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Şah Ünal FT, Gökçay Canpolat A, Elhan AH, Sevim S, Sak SD, Emral R, Demir Ö, Güllü S, Erdoğan MF, Çorapçıoğlu D, Şahin M. Cancer rates and characteristics of thyroid nodules with macrocalcification. Endocrine 2024; 84:1021-1029. [PMID: 38147262 DOI: 10.1007/s12020-023-03650-x] [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: 09/10/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023]
Abstract
AIMS The aim of this study was to determine the malignant potential of thyroid nodules with macrocalcifications and to evaluate the role of other sonographic findings in the diagnosis of malignancy in thyroid nodules besides macrocalcifications. METHODS The findings of 8250 patients who applied to our outpatient clinic and underwent thyroid ultrasonography(US) between 2008 and 2021 were retrospectively reviewed. We included a total of 296 patients with 296 macrocalcified nodules (macrocalcification group) and an age- and sex matched group of 300 patients (control group) with the cytopathologic and/or histopathologic data of fine-needle aspiration biopsy (FNAB) of thyroid nodules without calcification. Demographic characteristics of these patients, US characteristics of the nodules, and thyroid function tests were recorded. Cytopathological data of FNAB were classified according to BETHESDA. RESULTS The malignancy rate was 14.2% (42/296) in the macrocalcification group and 5.3% (16/300) in the control group (p < 0.001). There was no significant relationship between interrupted peripheral calcification and malignancy. Hypoechoic or markedly hypoechoic appearance, irregular border, solid structure, presence of accompanying pathological lymphadenopathy on sonographic examination and upper and middle zone localization were other sonographic features that increased the risk of malignancy of a nodule. The presence of autoimmunity was not found to be associated with the risk of malignancy. TSH and calcitonin levels of malignant nodules were higher than benign nodules. There was no significant difference between gender and malignancy. In the univariate analysis, it was found that the presence of macrocalcification increased the risk of malignancy 2.935 times. (OR:2.935, p < 0.001.95% CI for OR 1.611-5.349) In addition, being younger, being in the high TIRADS category, and being in the upper and middle zones were factors that increased the risk of malignancy. Gender, TSH level, nodule volume and structure were not associated with malignancy. However, after multivariate analysis, factors that significantly increased the risk of malignancy were younger age, higher TIRADS category, and nodule localization. CONCLUSION In our study, the malignancy rate was higher in the macrocalcification group than in the control group. However, no correlation was found after multivariate analysis. In the multivariate analysis, younger age, higher TIRADS category, and nodules located in the upper and middle zone were other factors associated with malignancy. There was no association between peripheral interrupted calcification and malignancy risk.
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Affiliation(s)
- Fatma Tuğçe Şah Ünal
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey.
| | - Asena Gökçay Canpolat
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Atilla Halil Elhan
- Ankara University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Selim Sevim
- Ankara University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Serpil Dizbay Sak
- Ankara University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Rıfat Emral
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Özgür Demir
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Sevim Güllü
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Murat Faik Erdoğan
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Demet Çorapçıoğlu
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Mustafa Şahin
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
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Alaraifi AK, Alessa M, Hijazi LO, Alayed AM, Alsalem AA. TSH level as a risk factor of thyroid malignancy for nodules in euthyroid patients. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:183-188. [PMID: 37204842 DOI: 10.14639/0392-100x-n2288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/08/2023] [Indexed: 05/20/2023]
Abstract
Objective With the increased prevalence of incidental thyroid cancer, determining the predictors of thyroid malignancy has become a source of debate. This study aimed to determine the impact of thyroid stimulating hormone (TSH) levels on rates of thyroid cancer in euthyroid patients. Methods A retrospective study included 421 patients who underwent thyroidectomy at a tertiary hospital between 2016 and 2020. Patients' demographics, history of cancer, pre-operative workup and final histology reports were obtained. The study sample was divided into two groups based on the final histopathology (benign vs malignant). The two groups were compared using the appropriate statistical tests to determine the predictors of thyroid cancer in euthyroid patients. Results TSH levels were significantly higher in patients with malignant nodules compared to those with benign nodules (1.94 vs 1.62, p = 0.002). It was 1.54 times more likely for thyroid nodules to be malignant when TSH levels were higher (p = 0.038). Meanwhile, larger nodules (> 4 cm) were significantly more prevalent in benign nodules (43.1%) than in malignant nodules (21.1%). Larger nodules decreased the possibility of thyroid cancer by 24% (OR = 0.760, p-value = 0.004). Conclusions High TSH levels in euthyroid patients were significantly correlated with the risk of thyroid malignancy. In addition, as Bethesda category proceeded toward malignancy, TSH levels increased. High TSH levels and small nodule diameters can be used as additional parameters in predicting thyroid cancer in euthyroid patients.
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Affiliation(s)
- Abdulaziz K Alaraifi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed Alessa
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Leen O Hijazi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Areej M Alayed
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulaziz A Alsalem
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Guarnotta V, La Monica R, Ingrao VR, Di Stefano C, Salzillo R, Pizzolanti G, Giannone AG, Almasio PL, Richiusa P, Giordano C. Ultrasound Parameters Can Accurately Predict the Risk of Malignancy in Patients with "Indeterminate TIR3b" Cytology Nodules: A Prospective Study. Int J Mol Sci 2023; 24:ijms24098296. [PMID: 37176002 PMCID: PMC10179280 DOI: 10.3390/ijms24098296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/20/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
The increase in the incidence of thyroid nodules with cytological findings of TIR3b requires the identification of predictive factors of malignancy. We prospectively evaluated 2160 patients from January 2018 to June 2022 and enrolled 103 patients with indeterminate cytology TIR3b nodules who underwent total (73 patients) and hemi-thyroidectomy (30 patients). Among them, 61 had a histological diagnosis of malignancy (30 classic papillary thyroid carcinoma, 19 had follicular papillary thyroid carcinoma variant, 3 had Hurtle cell carcinoma and 9 had follicular thyroid carcinoma), while 42 had a benign histology. Clinical, ultrasonographic and cytological characteristics were recorded. In addition, BRAF mutation was analysed. Patients with a histological diagnosis of malignancy had a higher frequency of nodule diameter ≤11 mm (p = 0.002), hypoechogenicity (p < 0.001), irregular borders (p < 0.001), peri- and intralesional vascular flows (p = 0.004) and microcalcifications (p = 0.001) compared to patients with benign histology. In contrast, patients with benign histology had more frequent nodules with a halo sign (p = 0.012) compared to patients with histological diagnosis of malignancy. No significant differences were found in BRAF mutation between the two groups. Our study suggests that the combination of ultrasonographic and cytological data could be more accurate and reliable than cytology alone in identifying those patients with TIR3b cytology and a histology of malignancy to be referred for thyroidectomy, thus reducing the number of patients undergoing thyroidectomy for benign thyroid disease.
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Affiliation(s)
- Valentina Guarnotta
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Roberta La Monica
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Vincenza Rita Ingrao
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Claudia Di Stefano
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Riccardo Salzillo
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Giuseppe Pizzolanti
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Antonino Giulio Giannone
- Pathologic Anatomy Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Piero Luigi Almasio
- Gastroenterology and Hepatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Pierina Richiusa
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Carla Giordano
- Endocrinology and Diabetology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", PROMISE, University of Palermo, 90127 Palermo, Italy
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Teklewold B, Mekuria B, Chane W. Rate and Risk of Follicular Carcinoma in Patients with a Cytologic Diagnosis of Follicular Neoplasia: Experience from Tertiary Hospital in Ethiopia. OPEN ACCESS SURGERY 2022. [DOI: 10.2147/oas.s355808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kihara M, Miyauchi A, Hirokawa M, Masuoka H, Higashiyama T, Onoda N, Ito Y, Miya A. Long-term outcomes of cytologically benign thyroid tumors: a retrospective analysis of 3,102 patients at a single institution. Endocr J 2021; 68:1373-1381. [PMID: 34275959 DOI: 10.1507/endocrj.ej21-0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Some thyroid tumors that are cytologically diagnosed as benign may be pathologically diagnosed as malignant. Here, we investigated the long-term outcomes of patients with thyroid tumors with benign cytology, and the factors for malignancy. We retrospectively reviewed the cases of 3,102 patients with thyroid tumors >1 cm cytologically diagnosed as benign at our hospital during a 1-year period from January 2007. The median follow-up duration for all patients was 68.7 (range 0.0-168.7) months. Immediate surgery and delayed surgery were performed in 393 and 148 patients, respectively. Eventually, 541 (17.4%) of the 3,102 patients underwent a thyroidectomy, and 2,561 (82.6%) were observed without surgery. Among the surgically treated patients, the tumors of 525 (97.0%) and 16 (3.0%) were pathologically diagnosed as benign and malignant, respectively. There was no significant difference in age, gender, tumor size, serum thyroglobulin level at surgery, or the tumor volume-doubling rate (TV-DR) between the benign and malignant cases. Only the ultrasonographic findings based on our hospital's classification system were directly and significantly linked to pathological diagnosis (p < 0.01). Among the tumors of the 667 patients who were followed without surgery for >10 years, 89.9% remained unchanged and 7.2% were reduced in size. Ultrasonographic evaluation provides important information for therapeutic decision-making regarding surgery versus observation for cytologically benign tumors.
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Affiliation(s)
- Minoru Kihara
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akira Miyauchi
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | | | - Hiroo Masuoka
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | | | - Naoyoshi Onoda
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Yasuhiro Ito
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akihiro Miya
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
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Al-Salam S, Sharma C, Abu Sa’a MT, Afandi B, Aldahmani KM, Al Dhaheri A, Yahya H, Al Naqbi D, Al Zuraiqi E, Mohamed BK, Almansoori SA, Al Zaabi M, Al Derei A, Al Shamsi A, Kaabi JA. Ultrasound-guided fine needle aspiration cytology and ultrasound examination of thyroid nodules in the UAE: A comparison. PLoS One 2021; 16:e0247807. [PMID: 33826647 PMCID: PMC8026079 DOI: 10.1371/journal.pone.0247807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/12/2021] [Indexed: 01/12/2023] Open
Abstract
Background Thyroid nodules are a common clinical finding and most are benign, however, 5–15% can be malignant. There is limited regional data describing the accuracy of ultrasound-guided fine needle aspiration (FNA) cytological examination compared to ultrasound examination of thyroid in patients who have undergone thyroid surgery. Methods A retrospective analysis of ultrasonographic (US) reports, FNA cytology reports and histopathology reports of 161 thyroid nodules presented at the endocrine center at Tawam hospital in Al Ain city, the United Arab Emirates during the period 2011–2019 was performed. US reports and images with FNA cytopathology reports and slides were reviewed by an independent radiologist and pathologist. Results In total, 40 nodules were reported as benign by US examination, while very low suspicious, low suspicious, intermediate suspicious and highly suspicious categories were reported in 21, 41, 14 and 45 nodules respectively. In addition, 68 nodules were reported as benign (Bethesda category II), while atypical follicular cells of unknown significance (Bethesda category III), follicular neoplasm (Bethesda category IV), suspicious for malignancy (Bethesda category V), and malignant (Bethesda category VI) categories were reported in 33, 9, 24 and 27 nodules respectively. The risk of malignancy for US benign nodules was 5%, while the risks of malignancy in very low suspicious, low suspicious, intermediate suspicious and highly suspicious nodules were 52%, 36%, 100% and 87%, respectively. The risk of malignancy for Bethesda category II was 3%, while the risks of malignancy in category III, IV, V and VI were 58%, 67%, 96% and 100%, respectively. Conclusion Thyroid FNA cytological examination and ultrasonography are key tools in predicting malignancy in thyroid nodules. Thyroid nodules with the diagnosis of Bethesda category III & IV run a high risk of malignancy thus more vigilance is required.
