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Li C, Luo Y, Gan Y, Jiang Y, Li Q, Huang J. Development and validation of a predictive model for assessing the risk of follicular carcinoma in thyroid nodules identified as suspicious by intraoperative frozen section. Front Endocrinol (Lausanne) 2024; 15:1431247. [PMID: 39391875 PMCID: PMC11464355 DOI: 10.3389/fendo.2024.1431247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 09/02/2024] [Indexed: 10/12/2024] Open
Abstract
Introduction Follicular thyroid carcinoma (FTC) is the second most common thyroid malignancy and is characterized by a higher risk of distant metastasis compared to papillary thyroid cancer. Intraoperative frozen section (IOFS) diagnosis of FTC is challenging due to its limited sensitivity and accuracy, leading to uncertainty in intraoperative surgical decision-making. In response, we developed a predictive model to assess the risk of follicular carcinoma in thyroid nodules identified as suspicious for follicular neoplasm by IOFS. Methods This model was derived from preoperative clinical and ultrasound data of 493 patients who underwent thyroid surgery at Ningbo Medical Center Lihuili Hospital. It identified five significant predictors of follicular carcinoma: nodule size, thyroglobulin (Tg) level, hypoechogenicity, lobulated or irregular margins, and thick halo. Results The model demonstrated robust discrimination and calibration, with an area under the curve (AUC) of 0.83 (95% CI: 0.77-0.90) in the training set and 0.78 (95% CI: 0.68-0.88) in the validation set. In addition, it achieved a sensitivity of 81.63% (95% CI: 69.39-91.84) and 68.00% (95% CI: 48.00--4.00), a specificity of 77.42% (95% CI: 72.18-82.66) and 72.51% (95% CI: 65.50-78.96), an accuracy of 78.1% (95% CI: 73.4-82.4) and 71.9% (95% CI: 65.3-78.6), a positive predictive value (PPV) of 41. 67% (95% CI: 35.65-48.84) and 26.79% (95% CI: 19.40-34.33), respectively, and a negative predictive value (NPV) of 95.61% (95% CI: 92.86-97.99) and 94.07% (95% CI: 90.44-97.08) in the training and validation sets, respectively. Conclusion The model can accurately rule out FTC in low-risk nodules, thereby providing surgeons with a practical tool to determine the necessary extent of surgical intervention for nodules flagged as suspicious by IOFS.
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Affiliation(s)
- Cheng Li
- Department of Thyroid Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Yong Luo
- Department of Thyroid Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Yongli Gan
- Ningbo Clinical Diagnostic Pathology Center, Ningbo, China
| | - Yan Jiang
- Department of Ultrasound, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Qi Li
- Department of Thyroid Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Jin Huang
- Department of Surgery, The Second Hospital of Ninghai County, Ningbo, China
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Kim MK, Park H, Oh YL, Shin JH, Kim TH, Hahn SY. Role of ultrasound in predicting telomerase reverse transcriptase (TERT) promoter mutation in follicular thyroid carcinoma. Sci Rep 2024; 14:15323. [PMID: 38961252 PMCID: PMC11222544 DOI: 10.1038/s41598-024-66351-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/01/2024] [Indexed: 07/05/2024] Open
Abstract
Telomerase reverse transcriptase (TERT) promoter mutations are associated with tumor aggressiveness. This study aimed to demonstrate the ultrasonographic (US) features of TERT promoter-mutated follicular thyroid cancer (FTC) and evaluate their predictive performance. A total of 63 patients with surgically confirmed FTC between August 1995 and April 2021 were included. All data were available for analysis of preoperative US findings and TERT promoter mutation results. Genomic DNA was extracted from the archived surgical specimens to identify TERT promoter mutations. Logistic regression analysis was performed to compare US findings between TERT promoter-mutated and wild-type FTCs. Of the 63 patients with FTC, 10 (15.9%) had TERT promoter mutations. TERT promoter-mutated FTCs demonstrated significantly different US suspicion categories compared to wild-type FTCs (Ps = 0.0054 for K-TIRADS and 0.0208 for ACR-TIRADS), with a trend toward an increasing prevalence of the high suspicion category (40.0% for both K-TIRADS and ACR-TIRADS; Ps for trend = 0.0030 for K-TIRADS and 0.0032 for ACR-TIRADS). Microlobulated margins and punctate echogenic foci were independent risk factors associated with TERT promoter mutation in FTC (odds ratio = 9.693, 95% confidence interval = 1.666-56.401, p = 0.0115 for margins; odds ratio = 8.033, 95% confidence interval = 1.424-45.309, p = 0.0182 for punctate echogenic foci). There were no significant differences in the composition and echogenicity of the TERT promoter-mutated and wild-type FTCs. TERT promoter-mutated FTCs were categorized more frequently as high suspicion by the K-TIRADS and ACR-TIRADS. Based on US findings, the independent risk factors for TERT promoter mutations in FTC are microlobulated margins and punctate echogenic foci.
