang
- Department of Ultrasonograpy, Ningbo Medical Center Lihuili Eastern Hospital/Taipei Medical University Ningbo Medical Center, Ningbo, 315000, China
| | - Ye Zhu
- Department of Breast and Thyroid Surgery, Ningbo Medical Center Lihuili Eastern Hospital/Taipei Medical, University Ningbo Medical Center, Ningbo, 315000, China
| | - Tebo Hua
- Department of Breast and Thyroid Surgery, Ningbo Medical Center Lihuili Eastern Hospital/Taipei Medical, University Ningbo Medical Center, Ningbo, 315000, China
| | - Yijie Yuan
- Department of Breast and Thyroid Surgery, Ningbo Medical Center Lihuili Eastern Hospital/Taipei Medical, University Ningbo Medical Center, Ningbo, 315000, China
| | - Weizhu Wu
- Department of Breast and Thyroid Surgery, Ningbo Medical Center Lihuili Eastern Hospital/Taipei Medical, University Ningbo Medical Center, Ningbo, 315000, China.
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Zhao H, Liu X, Lei B, Cheng P, Li J, Wu Y, Ma Z. Impact of thyroid nodule sizes on the diagnostic performance of Korean thyroid imaging reporting and data system and contrast-enhanced ultrasound. Clin Hemorheol Microcirc 2019; 72:317-326. [PMID: 30856106 DOI: 10.3233/ch-180545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Huaqun Zhao
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Xueling Liu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Bei Lei
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Ping Cheng
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Jian Li
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Yedong Wu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Zhen Ma
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
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Li J, Wang Q, Wang L, Wang J, Wang D, Xin Z, Liu Y, Zhao Q. Diagnostic value of fine-needle aspiration combined with ultrasound for thyroid cancer. Oncol Lett 2019; 18:2316-2321. [PMID: 31402937 PMCID: PMC6676711 DOI: 10.3892/ol.2019.10584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 05/23/2019] [Indexed: 11/06/2022] Open
Abstract
Diagnostic value of fine-needle aspiration (FNA) combined with ultrasound for thyroid cancer was evaluated. A retrospective analysis was performed on the preoperative FNA and ultrasound data of 165 thyroid nodule patients, were divided into group A (≤1 cm group) and group B (>1 cm group) based on the maximum diameter line of the thyroid nodule. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FNA, ultrasound and FNA combined with ultrasound in the diagnosis of thyroid cancer were analyzed and compared. In group A (≤1 cm group), the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FNA in the diagnosis of thyroid cancer were 93.33, 71.43, 91.04, 96.55 and 55.56%, respectively, those of ultrasound were 86.67, 28.57, 80.60, 91.23 and 20%, respectively, and those of FNA combined with ultrasound were 100, 28.57, 92.54, 92.6 and 100%, respectively, with statistically significant differences in the sensitivity, specificity, accuracy, positive predictive value and negative predictive value between FNA, ultrasound and FNA combined with ultrasound (P<0.05). In group B, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FNA in the diagnosis of thyroid cancer were 100, 54.55, 94.90, 94.57 and 100%, respectively, those of ultrasound were 96.55, 72.73, 93.88, 96.55 and 72.73%, respectively, and those of FNA combined with ultrasound were 100, 63.64, 97.96, 95.92 and 100%, respectively, without statistically significant differences in the sensitivity, specificity, accuracy, positive predictive value and negative predictive value between FNA, ultrasound and FNA combined with ultrasound (P>0.05). FNA combined with ultrasound significantly improved the sensitivity and accuracy in the diagnosis of the thyroid nodule in group A, but it did not significantly improve the accuracy, sensitivity and specificity in the diagnosis of the thyroid nodule in group B.