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Affiliation(s)
- Suhail Al-Salam
- Department of Pathology, College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Charu Sharma
- Department of Internal Medicine, College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Bachar Afandi
- Endocrine Division–Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Alia Al Dhaheri
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hayat Yahya
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Duha Al Naqbi
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Esraa Al Zuraiqi
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Baraa Kamal Mohamed
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Shamsa Ahmed Almansoori
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Meera Al Zaabi
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Aysha Al Derei
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Amal Al Shamsi
- Department of Internal Medicine, College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Juma Al Kaabi
- Department of Internal Medicine, College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- * E-mail:
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Pan Q, Zhao J, Li M, Liu X, Xu Y, Li W, Wu S, Su Z. Exosomal miRNAs are potential diagnostic biomarkers between malignant and benign thyroid nodules based on next-generation sequencing. Carcinogenesis 2020; 41:18-24. [PMID: 31560760 DOI: 10.1093/carcin/bgz160] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/14/2019] [Accepted: 09/23/2019] [Indexed: 01/08/2023] Open
Abstract
An accurate biomarker or method for diagnosis of thyroid nodule with indeterminate fine-needle aspiration result is essential for clinical treatment. Micro RNAs (miRNAs) of exosomes are advantageous in the diagnosis of tumors because they are highly stable, and be protected by a bilayer membrane structure. Exosomes were isolated from 13 papillary thyroid carcinoma (PTC) and 7 nodular goiter (NG) patients' plasma. Small RNA sequencing was performed on exosomes' RNA in next-generation sequencing (NGS) platform. Then, we performed comprehensive analysis on miRNA expression profile in exosome of two groups. One hundred and twenty-nine differentially expressed miRNAs were identified in plasma exosomes between PTC and NG patients. Forty-nine miRNAs were up-regulated, and 80 miRNAs were down-regulated in PTC patients. Receiver operating characteristic (ROC) curves of 129 miRNAs were plotted. Area under curve (AUC) of 129 miRNAs was 0.571-0.951, with distribution peak of 0.82-0.86. AUC of 11 miRNAs was above 0.9, miR-5189-3p had the most optimal performance for diagnosis between PTC and NG, with 0.951 of AUC. Target genes of 129 miRNAs were enriched into 7 cancer-related signaling pathways, including mitogen-activated protein kinase (MAPK), tumor necrosis factor (TNF), NF-kappa B signaling pathway and so on. This study profiled the miRNA signature of exosomes from PTC patients and NG patients. We proposed a group of miRNAs in plasma exosomes as candidate biomarkers for thyroid nodule diagnosis.
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Affiliation(s)
- Qunxiong Pan
- Department of Surgical Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Jiangman Zhao
- Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai, China.,Shanghai Zhangjiang Institute of Medical Innovation, Shanghai 201204, China
| | - Mingzhu Li
- Department of Surgical Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Xiaoyu Liu
- Department of Surgical Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Yaping Xu
- Fujian Medical University, Fuzhou, Fujian, China
| | - Wushuang Li
- Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai, China.,Shanghai Zhangjiang Institute of Medical Innovation, Shanghai 201204, China
| | - Shouxin Wu
- Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai, China.,Shanghai Zhangjiang Institute of Medical Innovation, Shanghai 201204, China
| | - Zijian Su
- Department of Surgical Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
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Lu Y, Lan N, Zhang Y, Nie X, Pu S, Yuan W. Role of extracellular vesicles in the progression, diagnosis and treatment of thyroid cancer (Review). Int J Oncol 2020; 57:881-889. [PMID: 32945399 DOI: 10.3892/ijo.2020.5111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/04/2020] [Indexed: 11/06/2022] Open
Abstract
Extracellular vesicles (EVs) enclose a myriad of proteins and nucleic acids that are released in the extracellular milieu of cells through EVs. These secreted molecules serve as signaling factors that can alter the biological characteristics of tumor cells. Several studies have suggested that EVs are associated with tumor proliferation, metastasis and microenvironmental regulation in thyroid carcinoma (TC). The biomolecules in EVs can serve as differential diagnostic biomarkers for TC. Moreover, EVs derived from natural killer (NK) cells can be developed as potential immunotherapeutic agents, since they can actively target and kill tumor cells in TC. Recent years have witnessed a steep rise in the number of TC cases, and thus, accurate diagnosis and novel TC treatment strategies are being actively explored. The present review discusses the recent research investigations on EVs as far as the biological, clinical diagnosis and treatment of primary TC tumors are concerned. In addition, the new opportunities and challenges encountered in the practical applications of EVs in thyroid carcinoma are outlined.
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Affiliation(s)
- Ying Lu
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, P.R. China
| | - Ning Lan
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, P.R. China
| | - Yigan Zhang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, P.R. China
| | - Xin Nie
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, P.R. China
| | - Shuangshuang Pu
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, P.R. China
| | - Wenzhen Yuan
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, P.R. China
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Diagnostic Performance of Ultrasound Patterns by K-TIRADS and 2015 ATA Guidelines in Risk Stratification of Thyroid Nodules and Follicular Lesions of Undetermined Significance. AJR Am J Roentgenol 2019; 213:444-450. [PMID: 31039023 DOI: 10.2214/ajr.18.20961] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE. The objective of our study was to assess the malignancy rates of thyroid nodules in the cytologically determined subclass of atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) and to assess the diagnostic performance of ultrasound (US) patterns defined by the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and the 2015 American Thyroid Association (ATA) guidelines for risk stratification of AUS/FLUS nodules. MATERIALS AND METHODS. From January 2010 to December 2016, 1340 thyroid nodules were diagnosed as AUS/FLUS via fine-needle aspiration biopsy. Of these, 683 cytopathologically confirmed nodules were included in this study. Each nodule was assigned to a category and US pattern, as defined by the K-TIRADS and ATA guidelines. US patterns were compared between benign and malignant nodules, and malignancy rates were calculated according to the subclasses of AUS/FLUS nodules and the K-TIRADS and ATA guidelines. Predictors of malignancy were assessed using logistic regression analysis. RESULTS. The overall malignancy rate of AUS/FLUS nodules was 47.4% (324/683). There were significant differences in malignancy risk among the subclasses (p = 0.001). There were significant differences in malignancy rates according to US patterns, K-TIRADS categories, and ATA categories (p < 0.001). The malignancy rates in the K-TIRADS categories of benign, low, intermediate, and high suspicion were 0%, 1.99%, 34.66%, and 89.00%, respectively (p < 0.001). The malignancy rates in the ATA categories of benign, very low, low, intermediate, and high suspicion were 0%, 0%, 3.33%, 33.54%, and 87.67% (p < 0.001). CONCLUSION. AUS/FLUS nodules with a final diagnosis of malignancy had significantly higher rates of suspicious US features and different K-TIRADS and ATA categories than benign nodules. US categories by K-TIRADS and ATA guidelines can be useful in predicting malignancy and risk stratification, and management planning can be adjusted according to US pattern.
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10
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Grani G, Lamartina L, Durante C, Filetti S, Cooper DS. Follicular thyroid cancer and Hürthle cell carcinoma: challenges in diagnosis, treatment, and clinical management. Lancet Diabetes Endocrinol 2018; 6:500-514. [PMID: 29102432 DOI: 10.1016/s2213-8587(17)30325-x] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 12/16/2022]
Abstract
Follicular thyroid cancer is the second most common differentiated thyroid cancer histological type and has been overshadowed by its more common counterpart-papillary thyroid cancer-despite its unique biological behaviour and less favourable outcomes. In this Review, we comprehensively review the literature on follicular thyroid cancer to provide an evidence-based guide to the management of these tumours, to highlight the lack of evidence behind guideline recommendations, and to identify changes and challenges over the past decades in diagnosis, prognosis, and treatment. We highlight that correct identification of cancer in indeterminate cytological samples is challenging and ultrasonographic features can be misleading. Despite certain unique aspects of follicular thyroid cancer presentation and prognosis, no specific recommendations exist for follicular thyroid cancer and Hürthle cell carcinoma in evidence-based guidelines. Efforts should be made to stimulate additional research in this field.
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Affiliation(s)
- Giorgio Grani
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Livia Lamartina
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Cosimo Durante
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Sebastiano Filetti
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
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11
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Zhao CK, Xu HX, Xu JM, Sun CY, Chen W, Liu BJ, Bo XW, Wang D, Qu S. Risk stratification of thyroid nodules with Bethesda category III results on fine-needle aspiration cytology: The additional value of acoustic radiation force impulse elastography. Oncotarget 2018; 8:1580-1592. [PMID: 27906671 PMCID: PMC5352079 DOI: 10.18632/oncotarget.13685] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/15/2016] [Indexed: 01/10/2023] Open
Abstract
To assess the value of conventional ultrasound, conventional strain elastography (CSE) and acoustic radiation force impulse (ARFI) elastography in differentiating likelihood of malignancy for Bethesda category III thyroid nodules. 103 thyroid nodules with Bethesda category III results on fine-needle aspiration cytology (FNAC) in 103 patients were included and all were pathologically confirmed after surgery. Conventional ultrasound, CSE and ARFI elastography including ARFI imaging and point shear wave speed (SWS) measurement were performed. Univariate and multivariate analyses were performed to identify the independent factors associated with malignancy. Area under the receiver operating characteristic curve (Az) was calculated to assess the diagnostic performance. Pathologically, 65 nodules were benign and 38 were malignant. Significant differences were found between benign and malignant nodules in ARFI. The cut-off points were ARFI imaging grade ≥ 4, SWS > 2.94 m/s and SWS ratio > 1.09, respectively. ARFI imaging (Az: 0.861) had the highest diagnostic performance to differentiate malignant from benign nodules, following by conventional ultrasound (Az: 0.606 - 0.744), CSE (Az: 0.660) and point SWS measurement (Az: 0.725 - 0.735). Multivariate logistic regression analysis showed that ARFI imaging grade ≥ 4 was the most significant independent predictor. The combination of ARFI imaging with point SWS measurement significantly improved the specificity (100% vs. 80.0%) and positive predictive value (100 % vs. 72.9%) in comparison with ARFI imaging alone. ARFI elastography is a useful tool in differentiating malignant from benign thyroid nodules with Bethesda category III results on FNAC.
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Affiliation(s)
- Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Jun-Mei Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Cheng-Yu Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Wei Chen
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Shen Qu
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
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12
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Godazandeh G, Kashi Z, Zargarnataj S, Fazli M, Ebadi R, Kerdabadi EH. Evaluation the Relationship Between Thyroid Nodule Size with Malignancy and Accuracy of Fine Needle Aspiration Biopsy (FNAB). Acta Inform Med 2016; 24:347-350. [PMID: 28077891 PMCID: PMC5203751 DOI: 10.5455/aim.2016.24.347-350] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/10/2016] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Some studies have shown largest thyroid nodule size, especially ≥4cm that can predict malignancy and reduce fine needle aspiration biopsy (FNAB) accuracy. Therefore, this study is designed to evaluate relationship between thyroid nodule sizes with malignancy and its effect on FNBA accuracy. MATERIALS AND METHODS a retrospective analytical study design aims to investigate all patients with thyroid nodules who referred to surgery department of Imam-Khomeini Hospital of Mazandaran University of Medical Sciences in Sari from 20 March 2008 to 22 March 2014. We collected patient's demographic data, nodules size, FNAB reports and final pathology (after surgery) reports from their medical records. All data were analyses performed by SPSS18. RESULTS 167 patients (153 women) with mean age of 41.56±13.24 years old were enrolled for this study. In final pathology; 38 patients (22.8%) had malignant nodules. The mean age of patients with or without malignant nodules were 34.93±11.86 and 42.37±12.26 years old, respectively (P=0.002). The mean size of benign and malignant nodules were 2.91±1.29 cm and 3.38±1.86 cm, respectively (P=0.15). 25.2% of <4 cm nodules and 17.9% of ≥4 cm nodules were diagnosed as a malignant (P=0.29). FNAB was done on 95 patients that reported benign in 60 patients (63.2%), malignant in 18 patients (18.9%) and suspicious in 17 patients (17.9%). Positive and negative results of FNAB in all nodules were 3.5% and 6.3%, in <4cm nodules were 5.8% and 6.2% and in ≥4cm nodules were zero and 6.7%, respectively. The sensitivity, specificity, Positive predict value (PPV), negative predict value (NPV) and overall accuracy (OA) of FNAB in all nodules were 76.19%, 96.49%, 88.88%, 91.66% and 91.02%, and in <4cm nodules were 78.57%, 94.11%, 84.61%, 91.42% and 89.58%, and in ≥4cm nodules were 71.4%, 100%, 100%, 92% and 93.33%, respectively. CONCLUSION the results of this study revealed that the size of the thyroid nodules is not reliable at predicting malignancy and should not be applied in medical decision making. FNAB showed good specificity but the sensitivity was low in our study. In ≥4cm nodules; FNAB sensitivity was decreased and accompanied by higher false-negative results. Furthermore, FNABs with suspicious results were associated with high probability of malignancy.