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Affiliation(s)
- Myoung Kyoung Kim
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyunju Park
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Young Lyun Oh
- Department of Pathology, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Hyuk Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
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Dolidze DD, Bagatelia ZA, Lukin AY, Сovantsev SD, Shevyakova TV, Pichugina NV, Skripnichenko DM, Mulaeva KA. The possibilities of ultrasound imaging in the diagnosis of follicular neoplasia of the thyroid gland. HEAD AND NECK TUMORS (HNT) 2023; 13:81-90. [DOI: 10.17650/2222-1468-2023-13-1-81-90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
Thyroid cancer is the most common cancer of the endocrine system. The diagnosis of thyroid cancer has taken a step forward due to the introduction of fine-needle biopsy of the thyroid gland with subsequent evaluation of cytological material using the Bethesda system. One category of this classification traditionally remains a gray area of diagnosis. The detection of a follicular tumor in the cytological material (category IV according to Bethesda) does not allow one to reliably classify the neoplasia as benign or malignant and requires surgical intervention. The traditional informative and widely used method for diagnosing thyroid tumors is ultrasound. However, the sensitivity and specificity of the method varies over a wide range. This review analyzes the literature on the possibilities of ultrasound diagnostics in assessing the malignant potential of follicular tumors of the thyroid gland.
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Affiliation(s)
- D. D. Dolidze
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - Z. A. Bagatelia
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - A. Yu. Lukin
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - S. D. Сovantsev
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - T. V. Shevyakova
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - N. V. Pichugina
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | | | - K. A. Mulaeva
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
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4
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Xu D, Wang Y, Wu H, Lu W, Chang W, Yao J, Yan M, Peng C, Yang C, Wang L, Xu L. An artificial intelligence ultrasound system's ability to distinguish benign from malignant follicular-patterned lesions. Front Endocrinol (Lausanne) 2022; 13:981403. [PMID: 36387869 PMCID: PMC9660226 DOI: 10.3389/fendo.2022.981403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate the application value of a generally trained artificial intelligence (AI) automatic diagnosis system in the malignancy diagnosis of follicular-patterned thyroid lesions (FPTL), including follicular thyroid carcinoma (FTC), adenomatoid hyperplasia nodule (AHN) and follicular thyroid adenoma (FTA) and compare the diagnostic performance with radiologists of different experience levels. METHODS We retrospectively reviewed 607 patients with 699 thyroid nodules that included 168 malignant nodules by using postoperative pathology as the gold standard, and compared the diagnostic performances of three radiologists (one junior, two senior) and that of AI automatic diagnosis system in malignancy diagnosis of FPTL in terms of sensitivity, specificity and accuracy, respectively. Pairwise t-test was used to evaluate the statistically significant difference. RESULTS The accuracy of the AI system in malignancy diagnosis was 0.71, which was higher than the best radiologist in this study by a margin of 0.09 with a p-value of 2.08×10-5. Two radiologists had higher sensitivity (0.84 and 0.78) than that of the AI system (0.69) at the cost of having much lower specificity (0.35, 0.57 versus 0.71). One senior radiologist showed balanced sensitivity and specificity (0.62 and 0.54) but both were lower than that of the AI system. CONCLUSIONS The generally trained AI automatic diagnosis system can potentially assist radiologists for distinguishing FTC from other FPTL cases that share poorly distinguishable ultrasonographical features.
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Affiliation(s)
- Dong Xu
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
- Ultrasound Branch, Zhejiang Society for Mathematical Medicine, Hangzhou, China
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, China
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuan Wang
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Hao Wu
- Department of Ultrasound, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenliang Lu
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Wanru Chang
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Jincao Yao
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Meiying Yan
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Chanjuan Peng
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Chen Yang
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Liping Wang
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
- Ultrasound Branch, Zhejiang Society for Mathematical Medicine, Hangzhou, China
- *Correspondence: Liping Wang, ; Lei Xu,
| | - Lei Xu
- Ultrasound Branch, Zhejiang Society for Mathematical Medicine, Hangzhou, China
- Group of Computational Imaging and Digital Medicine, Zhejiang Qiushi Institute for Mathematical Medicine, Hangzhou, China
- Group of Intelligent Medical Devices, South and North Lake Institute for Medical Artificial Intelligence, Haiyan, China
- *Correspondence: Liping Wang, ; Lei Xu,
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A beneficial role of computer-aided diagnosis system for less experienced physicians in the diagnosis of thyroid nodule on ultrasound. Sci Rep 2021; 11:20448. [PMID: 34650185 PMCID: PMC8516898 DOI: 10.1038/s41598-021-99983-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/28/2021] [Indexed: 01/25/2023] Open
Abstract
Ultrasonography (US) is the primary diagnostic tool for thyroid nodules, while the accuracy is operator-dependent. It is widely used not only by radiologists but also by physicians with different levels of experience. The aim of this study was to investigate whether US with computer-aided diagnosis (CAD) has assisting roles to physicians in the diagnosis of thyroid nodules. 451 thyroid nodules evaluated by fine-needle aspiration cytology following surgery were included. 300 (66.5%) of them were diagnosed as malignancy. Physicians with US experience less than 1 year (inexperienced, n = 10), or more than 5 years (experienced, n = 3) reviewed the US images of thyroid nodules with or without CAD assistance. The diagnostic performance of CAD was comparable to that of the experienced group, and better than those of the inexperienced group. The AUC of the CAD for conventional PTC was higher than that for FTC and follicular variant PTC (0.925 vs. 0.499), independent of tumor size. CAD assistance significantly improved diagnostic performance in the inexperienced group, but not in the experienced groups. In conclusion, the CAD system showed good performance in the diagnosis of conventional PTC. CAD assistance improved the diagnostic performance of less experienced physicians in US, especially in diagnosis of conventional PTC.