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Affiliation(s)
- Juan Li
- Department of Special Inspection, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Qian Wang
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Liangliang Wang
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Jing Wang
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Dongxiao Wang
- Department of Special Inspection, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Zhaoqin Xin
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Yilin Liu
- Department of Special Inspection, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Qinghua Zhao
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
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Lee HJ, Kim YJ, Han HY, Seo JY, Hwang CM, Kim K. Ultrasound-guided needle biopsy of large thyroid nodules: Core needle biopsy yields more reliable results than fine needle aspiration. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:255-260. [PMID: 30820986 DOI: 10.1002/jcu.22721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 01/02/2019] [Accepted: 02/17/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE The objective of this study was to compare the false negative rate, sensitivity and false positive rate of ultrasound (US)-guided fine needle aspiration (FNA) with those of US-guided core needle biopsy (CNB) for large thyroid nodules ≥2.0 cm, which reportedly have an increased risk of thyroid malignancy. METHODS We retrospectively studied surgically confirmed thyroid nodules that had preoperative US-guided FNA or CNB between March 2005 and December 2013. We reviewed nodule size, sonographic features, cytohistologic results, and final surgical pathology. We assessed false negative rates, sensitivity, and false positive rates by biopsy method and nodule size for diagnosis of thyroid malignancy. We assessed complications for procedures. RESULTS US-guided CNB showed better diagnostic performance, in terms of lower false negative rates and greater sensitivity, than US-guided FNA in large thyroid nodules. There was no significant difference in false positive rate according to biopsy methods in large thyroid nodules. The false negative rates of large thyroid nodules (≥2.0 cm) were higher than those of small nodules (<2.0 cm). There were no major complications, and no significant differences in complication according to biopsy methods. CONCLUSION US-guided CNB improved the false negative rate and sensitivity for large nodules. Therefore, US-guided CNB can be considered a useful diagnostic method for large thyroid nodules that might reduce the risk of unnecessary diagnostic surgery.
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Affiliation(s)
- Hyeon Jin Lee
- Department of Radiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Young Joong Kim
- Department of Radiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Hye Yeon Han
- Department of Radiology, Daejeon Sun Medical Center, Daejeon, Republic of Korea
| | - Jae Young Seo
- Department of Radiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Cheol Mog Hwang
- Department of Radiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - KeumWon Kim
- Department of Radiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
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Bestepe N, Ozdemir D, Baser H, Ogmen B, Sungu N, Kilic M, Ersoy R, Cakir B. Is thyroid nodule volume predictive for malignancy? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:337-344. [PMID: 30916163 PMCID: PMC10528648 DOI: 10.20945/2359-3997000000113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 11/10/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We aimed to determine the roles of preoperative thyroid nodule diameter and volume in the prediction of malignancy. SUBJECTS AND METHODS The medical records of patients who underwent thyroidectomy between January 2007 and December 2014 were reviewed. The nodule diameters were grouped as < 1 cm, 1-1.9 cm, 2-3.9 cm and ≥ 4 cm, and volume was grouped as > 5 cm3, 5-9.9 cm3 and > 10 cm3. ROC (Receiver Operating Characteristic) curve analysis was performed to find the optimal cutoff value of diameter and volume that can predict malignancy. RESULTS There were 5561 thyroid nodules in 2463 patients. Five hundred and forty (9.7%) nodules were < 1 cm, 2,413 (43.4%) were 1-1.9 cm, 1,600 (28.8%) were 2-3.9 cm and 1,008 (18.1%) were ≥ 4 cm. Malignancy rates were 25.6%,10.6%, 9.7% and 8.5% in nodules < 1 cm, 1-1.9 cm, 2-3.9 cm and ≥ 4 cm, respectively. When classified according to volume, 3,664 (65.9%) nodules were < 5 cm3, 594 (10.7%) were 5-9.9 cm3 and 1,303 (23.4%) were ≥ 10 cm3. The malignancy rates were 12.7%, 11.4% and 7.8% for the nodules < 5 cm3, 5-9.9 cm3 and ≥ 10 cm3, respectively (p < 0.001). In ROC curve analysis, an optimal cutoff value for diameter or volume that can predict malignancy in all thyroid nodules or nodules ≥ 4 cm could not be determined. CONCLUSION In this surgical series, malignancy risk did not increase with increasing nodule diameter or volume. Although the volume of malignant nodules ≥ 4 cm was higher than that of benign nodules ≥ 4 cm, there was no optimal cutoff value. The diameter or volume of the nodule cannot be used to predict malignancy or decide on surgical resection.