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Affiliation(s)
- Gholamali Godazandeh
- Department of Thoracic Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Kashi
- Department of Endocrinology, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sadegh Zargarnataj
- Department of General Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehran Fazli
- Young Researcher and Elite Club, Kazerun Branch, Islamic Azad University, Kazerun, Iran
| | - Robab Ebadi
- Jupiter Medical Group, Meadow Springs Medical Center, WA, Australia
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13
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Lee KH, Kim DW, Baek JW, Lee YJ, Choo HJ, Cho YJ, Lee SJ, Park YM, Jung SJ, Baek HJ. Comparison of computed tomography features between follicular neoplasm and nodular hyperplasia. Cancer Imaging 2016; 16:31. [PMID: 27716452 PMCID: PMC5048647 DOI: 10.1186/s40644-016-0089-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To date, appropriate management for Bethesda IV thyroid nodules is controversial, and no specific features of follicular neoplasm and nodular hyperplasia on ultrasonography, computed tomography (CT), or other imaging modalities have been reported. This study aimed to compare CT features of follicular neoplasm and nodular hyperplasia and to determine the specific CT features that could be used to distinguish follicular neoplasm from nodular hyperplasia. METHODS In 122 patients who underwent preoperative CT of the neck and thyroid surgery, 59 follicular neoplasms and 65 nodular hyperplasias were included. In each case, non-enhanced and contrast-enhanced CT images were obtained, and a single radiologist retrospectively analyzed CT images, including degree and pattern of attenuation, nodular configuration, margin, shape, pattern of calcification, degree and pattern of nodular enhancement, and CT halo sign. A univariate and multivariate logistic regression analyses were used to evaluate the predictive power of each variable and CT features with a high predictive power, respectively. RESULTS According to the univariate analysis, iso-attenuation, intraglandular configuration, smooth margin, ovoid shape, decreased enhancement, and absence of CT halo sign were more frequently observed in nodular hyperplasia (p < 0.05), whereas low attenuation, expansile configuration, lobulated margin, taller-than-wide shape, increased enhancement, and presence of computed tomography halo sign were more frequently observed in follicular neoplasm (p < 0.05). Multivariate analysis revealed significant differences in configuration (OR: 2.73, 1.13-6.57), degree of enhancement (OR: 2.14, 1.21-3.78), and presence of CT halo sign (OR: 7.97, 2.74-23.37) between follicular neoplasm and nodular hyperplasia (p < 0.05). CONCLUSIONS Neck CT may be helpful for distinguishing follicular neoplasm from nodular hyperplasia. TRIAL REGISTRATION Rretrospectively registered.
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Affiliation(s)
- Kwang Hwi Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 48108, South Korea.,Department of Radiology, Newoori Namsan Hospital, Busan, 48305, South Korea
| | - Dong Wook Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, 47392, South Korea.
| | - Jin Wook Baek
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, 47392, South Korea
| | - Yoo Jin Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, 47392, South Korea
| | - Hye Jung Choo
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, 47392, South Korea
| | - Young Jun Cho
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, 47392, South Korea
| | - Sun Joo Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, 47392, South Korea
| | - Young Mi Park
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, 47392, South Korea
| | - Soo Jin Jung
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, 48108, South Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, 51476, South Korea
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14
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Villabona CV, Mohan V, Arce KM, Diacovo J, Aggarwal A, Betancourt J, Amer H, Jose T, DeSantis P, Cabral J. UTILITY OF ULTRASOUND VERSUS GENE EXPRESSION CLASSIFIER IN THYROID NODULES WITH ATYPIA OF UNDETERMINED SIGNIFICANCE. Endocr Pract 2016; 22:1199-1203. [PMID: 27409819 DOI: 10.4158/ep161231.or] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Thyroid nodules with fine-needle aspiration (FNA) cytology categorized as atypia of undetermined significance (AUS) often undergo additional diagnostic analysis with the Afirma Gene Expression Classifier (GEC), which classifies these as either high probability of being benign (GEC-B) or suspicious for malignancy (GEC-S). Our goal was to assess the clinical validity and utility of GEC in the evaluation of AUS cytology and evaluate the performance of ultrasonography (USG) for predicting malignancy in this subset. METHODS We conducted a study with a retrospective cohort of patients from January 2012 to January 2014 who had FNA of thyroid nodules >1 cm in size with AUS cytology. RESULTS Cleveland Clinic Florida has an overall prevalence of AUS of 5%. A total of 119 cases with nodules >1 cm in size were reported as AUS. Forty-eight (40.3%) had a GEC performed after the first FNA (AUS-1), and 27 of these were GEC-S. Of those 27, 21 went for surgery and 14 (66.6%) had thyroid cancer on histopathology. The remaining 71 with AUS-1 were sent for a second FNA: 19 nodules were benign and did not undergo further evaluation, while the remaining 52 were reported as AUS for the second consecutive time (AUS-2). AUS-2 samples were sent for GEC. Of these 52 AUS-2, 38 (73.1%) were reported as GEC-S. Thirty-five went for surgery and 32 (91.4%) had confirmed malignancy on histopathology. Positive predictive value (PPV) was 91.4% for AUS-2 and 66.6% for AUS-1. Moreover, AUS-2 nodules that were hypoechoic and solid on USG showed a PPV of 92% for malignancy. CONCLUSION In our practice, the diagnostic accuracy to predict malignancy with GEC for AUS-1 nodules was poor (PPV, 66.6%). The PPV of GEC testing was markedly higher at 91.4% performed after two consecutive AUS cytologies. AUS-2 nodules that were solid and hypoechoic on USG also had a high probability to be malignant (PPV, 92%). We recommend repeat FNA on AUS-1 nodules rather than proceeding directly to GEC testing. Also, we suggest that among AUS-2 nodules, surgery can be recommended when USG shows solid and hypoechoic features with GEC testing reserved for the remainder. ABBREVIATIONS AUS = atypia of undetermined significance FNA = fine-needle aspiration GEC = gene expression classifier GEC-B = GEC-benign GEC-S = GEC-suspicious for malignancy NPV = negative predictive value PPV = positive predictive value USG = ultrasonography.
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15
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Wu JX, Young S, Hung ML, Li N, Yang SE, Cheung DS, Yeh MW, Livhits MJ. Clinical Factors Influencing the Performance of Gene Expression Classifier Testing in Indeterminate Thyroid Nodules. Thyroid 2016; 26:916-22. [PMID: 27161519 DOI: 10.1089/thy.2015.0505] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Molecular diagnostic testing is increasingly used in the management of indeterminate thyroid nodules. Limited data exist regarding the influence of clinical factors on gene expression classifier (GEC) test performance. This study examined the positive and negative predictive value of GEC as stratified by nodule size. METHODS A prospectively maintained pathology database from a single tertiary referral center was queried from 2012 to 2015 for indeterminate thyroid nodules that underwent GEC testing. Nodule size, patient demographics, Bethesda classification, and Hürthle cell-predominant nodules (HCNs) were evaluated as predictors of GEC performance. RESULTS Two hundred and thirty-one patients with 245 indeterminate nodules were examined. Assuming all nodules to be benign unless proven malignant on histopathology, the sensitivity and specificity of GEC testing were 95.2% and 60.1%, respectively. The malignancy rate among resected nodules was 25.3%. The positive predictive value was consistent across nodule sizes: 45.5% for nodules <1 cm, 42.9% for nodules 1-1.9 cm, 36.0% for nodules 2-2.9 cm, 54.2% for nodules 3-3.9 cm, and 50.0% for nodules ≥4 cm. The negative predictive value ranged from 93.3% to 100% and was not affected by nodule size. HCNs had a high rate of GEC suspicious results (77.4% vs. 50.5% for nodules without Hürthle cell predominance, p < 0.01), though this did not correspond to a difference in the rate of malignancy (25.8% vs. 25.3%). CONCLUSIONS Nodule size did not affect GEC test performance in the present cohort. GEC benign results remain reliable in large nodules. GEC suspicious nodules >3 cm carry a similar risk of malignancy compared to smaller nodules, and do not warrant more aggressive treatment. GEC testing has limited clinical utility for HCNs due to the high rate of false-positive results.
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Affiliation(s)
- James X Wu
- 1 Section of Endocrine Surgery; UCLA David Geffen School of Medicine , Los Angeles, California
| | - Stephanie Young
- 1 Section of Endocrine Surgery; UCLA David Geffen School of Medicine , Los Angeles, California
| | - Matthew L Hung
- 1 Section of Endocrine Surgery; UCLA David Geffen School of Medicine , Los Angeles, California
| | - Ning Li
- 2 Department of Biomathematics; UCLA David Geffen School of Medicine , Los Angeles, California
| | - Sung Eun Yang
- 3 Department of Pathology and Laboratory Medicine; UCLA David Geffen School of Medicine , Los Angeles, California
| | - Dianne S Cheung
- 4 Division of Endocrinology, Metabolism, and Hypertension, UCLA David Geffen School of Medicine , Torrance, California
| | - Michael W Yeh
- 1 Section of Endocrine Surgery; UCLA David Geffen School of Medicine , Los Angeles, California
| | - Masha J Livhits
- 1 Section of Endocrine Surgery; UCLA David Geffen School of Medicine , Los Angeles, California
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16
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Jiang L, Chu H, Zheng H. B-Raf mutation and papillary thyroid carcinoma patients. Oncol Lett 2016; 11:2699-2705. [PMID: 27073540 PMCID: PMC4812206 DOI: 10.3892/ol.2016.4298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 12/11/2015] [Indexed: 02/02/2023] Open
Abstract
Thyroid carcinoma is the most prevalent endocrine neoplasm globally. In the majority of thyroid carcinoma cases, a positive prognosis is predicted following administration of the appropriate treatment. A wide range of genetic alterations present in thyroid carcinoma exert their oncogenic actions partially through the activation of the mitogen-activated protein kinase pathway, with the B-Raf mutation in particular being focused on by experts for decades. The B-Raf gene has numerous mutations, however, V600E presents with the highest frequency. It is believed that the existence of the V600E mutation may demonstrate an association with the clinicopathological characteristics of patients, however, inconsistencies remain in the literature. A number of explanatory theories have been presented in order to resolve these discrepancies. Recently, it has been suggested that the V600E mutation may function as a target in a novel approach that may aid the diagnosis and prognosis of thyroid carcinoma, with a number of vying methods put forward to that effect. The current review aims to assist researchers in further understanding the possible association between B-Raf mutations and thyroid carcinoma.
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Affiliation(s)
- Lixin Jiang
- Department of General Surgery, Affiliated Hospital of Qingdao University, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Haidi Chu
- Department of General Surgery, Affiliated Hospital of Qingdao University, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Haitao Zheng
- Department of General Surgery, Affiliated Hospital of Qingdao University, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
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17
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Cantisani V, Maceroni P, D'Andrea V, Patrizi G, Di Segni M, De Vito C, Grazhdani H, Isidori AM, Giannetta E, Redler A, Frattaroli F, Giacomelli L, Di Rocco G, Catalano C, D'Ambrosio F. Strain ratio ultrasound elastography increases the accuracy of colour-Doppler ultrasound in the evaluation of Thy-3 nodules. A bi-centre university experience. Eur Radiol 2015; 26:1441-9. [PMID: 26337431 DOI: 10.1007/s00330-015-3956-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/20/2015] [Accepted: 07/28/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To assess whether ultrasound elastography (USE) with strain ratio increases diagnostic accuracy of Doppler ultrasound in further characterisation of cytologically Thy3 thyroid nodules. METHODS In two different university diagnostic centres, 315 patients with indeterminate cytology (Thy3) in thyroid nodules aspirates were prospectively evaluated with Doppler ultrasound and strain ratio USE before surgery. Ultrasonographic features were analysed separately and together as ultrasound score, to assess sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Receiver operating characteristic (ROC) curves to identify optimal cut-off value of the strain ratio were also provided. Diagnosis on a surgical specimen was considered the standard of reference. RESULTS Higher strain ratio values were found in malignant nodules, with an optimum strain ratio cut-off of 2.09 at ROC analysis. USE with strain ratio showed 90.6% sensitivity, 93% specificity, 82.8% PPV, 96.4% NPV, while US score yielded a sensitivity of 52.9%, specificity of 84.3%, PPV 55.6% and NPV 82.9%. The diagnostic gain with strain ratio was statistically significant as proved by ROC areas, which was 0.9182 for strain ratio and 0.6864 for US score. CONCLUSIONS USE with strain ratio should be considered a useful additional tool to colour-Doppler US, since it improves characterisation of thyroid nodules with indeterminate cytology. KEY POINTS • Strain ratio measurements improve differentiation of thyroid nodules with indeterminate cytology • Elastography with strain ratio is more reliable than ultrasound features and ultrasound score • Strain ratio may help to better select patients with Thy 3 nodules candidate for surgery.
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Affiliation(s)
- Vito Cantisani
- Department of Radiology, Anatomical Pathology and Oncology, "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Piero Maceroni
- Department of Diagnostic Imaging for Surgery, Orthopaedics and Traumatology, "Sapienza" University of Rome, Rome, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Gregorio Patrizi
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Mattia Di Segni
- Department of Radiology, Anatomical Pathology and Oncology, "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Hektor Grazhdani
- Department of Radiology, Anatomical Pathology and Oncology, "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Adriano Redler
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | | | - Laura Giacomelli
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Di Rocco
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiology, Anatomical Pathology and Oncology, "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Ferdinando D'Ambrosio
- Department of Radiology, Anatomical Pathology and Oncology, "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
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18
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Kamaya A, Lewis GH, Liu Y, Akatsu H, Kong C, Desser TS. Atypia of undetermined significance and follicular lesions of undetermined significance: sonographic assessment for prediction of the final diagnosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:767-774. [PMID: 25911708 DOI: 10.7863/ultra.34.5.767] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To determine whether radiologic assessment of thyroid nodules can potentially help guide clinical management after a cytologic diagnosis of atypia of undetermined significance or a follicular lesion of undetermined significance. METHODS We identified 41 patients with 41 thyroid nodules initially diagnosed as atypia or follicular lesions of undetermined significance on fine-needle aspiration that were subsequently definitively diagnosed by either surgical resection or repeated fine-needle aspiration. All sonograms of nodules were reviewed by 2 blinded board-certifiedradiologists. Lesions were assessed in 3 ways: (1) Mayo pattern classification as benign, indeterminate, or worrisome for malignancy (Ultrasound Q 2005; 21:157-165); (2) thyroid imaging reporting and data system scores (scale of 1-5) based on 2 different previously published scoring criteria (Park et al [Thyroid 2009; 19:1257-1264] and Kwak et al [Radiology 2011; 260:892-899]); and (3) binary classification as benign or malignant. RESULTS Of the 41 nodules, 25 had benign histologic findings, and 16 were malignant. Mayo pattern classification was 100% accurate for the benign score. Lesions with a Mayo score of indeterminate were malignant in 21% of cases (6 of 28) and benign in 79% (22 of 28). Lesions with a Mayo score of malignant were malignant in 91% of cases (10 of 11) and benign in 9% (1 of 11). Thyroid imaging reporting and data system scores had area under the receiver operating characteristic curve values of 0.827 for Park scores and 0.822 for Kwak scores. Radiologist binary classification of thyroid nodules showed 88% overall accuracy. CONCLUSIONS Radiologist assessment of thyroid nodules in cases of atypia of undetermined significance or follicular lesions of undetermined significance is highly predictive of the final diagnosis and can help guide management of thyroid nodules of these pathologic types.
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Affiliation(s)
- Aya Kamaya
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.).
| | - Gloria Huang Lewis
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
| | - Yi Liu
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
| | - Haruko Akatsu
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
| | - Christina Kong
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
| | - Terry S Desser
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
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19
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Ucler R, Usluogulları CA, Tam AA, Ozdemir D, Balkan F, Yalcın S, Kıyak G, Ersoy PE, Guler G, Ersoy R, Cakır B. The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy for thyroid nodules three centimeters or larger in size. Diagn Cytopathol 2015; 43:622-8. [PMID: 25914194 DOI: 10.1002/dc.23289] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/05/2015] [Accepted: 03/30/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Whether under ultrasonography (US) guidance or not, fine-needle aspiration biopsy (FNAB) has some limitations, particularly in larger nodules. In this study, we aimed to evaluate the diagnostic value of US-guided fine-needle aspiration biopsy (US-FNAB) in thyroid nodules equal to or larger than 3 cm. MATERIALS AND METHODS Data of 267 patients operated for nodular goiter in the period of January 2006 and March 2012 were reviewed retrospectively. The study group (40 males, 104 females; mean age 42.3 ± 12.3, between 17 and 71) consisted of patients with nodules with a diameter of 3 cm or larger. Patients with nodules less than 3 cm in diameter were considered as the control group (27 males, 96 females; mean age 44.4 ± 11.9, between 18 and 71). RESULTS For nodules smaller than 3 cm, US-FNAB had an accuracy rate of 60% and a false negativity rate of 21.9%. In nodules equal to or larger than 3 cm, the accuracy rate of US-FNAB was 80%, with a false negativity rate of 6.7%. Malignancy was observed in 16% of the study group and 42.3% of the control group. CONCLUSION This study showed that increased nodule diameter is not associated with limitations in the diagnostic value of US-FNAB. We also found that the malignancy rate was smaller for larger nodules. This finding reflects the importance of accurate and rational diagnostic work-up and clinical management for detecting malignancy and surgical decision-making.
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Affiliation(s)
- Rıfkı Ucler
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Celil Alper Usluogulları
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Abbas Ali Tam
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Didem Ozdemir
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Fevzi Balkan
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Samet Yalcın
- Department of General Surgery, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Gulten Kıyak
- Department of General Surgery, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Pamir Eren Ersoy
- Department of General Surgery, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Gulnur Guler
- Department of Pathology, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Bekir Cakır
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
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Kakudo K, Kameyama K, Hirokawa M, Katoh R, Nakamura H. Subclassification of follicular neoplasms recommended by the Japan thyroid association reporting system of thyroid cytology. Int J Endocrinol 2015; 2015:938305. [PMID: 25722720 PMCID: PMC4334867 DOI: 10.1155/2015/938305] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/17/2015] [Accepted: 01/18/2015] [Indexed: 12/30/2022] Open
Abstract
Background. The Japan Thyroid Association recently published guidelines for clinical practice for the management of thyroid nodules, which include a diagnostic system for reporting thyroid fine needle aspiration cytology. It is characterized by the subclassification of follicular neoplasms, which is different from other internationally accepted reporting systems. Materials and Methods. This study examined observer variability in the subclassification of follicular neoplasms among 4 reviewers using Papanicolaou-stained smear samples from 20 surgically treated patients with indeterminate cytology. Results. The favor malignant subcategory had high predictive value of malignancy (risk of malignancy: 60-75%) and good agreement among the 4 reviewers (κ = 0.7714). Conclusion. These results clearly confirmed that the risk stratification of follicular neoplasms, which was adapted from cytology practice of high-volume thyroid centers in Japan, can provide clinically helpful information to estimate the risk of malignancy and to triage patients for surgery.
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Affiliation(s)
- Kennichi Kakudo
- Department of Pathology, Nara Hospital, Kinki University Faculty of Medicine, Otoda-cho 1248-1, Ikoma, Nara 630-0293, Japan
- *Kennichi Kakudo:
| | - Kaori Kameyama
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | | | - Ryohei Katoh
- Department of Human Pathology, Yamanashi University School of Medicine, Yamanashi 409-3898, Japan
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Arpaci D, Ozdemir D, Cuhaci N, Dirikoc A, Kilicyazgan A, Guler G, Ersoy R, Cakir B. Evaluation of cytopathological findings in thyroid nodules with macrocalcification: macrocalcification is not innocent as it seems. ACTA ACUST UNITED AC 2014; 58:939-45. [DOI: 10.1590/0004-2730000003602] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 08/10/2014] [Indexed: 11/22/2022]
Abstract
Objective Microcalcification is strongly correlated with papillary thyroid cancer. It is not clear whether macrocalcification is associated with malignancy. In this study, we aimed to assess the result of fine needle aspiration biopsies (FNAB) of thyroid nodules with macrocalcifications. Subjects and methods We retrospectively evaluated 269 patients (907 nodules). Macrocalcifications were classified as eggshell and parenchymal macrocalcification. FNAB results were divided into four groups: benign, malignant, suspicious for malignancy, and non-diagnostic. Results There were 79.9% female and 20.1% male and mean age was 56.9 years. Macrocalcification was detected in 46.3% nodules and 53.7% nodules had no macrocalcification. Parenchymal and eggshell macrocalcification were observed in 40.5% and 5.8% nodules, respectively. Cytologically, malignant and suspicious for malignancy rates were higher in nodules with macrocalcification compared to nodules without macrocalcification (p = 0.004 and p = 0.003, respectively). Benign and non-diagnostic cytology results were similar in two groups (p > 0.05). Nodules with eggshell calcification had higher rate of suspicious for malignancy and nodules with parenchymal macrocalcification had higher rates of malignant and suspicious for malignancy compared to those without macrocalcification (p = 0.01, p = 0.003 and p = 0.007, respectively). Conclusions Our findings suggest that macrocalcifications are not always benign and are not associated with increased nondiagnostic FNAB results. Macrocalcification, particularly the parenchymal type should be taken into consideration. Arq Bras Endocrinol Metab. 2014;58(9):939-45
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Li Z, Franklin J, Zelcer S, Sexton T, Husein M. Ultrasound surveillance for thyroid malignancies in survivors of childhood cancer following radiotherapy: a single institutional experience. Thyroid 2014; 24:1796-805. [PMID: 25286003 DOI: 10.1089/thy.2014.0132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Survivors of childhood cancer (SCC) who have received radiotherapy to the head, neck, and upper thorax are at higher risk of developing subsequent thyroid malignancies. As part of the post treatment long-term follow-up protocol, the current Children's Oncology Group guideline recommends surveillance by annual palpation; however, thyroid nodules are difficult to detect by physical examinations alone, and potentially malignancy-harboring nodules may be undetected. Since thyroid ultrasound is a sensitive and noninvasive procedure, it was incorporated in our institutional follow-up protocol. The aim of this study was to examine the outcome of ultrasound screening in this high-risk population. The following describes our experience from 2007 to 2013. METHODS A retrospective chart review was conducted on survivors enrolled in our follow-up program. SCC who have received direct or scattered radiation to the thyroid gland, and who were ≥10 years from the diagnosis of primary childhood cancer were considered to be at-risk. RESULTS Seventy-eight survivors met the inclusion criteria and were screened. Thyroid ultrasound detected thyroid nodule(s) in 46 patients (59%), 17 of which had nodule(s) between 5 and 10 mm (22%), and 15 patients had nodules ≥10 mm (19%). Fourteen patients (18%) underwent fine-needle aspiration biopsy. Six patients (8%) underwent surgery, and 5 (6%) had confirmed papillary carcinoma. At the time of the first ultrasound, thyroid nodules of various sizes were found. However, over time, these nodules demonstrated slow growth rates. CONCLUSIONS Incorporation of thyroid ultrasound into routine follow-up of high-risk SCC may aid in the detection of thyroid malignancies that are not clinically apparent. The use of ultrasound allows detailed characterization of the thyroid nodule and reliable monitoring of nodule progression. In SCC without suspicious nodule(s), it may be reasonable to perform screening ultrasounds less frequently due to the slow growth rate of thyroid nodules. However, in those with suspicious features, surgical work-up resulted in the removal of a high number of malignancies, with few unnecessary surgeries and complications.