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Affiliation(s)
- Nagihan Bestepe
- Ankara Ataturk Educational and Research HospitalDepartment of Endocrinology and MetabolismAnkaraTurkeyAnkara Ataturk Educational and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Didem Ozdemir
- Yildirim Beyazit UniversityYildirim Beyazit UniversitySchool of MedicineDepartment of Endocrinology and MetabolismAnkaraTurkeyYildirim Beyazit University, School of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Husniye Baser
- Ankara Ataturk Educational and Research HospitalDepartment of Endocrinology and MetabolismAnkaraTurkeyAnkara Ataturk Educational and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Berna Ogmen
- Ankara Ataturk Educational and Research HospitalDepartment of Endocrinology and MetabolismAnkaraTurkeyAnkara Ataturk Educational and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Nuran Sungu
- Yildirim Beyazit UniversityYildirim Beyazit UniversitySchool of MedicineDepartment of PathologyAnkaraTurkeyYildirim Beyazit University, School of Medicine, Department of Pathology, Ankara, Turkey
| | - Mehmet Kilic
- Yildirim Beyazit UniversityYildirim Beyazit UniversitySchool of MedicineDepartment of General SurgeryAnkaraTurkeyYildirim Beyazit University, School of Medicine, Department of General Surgery, Ankara, Turkey
| | - Reyhan Ersoy
- Yildirim Beyazit UniversityYildirim Beyazit UniversitySchool of MedicineDepartment of Endocrinology and MetabolismAnkaraTurkeyYildirim Beyazit University, School of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Bekir Cakir
- Yildirim Beyazit UniversityYildirim Beyazit UniversitySchool of MedicineDepartment of Endocrinology and MetabolismAnkaraTurkeyYildirim Beyazit University, School of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
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Aydoğan Bİ, Şahin M, Ceyhan K, Deniz O, Demir Ö, Emral R, Tonyukuk Gedik V, Uysal AR, Çorapçıoğlu D. The influence of thyroid nodule size on the diagnostic efficacy and accuracy of ultrasound guided fine-needle aspiration cytology. Diagn Cytopathol 2019; 47:682-687. [PMID: 30861335 DOI: 10.1002/dc.24170] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/12/2019] [Accepted: 02/26/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Diagnostic accuracy of fine-needle aspiration cytology (FNAC) in large and subcentimeter nodules is still debated. We aimed to evaluate the impact of nodule size on efficacy of the ultrasound-guided FNAC. METHODS B-mode grayscale ultrasound (US), US-guided FNAC according to Bethesda system and histopathological data of 514 nodules from 371 patients, who underwent thyroidectomy were examined retrospectively. Nodules were grouped by maximal diameter; group A nodules were smaller than 10 mm (n = 59), group B nodules were between 10 and 29 mm (n = 218), and group C nodules were 30 mm or greater (n = 130). RESULTS Sensitivity, specificity, and accuracy of FNAC was 92.0%, 100%, and 95.1% in group A, 80.7%, 99.1%, and %92.9 in group B, 70.0%, 98.9%, and 95.8% in group C nodules, respectively. The prevalence of papillary thyroid cancer (PTC) and incidental PTC were 44.2% (n = 164) and 6.4% (n = 24), respectively. Malignancy rate was more frequent in group A when compared to groups B and C (P < 0.01). Nodule size was positively associated with follicular cancer risk (P = 0.009). The thyroid stimulating hormone level was positively associated with malignancy (P = 0.02) and optimal cut-off value was 0.96 mIU/L. False-negative rate was 8.0%, 19.3%, and 30.0% in groups A, B, and C nodules, respectively. CONCLUSIONS Although the malignancy rate was low in nodules ≥30 mm, diagnostic surgery for large nodules should be considered because of decreased reliability of FNAC, ineffectiveness of clinical and sonographic criteria. False-negative rate was relatively low and malignancy rate was high in subcentimeter nodules, supporting the accuracy of FNAC.