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Affiliation(s)
- Zhe Li
- 1 Schulich School of Medicine and Dentistry, University of Western Ontario , London, Ontario, Canada
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Yoon RG, Baek JH, Lee JH, Choi YJ, Hong MJ, Song DE, Kim JK, Yoon JH, Kim WB. Diagnosis of thyroid follicular neoplasm: fine-needle aspiration versus core-needle biopsy. Thyroid 2014; 24:1612-7. [PMID: 25089716 DOI: 10.1089/thy.2014.0140] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although fine-needle aspiration (FNA) is a safe and accurate diagnostic procedure for assessing thyroid nodules, it has limitations in diagnosing follicular neoplasms due to its relatively high false-positive rate. The purpose of the present study was to evaluate the diagnostic role of core-needle biopsy (CNB) for thyroid nodules with follicular neoplasm (FN) in comparison with FNA. METHODS A series of 107 patients (24 men, 83 women; mean age, 47.4 years) from 231 FNAs and 107 patients (29 men, 78 women; mean age, 46.3 years) from 186 CNBs with FN readings, all of whom underwent surgery, from October 2008 to December 2013 were retrospectively analyzed. The false-positive rate, unnecessary surgery rate, and malignancy rate for the FNA and CNB patients according to the final diagnosis following surgery were evaluated. RESULTS The CNB showed a significantly lower false-positive and unnecessary surgery rate than the FNA (4.7% versus 30.8%, 3.7% versus 26.2%, p < 0.001, respectively). In the FNA group, 33 patients (30.8%) had non-neoplasms, including nodular hyperplasia (n = 32) and chronic lymphocytic thyroiditis (n = 1). In the CNB group, 5 patients (4.7%) had non-neoplasms, all of which were nodular hyperplasia. Moreover, the CNB group showed a significantly higher malignancy rate than FNA (57.9% versus 28%, p < 0.001). CONCLUSIONS CNB showed a significantly lower false-positive rate and a higher malignancy rate than FNA in diagnosing FN. Therefore, CNB could minimize unnecessary surgery and provide diagnostic confidence when managing patients with FN to perform surgery.
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Affiliation(s)
- Ra Gyoung Yoon
- 1 Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
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Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, Gilbert J, Harrison B, Johnson SJ, Giles TE, Moss L, Lewington V, Newbold K, Taylor J, Thakker RV, Watkinson J, Williams GR. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014; 81 Suppl 1:1-122. [PMID: 24989897 DOI: 10.1111/cen.12515] [Citation(s) in RCA: 732] [Impact Index Per Article: 73.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Petros Perros
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne
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Yoon JH, Lee HS, Kim EK, Moon HJ, Kwak JY. A nomogram for predicting malignancy in thyroid nodules diagnosed as atypia of undetermined significance/follicular lesions of undetermined significance on fine needle aspiration. Surgery 2014; 155:1006-13. [DOI: 10.1016/j.surg.2013.12.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/30/2013] [Indexed: 01/21/2023]
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26
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Yoo WS, Choi HS, Cho SW, Moon JH, Kim KW, Park HJ, Park SY, Choi SI, Choi SH, Lim S, Yi KH, Park DJ, Jang HC, Park YJ. The role of ultrasound findings in the management of thyroid nodules with atypia or follicular lesions of undetermined significance. Clin Endocrinol (Oxf) 2014; 80:735-42. [PMID: 24117478 DOI: 10.1111/cen.12348] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/27/2013] [Accepted: 10/01/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Atypia or follicular lesions of undetermined significance (AUS/FLUS) is a broad cytological category in the Bethesda system for classifying thyroid cytology. This study investigated the diagnostic accuracy of ultrasound (US) analysis of thyroid nodules with AUS/FLUS. PATIENTS AND METHODS Of 5062 subjects with nodules subjected to fine-needle aspiration cytology (FNACs) at our institution from January 2010 through May 2012, 383 met the Bethesda criteria for AUS/FLUS. After excluding subjects who had a history of thyroid cancer, who only underwent repeat FNA or who underwent no further examinations, we selected 249 subjects who had subsequently undergone a core-needle biopsy and/or surgery. Of these, 100 were found to have malignant nodules (40·2%), 122 had benign nodules (49%), and 27 had nodules with indeterminate status (10·8%). We compared specific US parameters, including size, location, content, shape, margin, echogenicity, echotexture and calcification across these subject groups. RESULTS Multivariate analysis revealed that malignancy was associated with taller-than-wide shape (TDW) (OR = 8·43, P = 0·002), ill-defined margin (OR = 3·23, P = 0·002) and marked hypoechogenicity. (OR = 3·61, P = 0·001). The specificity and positive predictive values of TDW were 98% and 90·6%,respectively. The specificity and positive predictive values of 'TDW and marked hypoechogenicity' were both 100%. CONCLUSION US findings play a complementary role in the diagnosis of thyroid nodules with AUS/FLUS. In case of highly suspicious US findings such as 'TDW and marked hypoechogenicity', could be very helpful in the diagnosis of malignancy.
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Affiliation(s)
- Won Sang Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Dankook University Hospital, Seoul, Korea
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Trimboli P, Treglia G, Guidobaldi L, Saggiorato E, Nigri G, Crescenzi A, Romanelli F, Orlandi F, Valabrega S, Sadeghi R, Giovanella L. Clinical characteristics as predictors of malignancy in patients with indeterminate thyroid cytology: a meta-analysis. Endocrine 2014; 46:52-9. [PMID: 24197803 DOI: 10.1007/s12020-013-0057-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/05/2013] [Indexed: 11/30/2022]
Abstract
Indeterminate thyroid nodules (ITN) constitute the gray zone of thyroid fine-needle aspiration cytology (FNAC). About 70-80 % of ITN are later diagnosed as benign; therefore, it is very important to identify the predictors of malignancy. Aim of the study was to summarize published data about clinical risk factors for malignancy in patients with ITN and thereby provide more robust estimates of the effect of these risk factors. Sources comprised studies published through December 2012. Original articles that investigated clinical parameters as potential predictors of malignancy in ITN were identified. Two authors performed the data extraction independently. A meta-analysis of 19 relevant studies was conducted that included 3,494 patients with ITN according to FNAC. The pooled prevalence of malignancy was 28 % (95 % CI 23-33), 26 % in females and 34 % in males. The pooled OR was 1.51 (95 % CI 1.2-1.83) for males and 0.68 (95 % CI 0.53-0.88) for females. Regarding the nodule's size, the pooled OR was 2.10 (95 % CI 1.26-3.50) for nodules >4 cm in diameter. Analysis of the patient age as a risk factor was not feasible because of marked difference found between the studies. In patients with indeterminate thyroid nodules diagnosed at FNAC, the pooled rate of malignancy from 19 studies was 28 %. Patients that are male and have ITN greater than 4 cm in diameter should be considered at higher risk of cancer.
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Affiliation(s)
- Pierpaolo Trimboli
- Section of Endocrinology and Diabetology, Ospedale Israelitico, Rome, Italy
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Brito JP, Gionfriddo MR, Al Nofal A, Boehmer KR, Leppin AL, Reading C, Callstrom M, Elraiyah TA, Prokop LJ, Stan MN, Murad MH, Morris JC, Montori VM. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab 2014; 99:1253-63. [PMID: 24276450 PMCID: PMC3973781 DOI: 10.1210/jc.2013-2928] [Citation(s) in RCA: 291] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Significant uncertainty remains surrounding the diagnostic accuracy of sonographic features used to predict the malignant potential of thyroid nodules. OBJECTIVE The objective of the study was to summarize the available literature related to the accuracy of thyroid nodule ultrasound (US) in the prediction of thyroid cancer. METHODS We searched multiple databases and reference lists for cohort studies that enrolled adults with thyroid nodules with reported diagnostic measures of sonography. A total of 14 relevant US features were analyzed. RESULTS We included 31 studies between 1985 and 2012 (number of nodules studied 18,288; average size 15 mm). The frequency of thyroid cancer was 20%. The most common type of cancer was papillary thyroid cancer (84%). The US nodule features with the highest diagnostic odds ratio for malignancy was being taller than wider [11.14 (95% confidence interval 6.6-18.9)]. Conversely, the US nodule features with the highest diagnostic odds ratio for benign nodules was spongiform appearance [12 (95% confidence interval 0.61-234.3)]. Heterogeneity across studies was substantial. Estimates of accuracy depended on the experience of the physician interpreting the US, the type of cancer and nodule (indeterminate), and type of reference standard. In a threshold model, spongiform appearance and cystic nodules were the only two features that, if present, could have avoided the use of fine-needle aspiration biopsy. CONCLUSIONS Low- to moderate-quality evidence suggests that individual ultrasound features are not accurate predictors of thyroid cancer. Two features, cystic content and spongiform appearance, however, might predict benign nodules, but this has limited applicability to clinical practice due to their infrequent occurrence.
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Affiliation(s)
- Juan P Brito
- Departments of Diabetes, Metabolism, and Nutrition (J.P.B., M.N.S., J.C.M., V.M.M.), Pediatric Endocrinology and Metabolism (A.A.N.), and Radiology (C.R., M.C.), Knowledge and Evaluation Research Unit (J.P.B., M.R.G., K.R.B., A.L.L., T.A.E., L.J.P., M.H.M., V.M.M.), Mayo Graduate School (M.R.G.), and Division of Preventive Medicine (M.H.M.), Mayo Clinic, Rochester, Minnesota 55905
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Calò PG, Medas F, Santa Cruz R, Podda F, Erdas E, Pisano G, Nicolosi A. Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option? BMC Surg 2014; 14:12. [PMID: 24597765 PMCID: PMC3946766 DOI: 10.1186/1471-2482-14-12] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/28/2014] [Indexed: 12/18/2022] Open
Abstract
Background Identification of the best management strategy for nodules with Thy3 cytology presents particular problems for clinicians. This study investigates the ability of clinical, cytological and sonographic data to predict malignancy in indeterminate nodules with the scope of determining the need for total thyroidectomy in these patients. Methods The study population consisted of 249 cases presenting indeterminate nodules (Thy3): 198 females (79.5%) and 51 males (20.5%) with a mean age of 52.43 ± 13.68 years. All patients underwent total thyroidectomy. Results Malignancy was diagnosed in 87/249 patients (34.9%); thyroiditis co-existed in 119/249 cases (47.79%) and was associated with cancer in 40 cases (40/87; 45.98%). Of the sonographic characteristics, only echogenicity and the presence of irregular margins were identified as being statistically significant predictors of malignancy. 52/162 benign lesions (32.1%) and 54/87 malignant were hypoechoic (62.07%); irregular margins were present in 13/162 benign lesions (8.02%), and in 60/87 malignant lesions (68.97%). None of the clinical or cytological features, on the other hand, including age, gender, nodule size, the presence of microcalcifications or type 3 vascularization, were significantly associated with malignancy. Conclusions The rate of malignancy in cytologically indeterminate lesions was high in the present study sample compared to other reported rates, and in a significant number of cases Hashimoto’s thyroiditis was also detected. Thus, considering the fact that clinical and cytological features were found to be inaccurate predictors of malignancy, it is our opinion that surgery should always be recommended. Moreover, total thyroidectomy is advisable, being the most suitable procedure in cases of multiple lesions, hyperplastic nodular goiter, or thyroiditis; the high incidence of malignancy and the unreliability of intraoperative frozen section examination also support this preference for total over hemi-thyroidectomy.
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Affiliation(s)
- Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, S,S, 554, Bivio Sestu, 09042 Monserrato, (CA), Italy.
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Outcome of thyroid nodules characterized as atypia of undetermined significance or follicular lesion of undetermined significance and correlation with Ultrasound features and BRAF(V600E) mutation analysis. AJR Am J Roentgenol 2014; 201:W854-60. [PMID: 24261392 DOI: 10.2214/ajr.12.9901] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We aimed to establish the malignancy rate of thyroid nodules initially characterized as atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) and whether they differ according to histologic subcategory. We also investigated the value of ultrasound features that predict malignancy and BRAF(V600E) mutation analysis and suggest strategies for the management of AUS/FLUS nodules. MATERIALS AND METHODS A total of 165 AUS/FLUS nodules were investigated. There are nine histologic subcategories of AUS/FLUS nodules. We compared the risk of malignancy in thyroid nodules according to the histologic subcategory using ultrasound findings and of those exhibiting the BRAF(V600E) mutation. RESULTS The malignancy rate of nodules with an initial diagnosis of AUS/FLUS was 55.2% (91/165). The malignancy rates by histologic subcategory were 0% in groups 1 (0/2), 2 (0/3), 4 (0/3), 7 (0/3), and 8 (0/1); 76.5% (13/17) in group 3; 83.1% (59/71) in group 5; and 29.2% (19/65) in group 9. The malignancy rate of nodules with suspicious ultrasound features was 79.3% (73/92), and the malignancy rate of nodules with indeterminate ultrasound features was 24.7% (18/73). AUS/FLUS nodules exhibiting taller-than-wide shape, illdefined margins, and microcalcifications or macrocalcifications showed significantly higher odds ratios. The likelihood of BRAF(V600E) mutation-positive nodules showing malignancy was 97.5% (39/40), whereas 39.7% (25/63) of BRAF(V600E) mutation-negative nodules were malignant (p < 0.05). CONCLUSION The malignancy rate of AUS/FLUS nodules in our study cohort was higher than previously reported. Nodules with suspicious features on ultrasound had a higher malignancy rate than did those with indeterminate features on ultrasound. The malignancy rate differed according to histologic subcategory; therefore, management of AUS/FLUS nodules should be tailored according to histologic subcategory.
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Kakudo K, Kameyama K, Miyauchi A, Nakamura H. Introducing the reporting system for thyroid fine-needle aspiration cytology according to the new guidelines of the Japan Thyroid Association. Endocr J 2014; 61:539-52. [PMID: 24727657 DOI: 10.1507/endocrj.ej13-0494] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Japan Thyroid Association (JTA) recently published new guidelines for clinical management of thyroid nodules. This paper introduces their diagnostic system for reporting thyroid fine-needle aspiration cytology. There are two points where the new reporting system that differs from existing internationally-accepted ones. The first is the subclassification of the so-called indeterminate category, which is divided into 'follicular neoplasm' and 'others'. The second is the subclassification of follicular neoplasm into 'favor benign', 'borderline' and 'favor malignant'. It is characterized by self-explanatory terminologies as to histological type and probability of malignancy to establish further risk stratification as well as to facilitate communication between clinicians and cytopathologists. The different treatment strategies adopted for thyroid nodules is deeply influenced by the particular diagnostic system used for thyroid cytology. In Western countries all patients with follicular neoplasms are advised to have immediate diagnostic surgery while patients in Japan often undergo further risk stratification without immediate surgery. The JTA diagnostic system of reporting thyroid cytology is designed for further risk stratification of patients with indeterminate cytology. If a surgeon applies diagnostic lobectomy to all patients with follicular neoplasm unselectively, this subclassification of follicular neoplasm has no practical meaning and is unnecessary. Cytological risk stratification of follicular neoplasms is optional and cytopathologists can choose either a simple 6-tier system without stratification of follicular neoplasm or a complicated 8-tier system depending on their experience in thyroid cytology and clinical management.
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Affiliation(s)
- Kennichi Kakudo
- Department of Pathology, Nara Hospital Kinki University Faculty of Medicine, Ikoma 630-0293, Japan
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Ultrasonographic features associated with malignancy in cytologically indeterminate thyroid nodules. Eur J Surg Oncol 2013; 40:182-6. [PMID: 24373298 DOI: 10.1016/j.ejso.2013.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 10/28/2013] [Accepted: 11/15/2013] [Indexed: 12/24/2022] Open
Abstract
CONTEXT Thyroid nodules with indeterminate cytology usually are treated with surgery, but most are benign. Neck ultrasonography has varied results in predicting malignancy. OBJECTIVE To evaluate the predictive value of ultrasonography and the frequency of malignancy in patients who had indeterminate thyroid nodules. DESIGN Retrospective study. SETTING University hospital. PATIENTS There were 78 patients who had thyroid nodules that were diagnosed on cytology (fine needle aspiration) as a follicular lesion (atypia of undetermined significant) or follicular neoplasm. Ultrasonography was available in 69 patients (88%). INTERVENTION AND MAIN OUTCOME MEASURES Diagnostic fine needle aspiration (cytology), ultrasonography, and surgical pathology of thyroid nodules. RESULTS Fine needle aspiration was indeterminate in all patients, with follicular lesions in 60 patients (77%) and follicular neoplasm in 18 patients (23%). Ultrasonography showed micro calcification in 6 patients (9%), irregular border in 15 patients (22%), size ≥ 3 cm in 31 patients (45%), and hypoechogenicity in 43 patients (62%). Surgical pathology showed that the nodules were benign in 50 patients (64%) and malignant in 28 patients (36%). Malignancy was significantly associated with male sex (relative risk, 2.3), solid nodule structure (relative risk, 2.6), and irregular border (relative risk, 3.6). Compared with other ultrasonographic characteristics, irregular borders had the highest specificity (93%), positive predictive value (80%), and accuracy (78%) for malignancy. CONCLUSIONS The frequency of malignancy is high in indeterminate thyroid nodules. Based on the limited accuracy or predictive value of ultrasonographic risk factors, surgery is the treatment of choice for indeterminate thyroid nodules.
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Lee SH, Baek JS, Lee JY, Lim JA, Cho SY, Lee TH, Ku YH, Kim HI, Kim MJ. Predictive factors of malignancy in thyroid nodules with a cytological diagnosis of follicular neoplasm. Endocr Pathol 2013; 24:177-83. [PMID: 24014040 DOI: 10.1007/s12022-013-9263-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In cases of follicular neoplasm identified by thyroid fine-needle aspiration (FNA), surgery is required to achieve a precise diagnosis. We investigated potential clinical factors for the preoperative prediction of malignancy in thyroid nodules with a cytological diagnosis of follicular neoplasm. We retrospectively reviewed the data of 97 patients who were diagnosed with follicular neoplasm by FNA and had undergone surgery at the Korea Cancer Center Hospital between April 2010 and April 2012. Age, sex, laboratory data (such as thyroid-stimulating hormone, free T4, thyroglobulin (Tg), and Tg antibody), and ultrasonographic findings were reviewed from the electronic medical records. Of 97 patients, 50 (51.5 %) were diagnosed with benign nodules, 16 (16.5 %) with follicular thyroid carcinoma (FTC), and 31 (32.0 %) with papillary thyroid carcinoma (PTC). In comparison with the features of benign nodules, FTC presented with a large nodule size, high serum Tg level, isoechogenicity, calcifications, and peripheral halo, whereas PTC exhibited traits similar to those of benign nodules, except for high serum Tg level and the presence of calcifications on ultrasonography. Therefore, a high serum Tg level (≥75 ng/mL) and calcification were the only significant predictive factors for malignancy in case of follicular neoplasm (p < 0.01). Serum Tg levels and the presence of calcification on ultrasonography are important clinical features to predict malignancy in thyroid nodules with cytological diagnosis of follicular neoplasm.
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Affiliation(s)
- Seong Hyeon Lee
- Department of Internal Medicine, Korea Cancer Center Hospital, 75, Nowon-ro, Nowon-gu, Seoul, 139-706, Republic of Korea
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Carr R, Ustun B, Chhieng D, Schofield K, Theoharis C, Hammers L, Adeniran AJ. Radiologic and clinical predictors of malignancy in the follicular lesion of undetermined significance of the thyroid. Endocr Pathol 2013; 24:62-8. [PMID: 23595630 DOI: 10.1007/s12022-013-9240-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Various ultrasonographic characteristics of thyroid nodules have been associated with a higher likelihood of malignancy, and certain clinical features may also increase the likelihood of malignancy in patients. This study is designed to determine the ultrasonographic and clinical predictors of malignancy in the atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category. A search through the cytology files at our institution was made for cases with diagnosis of AUS/FLUS. The clinical and radiologic findings were correlated with the final surgical pathology diagnosis. A total of 140 cases of AUS/FLUS with corresponding surgical intervention were identified (112 females and 28 males). There was a 79 % malignancy rate in nodules with irregular contours, compared to 51 % in nodules with regular outlines. Nodules demonstrating calcifications showed a 57 % malignancy rate, compared to 50 % in nodules without calcifications. Sixty-one percent of cases with an ultrasonographic diagnosis of indeterminate to suspicious were malignant following surgical resection. The rates of malignancy in patients with radiation exposure, symptomatic nodules, and positive family history of thyroid cancer were 22, 59, and 33 %, respectively. BRAF mutation was demonstrated in 57 % of malignant cases and in none of benign cases. No single clinical or ultrasonographic feature or combination of features is adequately sensitive or specific to identify all malignant nodules. However, a combination of solid nodules, nodules with irregular contours, symptomatic nodules, and positive BRAF mutation has high predictive value for malignancy in patients with a cytologic diagnosis of AUS/FLUS.
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Affiliation(s)
- Ryan Carr
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06519, USA
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Kihara M, Hirokawa M, Masuoka H, Yabuta T, Shindo H, Higashiyama T, Fukushima M, Yamada O, Takamura Y, Ito Y, Kobayashi K, Miya A, Miyauchi A. Evaluation of cytologically benign solitary thyroid nodules by ultrasonography: A retrospective analysis of 1877 cases. Auris Nasus Larynx 2013; 40:308-11. [DOI: 10.1016/j.anl.2012.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 09/21/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
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Hahn SY, Shin JH, Han BK, Ko EY, Ko ES. Ultrasonography-guided core needle biopsy for the thyroid nodule: does the procedure hold any benefit for the diagnosis when fine-needle aspiration cytology analysis shows inconclusive results? Br J Radiol 2013; 86:20130007. [PMID: 23564885 DOI: 10.1259/bjr.20130007] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE We evaluated the diagnostic role of ultrasonography-guided core needle biopsy (CNB) according to ultrasonography features of thyroid nodules that had inconclusive ultrasonography-guided fine-needle aspiration (FNA) results. METHODS A total of 88 thyroid nodules in 88 patients who underwent ultrasonography-guided CNB because of previous inconclusive FNA results were evaluated. The patients were classified into three groups based on ultrasonography findings: Group A, which was suspicious for papillary thyroid carcinoma (PTC); Group B, which was suspicious for follicular (Hurthle cell) neoplasm; and Group C, which was suspicious for lymphoma. The final diagnoses of the thyroid nodules were determined by surgical confirmation or follow-up after ultrasonography-guided CNB. RESULTS Of the 88 nodules, the malignant rate was 49.1% in Group A, 12.0% in Group B and 90.0% in Group C. The rates of conclusive ultrasonography-guided CNB results after previous incomplete ultrasonography-guided FNA results were 96.2% in Group A, 64.0% in Group B and 90.0% in Group C (p=0.001). 12 cases with inconclusive ultrasonography-guided CNB results were finally diagnosed as 8 benign lesions, 3 PTCs and 1 lymphoma. The number of previous ultrasonography-guided FNA biopsies was not significantly different between the conclusive and the inconclusive result groups of ultrasonography-guided CNB (p=0.205). CONCLUSION Ultrasonography-guided CNB has benefit for the diagnosis of thyroid nodules with inconclusive ultrasonography-guided FNA results. However, it is still not helpful for the differential diagnosis in 36% of nodules that are suspicious for follicular neoplasm seen on ultrasonography. ADVANCES IN KNOWLEDGE This study shows the diagnostic contribution of ultrasonography-guided CNB as an alternative to repeat ultrasonography-guided FNA or surgery.