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Affiliation(s)
- Berna İmge Aydoğan
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Şahin
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Koray Ceyhan
- Department of Cytology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Olgun Deniz
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özgür Demir
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Rifat Emral
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Vedia Tonyukuk Gedik
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ali Rıza Uysal
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Demet Çorapçıoğlu
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
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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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Abstract
The incidence of thyroid cancer worldwide has increased significantly over the past 3 decades, due predominantly to an increase in papillary thyroid cancer. Although most of these cancers are small and localized, population-based studies have documented a significant increase in thyroid cancers of all sizes and stages, in addition to incidence-based mortality for papillary thyroid cancer. This suggests that the increasing incidence of thyroid cancer is due in large part to increasing surveillance and overdiagnosis, but that there also appears to be a true increase in new cases of thyroid cancer.
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Affiliation(s)
- Carolyn Dacey Seib
- Department of Surgery, University of California, San Francisco, 1600 Divisadero Street, 4th Floor, Box 1674, San Francisco, CA 94143, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, Suite S320, Box 0104, San Francisco, CA 94143, USA; Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Suite S320, Box 0104, San Francisco, CA 94143, USA.
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Ahn HS, Na DG, Baek JH, Sung JY, Kim J. False negative rate of fine‐needle aspiration in thyroid nodules: impact of nodule size and ultrasound pattern. Head Neck 2019; 41:967-973. [DOI: 10.1002/hed.25530] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 08/06/2018] [Accepted: 09/28/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
- Hye Shin Ahn
- Department of RadiologyChung‐Ang University Hospital, Chung‐Ang University College of Medicine Seoul South Korea
| | - Dong Gyu Na
- Department of RadiologyGangNeung Asan Hospital Gangneung South Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of RadiologyAsan Medical Center, University of Ulsan College of Medicine Seoul South Korea
| | - Jin Yong Sung
- Department of RadiologyThyroid Center, Daerim St. Mary's Hospital Seoul South Korea
| | - Ji‐Hoon Kim
- Department of RadiologySeoul National University Hospital, Seoul National University College of Medicine Seoul South Korea
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Cohen O, Zornitzki T, Yarkoni TR, Lahav Y, Schindel D, Halperin D, Yehuda M. Follow‐up of large thyroid nodules without surgery: Patient selection and long‐term outcomes. Head Neck 2019; 41:1696-1702. [DOI: 10.1002/hed.25641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 10/07/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Oded Cohen
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of MedicineHebrew University in Jerusalem Rehovot Israel
| | - Taiba Zornitzki
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hadassah School of MedicineHebrew University in Jerusalem Rehovot Israel
| | - Tom Raz Yarkoni
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of MedicineHebrew University in Jerusalem Rehovot Israel
| | - Yonatan Lahav
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of MedicineHebrew University in Jerusalem Rehovot Israel
| | - Doron Schindel
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of MedicineHebrew University in Jerusalem Rehovot Israel
| | - Doron Halperin
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of MedicineHebrew University in Jerusalem Rehovot Israel
| | - Moshe Yehuda
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of MedicineHebrew University in Jerusalem Rehovot Israel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of MedicineTel Aviv University Tel Aviv Israel
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Cipriani NA, White MG, Angelos P, Grogan RH. Large Cytologically Benign Thyroid Nodules Do Not Have High Rates of Malignancy or False-Negative Rates and Clinical Observation Should be Considered: A Meta-Analysis. Thyroid 2018; 28:1595-1608. [PMID: 30280990 DOI: 10.1089/thy.2018.0221] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Management of large thyroid nodules is controversial, as data are conflicting regarding overall rates of malignancy (ROM) in all nodules and frequency of false-negative fine-needle aspiration results (FNR) in cytologically benign nodules. This meta-analysis aimed to evaluate and compare ROM and FNR in small versus large nodules published in the literature. Methods: Articles indexed in PubMed, written in English, published electronically or in print on or prior to December 8 2017 were searched for "false negative thyroid size or cm" and "malignancy rates benign thyroid nodules." Three hundred fifty-two unique citations were identified. Multiple reviewers selected a final set of 35 articles that contained nodules stratified by size (3, 4, or 5 cm), with benign or all cytologic diagnoses, and with postsurgical histologic diagnoses. Multiple observers extracted data, including numbers of total, cytologically benign, and histologically malignant nodules. Size cutoffs of 3, 4, and/or 5 cm were analyzed in 14, 24, and 1 article, respectively. Results: ROM in all nodules ≥3 cm (13.1%) and ≥4 cm (20.9%) was lower than those <3 cm (19.6%) and <4 cm (19.9%; odds ratio [OR] = 0.72 [confidence interval (CI) 0.64-0.81] and OR = 0.85 [CI 0.77-0.95]). FNR in nodules ≥3 cm (7.2%) was not different from smaller nodules (5.7%; OR = 1.47 [CI 0.80-2.69]). FNR in nodules ≥4 cm (6.7%) was slightly higher than those <4 cm (4.5%; OR = 1.38 [CI 1.06-1.80]). The most frequently reported false-negative diagnosis was papillary thyroid carcinoma. Conclusions: Rates of malignancy and false-negative FNA results vary but, in most studies, are not higher in larger nodules. Patients with large, cytologically benign thyroid nodules need not undergo immediate surgical resection, as false-negative FNA rates are low and are expected to decrease in light of nomenclature revision of a subset of follicular variants of papillary thyroid carcinoma.
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Affiliation(s)
- Nicole A Cipriani
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Michael G White
- Endocrine Surgery Research Program Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Peter Angelos
- Endocrine Surgery Research Program Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Raymon H Grogan
- Department of Endocrine Surgery, Baylor St. Luke's Medical Center, Houston, Texas
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Zhao L, Yan H, Pang P, Fan X, Jia X, Zang L, Luo Y, Wang F, Yang G, Gu W, Du J, Wang X, Lyu Z, Dou J, Mu Y. Thyroid nodule size calculated using ultrasound and gross pathology as predictors of cancer: A 23-year retrospective study. Diagn Cytopathol 2018; 47:187-193. [PMID: 30499203 DOI: 10.1002/dc.24068] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Thyroid nodules are very common. Ultrasound (US) and fine needle aspiration (FNA) are both integral in cancer screening. This study investigated the concordance between thyroid nodule sizes measured by US and gross pathologic examination and their relationship with malignancy. METHODS A retrospective design was used to select consecutive patients with proven carcinoma of the thyroid. The number and maximum diameter of nodules, rates and types of malignancy, as well as predictors of malignancy were determined. RESULTS The 10 944 patients examined had 15 283 thyroid nodules, 44.6% of which were malignant. Of the 4449 nodules sampled by FNA and the 8748 not sampled by FNA, 76.5% and 30.5% were malignant, respectively. The sensitivity, specificity, positive and negative predictive values (NPVs), and overall accuracy of FNA based on final pathology were 97.9%, 96.3%, 98.8%, 93.5%, and 97.5%, respectively. Nodule sizes determined by US were comparable with most nodules having either the same size range (n = 2959, 77.7%) or differing only by one size range (n = 770, 20.5%). CONCLUSIONS Thyroid nodule size is inversely related to malignancy risk, as larger nodules have lower malignancy rates. Nodule size estimated by US shows relatively good correlation with final pathologic size. However, thyroid nodules should undergo FNA regardless of size. If the FNA is not benign, nodule size should influence therapeutic decision making.