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Affiliation(s)
- S Y Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
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Gweon HM, Son EJ, Youk JH, Kim JA. Thyroid nodules with Bethesda system III cytology: can ultrasonography guide the next step? Ann Surg Oncol 2013; 20:3083-8. [PMID: 23700214 DOI: 10.1245/s10434-013-2990-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND This study was designed to evaluate the feasibility and the role of thyroid ultrasound (US) in predicting malignancy for Bethesda system III nodules and to suggest management guidelines for these nodules. METHODS A total of 155 thyroid nodules with Bethesda system III cytology in 155 patients with surgery or follow-up repeat FNA were included in this study. On the basis of US features, final assessment for thyroid nodules were prospectively classified into one of three categories: (1) probably benign, (2) low suspicious for malignancy, and (3) suspicious for malignancy. The clinicopathologic characteristics of patients and US features of nodules were compared according to malignancy and benignity. RESULTS Of the 155 Bethesda system III nodules, 69 (44.5%) underwent surgery without repeat FNA and 86 (55.5%) nodules underwent repeat FNA, and a malignancy rate of 55.5% (86/155) was determined. Thyroid nodules with concurrent thyroid cancer were more likely to be malignant (P<0.001). The malignancy rate of sonographically suspicious for malignancy was 100%, higher than the 58% of sonographically low suspicious for malignancy, and 7.7% of sonographically probably benign nodules (P<0.001). CONCLUSIONS US assessment may help the clinician decide between surgery and repeat FNA for managing Bethesda system III nodules. When the US assessment for the thyroid nodules is suspicious for malignancy, repeat FNA may be unnecessary and surgery should be considered.
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Affiliation(s)
- Hye Mi Gweon
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Incidence of malignancy in thyroid nodules determined to be follicular lesions of undetermined significance on fine-needle aspiration. World J Surg 2012; 36:69-74. [PMID: 22057754 DOI: 10.1007/s00268-011-1336-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) for thyroid nodules is the most important method for determining a diagnosis. The system for reporting results is based on a cytopathologic classification that stratifies the risk of malignancy. METHODS We retrospectively studied 197 patients who underwent FNA for diagnostic evaluation of a thyroid nodule and had their results reported as a follicular lesion of undetermined significance (FLUS) using the Bethesda classification system. The objective of the study was to analyze the incidence and histopathologic types of malignancy in these cases. RESULTS The final histopathologic breakdown is as follows: 65 cases (32.9%) of follicular adenoma, 81 cases (41.1%) of microfollicular adenomatoid nodule, 19 cases (9.6%) of microfollicular adenomatoid nodule on the background of thyroiditis, 17 cases (8.6%) of follicular carcinoma, 9 cases (4.6%) of follicular variant papillary carcinoma, and 6 cases (3.1%) of classic papillary carcinoma, for a 16.2% incidence of malignancy. Beyond these diagnoses in the FNA-biopsied nodules, we observed 29 cases (14.7%) of incidental ipsilateral papillary thyroid microcarcinoma (PTM) and 13 cases (6.6%) of incidental contralateral thyroid lobe PTM. CONCLUSIONS This study observed a 16.2% incidence of thyroid cancer in the nodule designated FLUS compared to the 5 to 15% rate reported by the Bethesda FNA classification. The overall incidence of incidental PTM in the thyroid gland was 21.3%. These data support considering surgical intervention for at least diagnostic purposes in a patient with the FNAB diagnosis of FLUS.
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Gómez Sáez JM. Diagnostic and prognostic markers in differentiated thyroid cancer. Curr Genomics 2012; 12:597-608. [PMID: 22654559 PMCID: PMC3271312 DOI: 10.2174/138920211798120826] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 08/08/2011] [Accepted: 09/07/2011] [Indexed: 02/06/2023] Open
Abstract
The MAPK/ERK (mitogen-activated protein kinase/extracellular signal- regulated kinase signaling pathway) and PI3K/Akt (lipid kinase phoshoinositide-3-kinase signaling pathway) play an important role in transmission of cell signals through transduction systems as ligands, transmembrane receptors and cytoplasmic secondary messengers to cell nucleus, where they influence the expression of genes that regulate important cellular processes: cell growth, proliferation and apoptosis. The genes, coding the signaling cascade proteins (RET, RAS, BRAF, PI3K, PTEN, AKT), are mutated or aberrantly expressed in thyroid cancer derived from follicular thyroid cell. Genetic and epigenetic alternations, concerning MAPK/ERK and PI3K/Akt signaling pathways, contribute to their activation and interaction in consequence of malignant follicular cell transformation. Moreover, it is additionally pointed out that genetic, as well as epigenetic DNA changing via aberrant methylation of several tumor suppressor and thyroid-specific genes is associated with tumor aggressiveness, being a jointly responsible mechanism for thyroid tumorigenesis. In the present manuscript the currently developed diagnostic and prognostic genetic/epigenetic markers are presented; the understanding of this molecular mechanism provides access to novel molecular therapeutic strategies.
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Affiliation(s)
- José M Gómez Sáez
- Endocrinology and Nutrition Service, University Hospital of Bellvitge, L´Hospitalet of Llobregat, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Barcelona, Spain
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Rossi M, Buratto M, Bruni S, Filieri C, Tagliati F, Trasforini G, Rossi R, Beccati MD, Degli Uberti EC, Zatelli MC. Role of ultrasonographic/clinical profile, cytology, and BRAF V600E mutation evaluation in thyroid nodule screening for malignancy: a prospective study. J Clin Endocrinol Metab 2012; 97:2354-61. [PMID: 22535974 DOI: 10.1210/jc.2011-3494] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
CONTEXT Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the most reliable nonsurgical test for distinguishing benign from malignant thyroid nodules. However, there is no consensus on which nodules should undergo FNAB. AIMS The aims of this study were to evaluate the utility of US-guided FNAB in the diagnostic assessment of nodules with or without clinical/US features suggestive for malignancy and to investigate the additional contribution of BRAF V600E mutation analysis in the detection of differentiated thyroid cancer. DESIGN AND METHODS Thyroid cytoaspirates from 2421 nodules at least 4 mm in diameter were performed in 1856 patients who underwent cytological evaluation and biomolecular analysis. RESULTS Cytology showed high positive predictive value and specificity for the diagnosis of malignant lesions. BRAF V600E mutation was found in 115 samples, 80 of which were also cytologically diagnosed as papillary thyroid cancer. BRAF mutation analysis significantly enhanced the diagnostic value of cytology, increasing FNAB diagnostic sensitivity for malignant nodules by approximately 28%. Micro PTC (63% of diagnosed papillary thyroid carcinoma) showed a high prevalence of multifocality, extrathyroidal extension, and lymph node metastases, underlining the malignant potential of thyroid microcarcinomas. Each investigated US/clinical characteristic of suspected malignancy correlated with the presence of a thyroid cancer in thyroid nodules with diameter of at least 4 mm. CONCLUSIONS These data indicate that nodules of at least 4 mm may underlie a thyroid cancer independently of US/clinical characteristics of suspected malignancy, suggesting the need to perform FNAB. The diagnostic sensitivity for thyroid cancer is significantly increased by BRAF V600E mutation analysis, indicating that the screening for BRAF mutation in FNAB samples has a relevant diagnostic potential.
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Affiliation(s)
- Martina Rossi
- Section of Endocrinology, Department of Biomedical Sciences and Advanced Therapies, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy
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Kim DW, Lee EJ, Jung SJ, Ryu JH, Kim YM. Role of sonographic diagnosis in managing Bethesda class III nodules. AJNR Am J Neuroradiol 2011; 32:2136-41. [PMID: 21920860 PMCID: PMC7964421 DOI: 10.3174/ajnr.a2686] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Accepted: 04/03/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Bethesda class III cytology is an important limitation of the US-FNA in assessing thyroid nodules. This study aimed to assess the diagnostic efficacy of US in evaluating thyroid nodules with Bethesda class III cytology. MATERIALS AND METHODS From January 2008 to December 2009, 1036 patients with 1289 thyroid nodules diagnosed by US and subsequent US-FNA biopsy were enrolled in the study. On the basis of US features, each thyroid nodule was prospectively classified by a single radiologist into 1 of 5 diagnostic categories: benign, probably benign, borderline, possibly malignant, and malignant. Solid nodules were classified by using all 5 categories, whereas partially cystic nodules were classified by using 4 (borderline was omitted). We calculated the diagnostic efficacy of thyroid US by comparing the US diagnoses with the histopathology results of Bethesda class III nodules. RESULTS Of the 51 Bethesda class III nodules, 35 were surgically confirmed and 8 were histologically diagnosed, and a malignancy rate of 46.5% (20/43) was determined. From the 43 nodules, the sensitivity, specificity, positive and negative predictive values, and accuracy were calculated with 9 borderline nodules excluded (100%, 94.7%, 93.3%, 100%, and 97.0%, respectively) and with the 9 when reclassified as benign (63.6%, 95.2%, 93.3%, 71.4%, and 79.1%, respectively) and malignant (100%, 85.7%, 88.0%, 100%, and 93.0%, respectively). The values obtained with exclusion and malignancy reclassification of 9 borderline nodules were not significantly different (P = .250). CONCLUSIONS US diagnosis by using the present US classification system can be helpful for managing Bethesda class III nodules.
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Affiliation(s)
- D W Kim
- Department of Radiology, Inje University College of Medicine, Busan, South Korea.
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Dutta S, Thaha MA, Smith DM. Do sonographic and cytological features predict malignancy in cytologically indeterminate thyroid nodules? Ann R Coll Surg Engl 2011; 93:361-4. [PMID: 21943458 DOI: 10.1308/003588411x580160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The current algorithm for managing patients with indeterminate (Thy3) thyroid cytology is a thyroid lobectomy followed by a completion thyroidectomy depending on histology. We investigated whether sonographic and or cytological features in addition to clinical characteristics would predict the potential for malignancy in a cohort of patients with thyroid nodules of indeterminate cytology. METHODS Perusing a clinical database of all patients undergoing ultrasonography guided fine needle aspiration (FNA) of thyroid nodules, we identified all Thy3 lesions. The demographic, ultrasonography and cytological details of benign and malignant groups were compared by t-test, chi-square test and, when appropriate, Fisher's exact test. Association between studied characteristics and malignancy was tested by binary logistic regression using single input. A p-value of <0.05 was considered significant. RESULTS During the retrospective study period of January 2003 to July 2010, a total of 1,019 patients underwent FNA, of which 69 (6.8%) were classed as Thy3. Of these, 59 underwent surgical treatment and the histological outcomes were grouped as benign (n=42, 71.2%) and malignant (n=17, 28.8%). These groups were analysed for the predictive variables. Age, sex and sonological characters were similar in the two groups (p>0.05). The two microcalcifications observed were both in the malignant group. Among all the variables assessed, only the absence of normal follicular cells was associated with malignant nodules (univariate analysis, p=0.034). CONCLUSIONS Malignancy was more common in Thy3 patients with an absence of normal follicular cells and such patients may therefore warrant a total thyroidectomy.