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Affiliation(s)
- Ling Zhao
- The Department and Key Laboratory of Endocrinology and Metabolism, PLA General Hospital, Beijing, People's Republic of China
| | - Huixian Yan
- Department of Endocrinology, Haidian Hospital, Beijing, People's Republic of China
| | - Ping Pang
- Department of Endocrinology, Hainan Branch of PLA General Hospital, Sanya, People's Republic of China
| | - Xiaojing Fan
- The Department and Key Laboratory of Endocrinology and Metabolism, PLA General Hospital, Beijing, People's Republic of China
| | - Xiaomeng Jia
- The Department and Key Laboratory of Endocrinology and Metabolism, PLA General Hospital, Beijing, People's Republic of China
| | - Li Zang
- The Department and Key Laboratory of Endocrinology and Metabolism, PLA General Hospital, Beijing, People's Republic of China
| | - Yukun Luo
- Department of Ultrasonography, PLA General Hospital, Beijing, People's Republic of China
| | - Fulin Wang
- Department of Pathology, PLA General Hospital, Beijing, People's Republic of China
| | - Guoqing Yang
- The Department and Key Laboratory of Endocrinology and Metabolism, PLA General Hospital, Beijing, People's Republic of China
| | - Weijun Gu
- The Department and Key Laboratory of Endocrinology and Metabolism, PLA General Hospital, Beijing, People's Republic of China
| | - Jin Du
- The Department and Key Laboratory of Endocrinology and Metabolism, PLA General Hospital, Beijing, People's Republic of China
| | - Xianling Wang
- The Department and Key Laboratory of Endocrinology and Metabolism, PLA General Hospital, Beijing, People's Republic of China
| | - Zhaohui Lyu
- The Department and Key Laboratory of Endocrinology and Metabolism, PLA General Hospital, Beijing, People's Republic of China
| | - Jingtao Dou
- The Department and Key Laboratory of Endocrinology and Metabolism, PLA General Hospital, Beijing, People's Republic of China
| | - Yiming Mu
- The Department and Key Laboratory of Endocrinology and Metabolism, PLA General Hospital, Beijing, People's Republic of China
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46
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Chen X, Zhou Q, Wang F, Zhang F, Du H, Zhang Q, Wu W, Gong X. Value of BRAF V600E in High-Risk Thyroid Nodules with Benign Cytology Results. AJNR Am J Neuroradiol 2018; 39:2360-2365. [PMID: 30498021 DOI: 10.3174/ajnr.a5898] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/29/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Limitations of ultrasound-guided fine-needle aspiration include nondiagnostic, indeterminate cytology and false-negative results. The BRAF V600E mutation is a specific biomarker for papillary thyroid carcinoma. This study aimed to investigate the additional diagnostic role of the BRAF V600E mutation in high-risk thyroid nodules with benign cytology results. MATERIALS AND METHODS A total of 787 high-risk nodules in 720 patients underwent ultrasound-fine-needle aspiration. A subsequent BRAF V600E mutation test was performed on thyroid nodules with benign cytology. Final pathology confirmed thyroid nodules with benign cytology that were positive for the BRAF V600E mutation. Ultrasound was performed on thyroid nodules with benign cytology results that were negative for the BRAF V600E mutation. Fine-needle aspiration was repeated on thyroid nodules with enlarged size or changed ultrasound features. RESULTS Among the 787 nodules, 292 thyroid nodules had benign cytology results with 256 nodules negative for the BRAF V600E mutation and 36 nodules positive for the BRAF V600E mutation. Thirty-one nodules positive for the BRAF V600E mutation were confirmed malignant, and 5 nodules were confirmed benign by pathology. Fine-needle aspiration was repeated on 11 enlarged thyroid nodules with benign cytology findings that were negative for the BRAF V600E mutation. The results of repeat fine-needle aspiration were 4 benign nodules, 2 follicular neoplasms or suspected follicular neoplasms, 3 suspected malignancies, and 2 malignant nodules. Among the 36 thyroid nodules positive for the BRAF V600E mutation, 25 (69.4%) had ≥2 suspicious ultrasound features and 11 (30.6%) nodules had 1 suspicious ultrasound feature. CONCLUSIONS The BRAF V600E mutation test can detect papillary thyroid carcinomas that might be missed by fine-needle aspiration. We recommend that fine-needle aspiration be routinely accompanied by the BRAF V600E mutation test in high-risk thyroid nodules with ≥2 suspicious ultrasound features.
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Affiliation(s)
- X Chen
- From the Departments of Endocrinology and Metabolism (X.C., Q. Zhou, W.W., X.G.)
| | - Q Zhou
- From the Departments of Endocrinology and Metabolism (X.C., Q. Zhou, W.W., X.G.)
| | - F Wang
- Pathology (F.W., Q. Zhang)
| | - F Zhang
- Department of Medicine (F.Z.), School of Renji College, Wenzhou Medical University, Wenzhou, China
| | - H Du
- Ultrasound (H.D.), The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, China
| | | | - W Wu
- From the Departments of Endocrinology and Metabolism (X.C., Q. Zhou, W.W., X.G.)
| | - X Gong
- From the Departments of Endocrinology and Metabolism (X.C., Q. Zhou, W.W., X.G.)