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Castro MR, Espiritu RP, Bahn RS, Henry MR, Gharib H, Caraballo PJ, Morris JC. Predictors of malignancy in patients with cytologically suspicious thyroid nodules. Thyroid 2011; 21:1191-8. [PMID: 22007937 PMCID: PMC3208245 DOI: 10.1089/thy.2011.0146] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Fine needle aspiration (FNA), although very reliable for cytologically benign and malignant thyroid nodules, has much lower predictive value in the case of suspicious or indeterminate nodules. We aimed to identify clinical predictors of malignancy in the subset of patients with suspicious FNA cytology. METHODS We reviewed the electronic medical records of 462 patients who had FNA of thyroid nodules at our institution with a suspicious cytological diagnosis, and underwent surgery at Mayo Clinic between January 2004 and September 2008. Demographic data including age, gender, history of exposure to radiation and use of thyroid hormone was collected. The presence of single versus multiple nodules by ultrasonography, nodule size, and serum thyroid-stimulating harmone (TSH) level before thyroid surgery were recorded. Analysis of the latter was limited to patients not taking thyroid hormone or antithyroid drugs at the time of FNA. RESULTS Of the 462 patients, 327 had lesions suspicious for follicular neoplasm (S-FN) or Hürthle cell neoplasm (S-HCN), 125 had cytology suspicious for papillary carcinoma (S-PC) and 10 had a variety of other suspicious lesions (medullary cancer, lymphoma and atypical). Malignancy rate for suspicious neoplastic lesions (FN+HCN) was ∼15%, whereas malignancy rate for lesions S-PC was 77%. Neither age, serum TSH level, or history of radiation exposure were associated with increased malignancy risk. The presence of multiple nodules (41.1% vs. 26.4%, p=0.0014) or smaller nodule size (2.6±1.8 cm vs. 2.9±1.6 cm, p=0.008) was associated with higher malignancy risk. In patients with cytology suspicious for neoplasm (FN, HCN) malignancy risk was higher in those receiving thyroid hormone therapy than in nonthyroid hormone users (37.7% vs. 16.5%, p=0.0004; odds ratio: 3.1), although serum TSH values did not differ significantly between thyroid hormone users and nonusers. CONCLUSION In patients with cytologically suspicious thyroid nodules, the presence of multiple nodules or smaller nodule size was associated with increased risk of malignancy. In addition, our study demonstrates for the first time, an increased risk of malignancy in patients with nodules suspicious for neoplasm who are taking thyroid hormone therapy. The reason for this association is unknown.
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Affiliation(s)
- M Regina Castro
- Division of Endocrinology and Metabolism, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
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Teama SH, Agwa SH, Fawzy A, Sayed MM, Ibrahim WA, Eid YM. Molecular detection of circulating thyroid specific transcripts (TSHR/Tg-mRNAs) in thyroid cancer patients: Their diagnostic significance. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2011. [DOI: 10.1016/j.ejmhg.2011.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Cochand-Priollet B, Dahan H, Laloi-Michelin M, Polivka M, Saada M, Herman P, Guillausseau PJ, Hamzi L, Poté N, Sarfati E, Wassef M, Combe H, Raulic-Raimond D, Chedin P, Medeau V, Casanova D, Kania R. Immunocytochemistry with cytokeratin 19 and anti-human mesothelial cell antibody (HBME1) increases the diagnostic accuracy of thyroid fine-needle aspirations: preliminary report of 150 liquid-based fine-needle aspirations with histological control. Thyroid 2011; 21:1067-73. [PMID: 21875347 DOI: 10.1089/thy.2011.0014] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Thyroid nodules are relatively common (7% of the population) but are malignant in only 5%-10% of cases. Fine-needle aspiration (FNA) to detect cancer can have > 90% sensitivity but only 50%-65% specificity because of false-positive results, which necessitates surgical controls. We aimed to assess the diagnostic accuracy of immunocytochemistry (ICC) of thyroid FNA to improve its sensitivity and specificity. METHODS We prospectively collected 2038 thyroid FNAs, of which 1397 were FNA biopsies with liquid-based cytology (Thin-Prep-Hologic®). ICC with cytokeratin 19 and HBME1 antibodies (Dako® A/S) was used for all malignant cases and cases of atypical cells of undetermined significance (AUS), follicular neoplasm (FN), and nodules suspicious for malignancy-papillary thyroid carcinoma (SM-PTC) as well as some benign cases (abnormal features on radiography or benign on secondary FNA). ICC results were defined as "non-contributory," "favoring benign," "favoring malignant," or "indeterminate." Results for 150 cases were compared with histological controls for diagnostic accuracy. RESULTS Of these 150 cases ICC was helpful for benign or malignant triage of 48 cases of AUS, FN, and SM-PTC (42% of these lesions). Six (4%) ICC results were false positive (favoring malignant with benign histology) but none were false negative (favoring benign with malignant histology). Results for indeterminate cytological cases favored malignant or benign disease with sensitivity, specificity, and negative and positive predictive values of 100%, 85.2%, 100%, and 86.2%, respectively. CONCLUSIONS ICC of thyroid FNAs with cytokeratin 19 and HBME1 antibodies can reduce the false-positive and false-negative results of single morphological analyses. It can increase the sensitivity and specificity of diagnosis, thus improving diagnostic accuracy and reducing the need for surgical controls.
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Yoon JH, Kwak JY, Moon HJ, Kim MJ, Kim EK. The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy and the sonographic differences between benign and malignant thyroid nodules 3 cm or larger. Thyroid 2011; 21:993-1000. [PMID: 21834673 DOI: 10.1089/thy.2010.0458] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although fine-needle aspiration biopsy (FNAB) is considered the standard for preoperative evaluation of thyroid nodules, the value of this has been questioned for large thyroid nodules. Here, we evaluated the diagnostic accuracy of ultrasound-guided FNAB (US-FNAB) for thyroid nodules that were 3 cm or larger as well as the sonographic differences between benign and malignant nodules in this size group. MATERIALS AND METHODS There were 661 thyroid masses equal to or larger than 3 cm who underwent US-FNAB from February 2002 to December 2006 and were included in this study. The cytology and surgical pathology readings in these patients were reviewed along with the ultrasonography features, the last from the retrospective review by one radiologist. Histopathology was used to calculate accuracy parameters for the US-FNAB cytology readings. In addition, the likely diagnoses for patients with a benign cytology reading were ascertained. RESULTS Thyroid surgery was performed for 206 of the 661 nodules in the same number of patients (31.2%). All subjects who had inadequate, indeterminate, or suspicious for malignancy cytology readings had thyroid surgery. All of the patients who did not have thyroid surgery were considered likely to have benign disease because of their initial cytology reading and follow-up, and finally, 587 (88.8%) were benign and 74 (11.2%) were malignant. When considering malignant, suspicious for malignancy, and indeterminate cytology readings as positive and benign cytology as negative, the sensitivity was 96.7%, specificity 85.9%, positive predictive value 76.6%, negative predictive value 98.2%, and accuracy 89.4%. Ultrasonography features of malignancy were more prevalent in thyroid nodules that were malignant compared with those that were benign or considered likely to be benign (70.3% vs. 1.2%, p < 0.001), and ultrasonography features of a benign nodule were more prevalent in thyroid nodules that were benign or considered likely to be benign than those that were malignant (94.9% vs. 29.7%, p < 0.001). CONCLUSION In this study, US-FNAB appeared to be a relatively accurate method to evaluate thyroid nodules larger than 3 cm, with false-negative rates of about 2%. Much larger series would be required to determine its utility in this setting.
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Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Lu Z, Mu Y, Zhu H, Luo Y, Kong Q, Dou J, Lu J. Clinical value of using ultrasound to assess calcification patterns in thyroid nodules. World J Surg 2011; 35:122-7. [PMID: 21042914 DOI: 10.1007/s00268-010-0827-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Differentiating between benign and malignant thyroid nodules is important for providing appropriate treatment. In the present study we examined the clinical usefulness of ultrasound in examining calcification patterns in thyroid nodules, and thus predict malignancy. METHODS The records of 1,498 Chinese patients who underwent thyroidectomy for nodular thyroid disease were retrospectively examined. All patients underwent thyroid ultrasound within 1 month before surgery. Calcification patterns in thyroid nodules were examined, and tissue samples were analyzed to determine a pathological diagnosis. Calcifications were defined as macrocalcifications, microcalcifications, rim calcifications, or isolated calcifications. RESULTS A total of 2,122 thyroid nodules were examined, and 259 nodules (12.2%) were found to be malignant. Papillary carcinoma accounted for 85.3% of all malignancies. The majority of benign lesions were nodular goiters. Calcification was detected in 49.6% of malignant nodules and 15.7% of benign nodules. Microcalcifications were significantly more common in malignant nodules as compared to benign nodules (33.7 vs. 6.4%; P < 0.001). The sensitivity and specificity of microcalcifications for predicting malignancy were 33.7 and 93.6%, respectively, while the positive and negative likelihood ratios were 42.0 and 91.1%, respectively. CONCLUSIONS Calcifications, as detected by ultrasonography, are evident in benign and malignant thyroid nodules. Although microcalcifications are more common in malignant thyroid nodules than in benign ones, the clinical value of using the presence of microcalcifications alone for predicting malignancy is limited.
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Affiliation(s)
- Zhaohui Lu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
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Park KT, Ahn SH, Mo JH, Park YJ, Park DJ, Choi SI, Park SY. Role of core needle biopsy and ultrasonographic finding in management of indeterminate thyroid nodules. Head Neck 2011; 33:160-5. [PMID: 20848434 DOI: 10.1002/hed.21414] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Thyroid fine-needle aspiration (FNA) is used as a screening test of choice for evaluation of thyroid nodules. However, approximately 15% to 25% of the cases are classified as indeterminate, posing dilemmas in decision-making. This study was designed to compare the diagnostic performances of second FNA and core needle biopsy of indeterminate nodules by initial FNA. METHODS From February 2005 through June 2009, 258 patients who completed scheduled follow-ups were enrolled and the follow-up results were analyzed. RESULTS Nondiagnostic results were obtained in 41.8% of the second FNA group and in 1.7% of the core needle biopsy group (p < .001; chi-square). The nodules that show borderline features in preoperative ultrasonography had a malignancy rate of 18.3% and could be identified successfully with core needle biopsy. CONCLUSION Core needle biopsy is a better method for evaluating indeterminate nodules by initial FNA than second FNA, especially in patients with ultrasonographic findings of a borderline nodule.
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Affiliation(s)
- Kyung Tae Park
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Bundang Hospital, Gyeonggi-Do, Seoul, Korea
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Abstract
Thyroid nodules are very common, and although the majority are benign, approximately 5% may harbor malignancy. The evaluation of the patient with solitary thyroid nodule is generally straightforward and will typically include measurement of serum TSH to assess thyroid function and fine-needle aspiration biopsy of the nodule, with or without ultrasound (US) guidance. The approach to the patient with nontoxic multinodular goiter represents a more difficult problem for the clinician. All patients should have serum TSH measured to assess functional thyroid status and US examination to evaluate the number, size, and sonographic features of the nodules and assist in the selection of nodules that may need fine-needle aspiration biopsy. Patients with nodules yielding malignant cytology should be referred for surgery. Given the lack of reliable markers to predict biological behavior of nodules with suspicious (indeterminate) cytology, patients with such nodules are generally advised to have surgery, unless autonomous function of these nodules can be confirmed by scintigraphy. Most of these patients, however, will ultimately prove to have benign follicular tumors. Many patients with benign but large goiters may experience clinical symptoms of pressure, such as dysphagia, choking sensation, or airway obstruction. Such patients will often require surgery for alleviation of symptoms. In the absence of malignancy, asymptomatic patients may be observed. Radioactive iodine, commonly used in many parts of Europe, is safe and effective and may be a reasonable option for many patients. Periodic follow-up with neck palpation and US exam is recommended for all patients.
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Affiliation(s)
- Rebecca S Bahn
- Division of Endocrinology and Metabolism, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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Rausei S, Dionigi G, Frattini F, Castano P, Leotta A, Rovera F, Boni L, Bartalena L, Dionigi R. Nodule size and fine-needle aspiration biopsy: diagnostic challenges for thyroid malignancy. Am J Surg 2011; 201:525-30. [DOI: 10.1016/j.amjsurg.2010.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 02/26/2010] [Accepted: 03/03/2010] [Indexed: 10/19/2022]
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