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47
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Bollig CA, Jorgensen JB, Zitsch RP, Dooley LM. Utility of Intraoperative Frozen Section in Large Thyroid Nodules. Otolaryngol Head Neck Surg 2018; 160:49-56. [PMID: 30322356 DOI: 10.1177/0194599818802183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine if the routine use of intraoperative frozen section (iFS) results in cost savings among patients with nodules >4 cm with nonmalignant cytology undergoing a thyroid lobectomy. STUDY DESIGN Case series with chart review; cost minimization analysis. SETTING Single academic center. SUBJECTS AND METHODS Records were reviewed on a consecutive sample of 48 patients with thyroid nodules >4 cm and nonmalignant cytology who were undergoing thyroid lobectomy in which iFS was performed between 2010 and 2015. A decision tree model of thyroid lobectomy with iFS was created. Comparative parameters were obtained from the literature. A cost minimization analysis was performed comparing lobectomy with and without iFS and the need for completion thyroidectomy with costs estimated according to 2014 data from Medicare, the Bureau of Labor Statistics, and the Nationwide Inpatient Sample. RESULTS The overall malignancy rate was 25%, and 33% of these malignancies were identified intraoperatively. When the malignancy rates obtained from our cohort were applied, performing routine iFS was the less costly scenario, resulting in a savings of $486 per case. When the rate of malignancy identified on iFS was adjusted, obtaining iFS remained the less costly scenario as long as the rate of malignancies identified on iFS exceeded 12%. If patients with follicular lesions on cytology were excluded, 50% of malignancies were identified intraoperatively, resulting in a savings of $768 per case. CONCLUSIONS For patients with nodules >4 cm who are undergoing a diagnostic lobectomy, the routine use of iFS may result in decreased health care utilization. Additional cost savings could be obtained if iFS is avoided among patients with follicular lesions.
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Affiliation(s)
- Craig A Bollig
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jeffrey B Jorgensen
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Robert P Zitsch
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Laura M Dooley
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
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48
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Abi-Raad R, Prasad M, Baldassari R, Schofield K, Callender GG, Chhieng D, Adeniran AJ. The Value of Negative Diagnosis in Thyroid Fine-Needle Aspiration: a Retrospective Study with Histologic Follow-Up. Endocr Pathol 2018; 29:269-275. [PMID: 29949024 DOI: 10.1007/s12022-018-9536-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The Bethesda System for reporting thyroid cytopathology (BSRTC) predicts an incidence of malignancy of less than 5% in thyroid nodules with a benign diagnosis on fine-needle aspiration (FNA). However, recent series have suggested that the true rate of malignancy might be significantly higher in this category of patients. We reviewed our experience by performing a retrospective analysis of patients with benign thyroid FNA results who underwent thyroidectomy between 2008 and 2013 at a large academic center. Information including demographics, ultrasound features, FNA diagnosis, and surgical follow-up information were recorded. Slides were reviewed on cytology-histology discrepant cases, and it was determined whether the discrepancy was due to sampling or interpretation error. A total of 802 FNA cases with a benign diagnosis and surgical follow-up were identified. FNA diagnoses included 738 cases of benign goiter and 64 cases of lymphocytic thyroiditis. On subsequent surgical resection, 144 cases were found to be neoplastic, including 117 malignant cases. False negative, defined as interpretation error and inadequate biopsy of the nodule harboring malignancy, was 6%. When cases of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) were excluded from the analysis, false-negative rate was 5%. When microPTC cases were excluded, false-negative rate was 3% and was slightly less than 3% when both microPTC and NIFTP cases were excluded from the analysis. Retrospective review of neoplastic cases showed that 57% were due to sampling error and 43% were due to interpretation error. Interpretation error was more likely to occur in follicular patterned neoplasms (75%), while sampling error was more common in non-follicular variants of papillary thyroid carcinoma (non-FVPTC) (61%). With the exclusion of microPTC, interpretation errors were still more likely to occur in follicular neoplasms (79%) but there was no significant difference in sampling error between non-FVPTC (37%) and follicular patterned neoplasms (42%). Tumor size was larger in cases with interpretation error (mean = 2.3 cm) compared to cases with sampling error (mean = 1.4 cm). This study shows that the false-negative rate of thyroid FNA at our institution is not significantly above the rate suggested by the BSRTC. Interpretation errors were more likely to occur in follicular patterned neoplasms, while non-FVPTC was more frequently found in false negative cases due to inadequate sampling.
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Affiliation(s)
- Rita Abi-Raad
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, CB510A, New Haven, CT, 06520, USA
| | - Manju Prasad
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, CB510A, New Haven, CT, 06520, USA
| | - Rebecca Baldassari
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, CB510A, New Haven, CT, 06520, USA
| | - Kevin Schofield
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, CB510A, New Haven, CT, 06520, USA
| | - Glenda G Callender
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - David Chhieng
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Adebowale J Adeniran
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, CB510A, New Haven, CT, 06520, USA.
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49
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Dong Y, Mao M, Zhan W, Zhou J, Zhou W, Yao J, Hu Y, Wang Y, Ye T. Size and Ultrasound Features Affecting Results of Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1367-1377. [PMID: 29120064 DOI: 10.1002/jum.14472] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 08/12/2017] [Accepted: 08/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Our goal was to assess the diagnostic efficacy of ultrasound (US)-guided fine-needle aspiration (FNA) of thyroid nodules according to size and US features. METHODS A retrospective correlation was made with 1745 whole thyroidectomy and hemithyroidectomy specimens with preoperative US-guided FNA results. All cases were divided into 5 groups according to nodule size (≤5, 5.1-10, 10.1-15, 15.1-20, and >20 mm). For target nodules, static images and cine clips of conventional US and color Doppler were obtained. Ultrasound images were reviewed and evaluated by two radiologists with at least 5 years US working experience without knowing the results of pathology, and then agreement was achieved. RESULTS The Bethesda category I rate was higher in nodules larger than 15 mm (P < .05). The diagnostic accuracy was best in nodules of 5 to 10 mm in diameter. The sensitivity, accuracy, PPV, and LR for negative US-guided FNA results were better in nodules with a size range of 5 to 15 mm. The specificity, negative predictive value (NPV), and LR for positive results and the Youden index rose with increasing nodule size. Seventeen false-positive and 60 false-negative results were found in this study. The false-negative rate rose with increasing nodule size. However, the false-positive rate was highest in the group containing the smallest nodules. Nodules with circumscribed margins and those that were nonsolid and nonhypoechoic and had no microcalcifications correlated with Bethesda I FNA results. Nodules with circumscribed margins and those that were nonsolid, heterogeneous, and nonhypoechoic and had increased vascularity correlated with false-negative FNA results. Borders correlated with Bethesda I false-negative and false-positive FNA results. CONCLUSIONS Tiny nodules (≤5 mm) with obscure borders tended to yield false-positive FNA results. Large nodules (>20 mm) with several US features tended to yield false-negative FNA results.
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Affiliation(s)
- YiJie Dong
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - MinJing Mao
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Departments of Laboratory, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - WeiWei Zhan
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - JianQiao Zhou
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wei Zhou
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - JieJie Yao
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - YunYun Hu
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yan Wang
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - TingJun Ye
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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50
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Park VY, Lee HS, Kim EK, Kwak JY, Yoon JH, Moon HJ. Frequencies and malignancy rates of 6-tiered Bethesda categories of thyroid nodules according to ultrasound assessment and nodule size. Head Neck 2018; 40:1947-1954. [DOI: 10.1002/hed.25179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 12/28/2017] [Accepted: 02/20/2018] [Indexed: 01/20/2023] Open
Affiliation(s)
- Vivian Youngjean Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit; 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
| | - Jin Young Kwak
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, 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
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