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Li W, Song Q, Lan Y, Li J, Zhang Y, Yan L, Li Y, Zhang Y, Luo Y. The Value of Sonography in Distinguishing Follicular Thyroid Carcinoma from Adenoma. Cancer Manag Res 2021; 13:3991-4002. [PMID: 34040440 PMCID: PMC8139727 DOI: 10.2147/cmar.s307166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/22/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose Differentiation between follicular thyroid carcinomas (FTCs) and follicular thyroid adenomas (FTAs) is difficult and the sonographic features of FTC are not yet fully established. The purpose of this study is to explore the sonographic features of FTC and the value of sonography in differentiating FTCs from FTAs. Patients and Methods A total of 28 pathologically proven FTCs and 53 FTAs in 78 patients who were performed thyroid surgery were included in this retrospective study. The sonographic features of each tumor including an interrupted halo, satellite nodule(s) with or without halo ring, local irregularity of margin and cluster of grapes sign were evaluated. A mode image of FTC halo was built up in our study. The frequencies of the sonographic features were compared by chi-square test or Fisher exact test between FTCs and FTAs. The relative risk of malignancy was assessed by logistic regression analysis. Results Logistic regression analysis showed that a thick, irregular and/or interrupted halo with or without satellite nodule(s), hypoechoic or marked hypoechoic echogenicity, a predominantly solid pattern, cluster of grapes sign, micro-or macro-calcifications, rim calcifications correlated with significant increases in relative risk for FTCs (odds ratio 11.48 (1.37-96.56), 6.74 (1.05-43.30), 17.51 (1.78-172.53), 9.55 (1.44-63.46), 9.36 (1.25-70.15) and 17.45 (1.04-292.65), respectively, p<0.05). Two new sonographic features, an interrupted halo and satellite nodule(s) with or without halo ring, can only be found in FTCs. Conclusion An interrupted halo and satellite nodule(s) with or without halo ring are specific sonographic features for FTCs. Sonography could play a role in differentiating follicular thyroid carcinoma from adenoma.
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Affiliation(s)
- Wen Li
- Department of Ultrasound, Medical School of Chinese PLA, Beijing, People's Republic of China.,Department of Ultrasound, The First Medical Center Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Qing Song
- Department of Ultrasound, The First Medical Center Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yu Lan
- Department of Ultrasound, The First Medical Center Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jie Li
- Department of Pathology, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ying Zhang
- Department of Ultrasound, The First Medical Center Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yingying Li
- Department of Ultrasound, The First Medical Center Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yan Zhang
- Department of Ultrasound, The First Medical Center Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center Chinese PLA General Hospital, Beijing, People's Republic of China
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Abou-Foul AK, Muzaffar J, Diakos E, Best JE, Momtahan N, Jayaram S. Correlation Between Thyroid Fine Needle Aspiration Cytology and Postoperative Histology: A 10-Year Single-Centre Experience. Cureus 2021; 13:e14504. [PMID: 34007757 PMCID: PMC8123937 DOI: 10.7759/cureus.14504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Fine needle aspiration cytology (FNAC) forms part of the routine workup for suspicious thyroid nodules. Whilst cytological analysis is less precise than histological assessment, it is quick and easy to perform and may avoid the need for invasive and potentially risky surgery. Methods This retrospective study spanned a 10-year period comparing preoperative FNAC with postoperative histology results to establish the accuracy of diagnosis and malignancy rates within our population. These results were then compared to the published figures in the literature. Results The histological reports of 659 consecutive cases of thyroid surgery between 2006 and 2015 were retrieved from our hospital database. Among the 471 patients (71.5%) who underwent preoperative FNAC, the postoperative histology was reported as benign in 352 (74.7%) and malignant in 119 cases (25.3%). Papillary thyroid cancer (PTC) was the commonest histological diagnosis. Thy1 grade was reported in 165 (30%) cases, with 19.4% having a final histological diagnosis of malignancy. In the Thy2 group, 85.3% of patients had a benign final histological diagnosis, while 14.7% had malignancy (false-negative results). Malignancy was found in 89% of Thy4 and 100% of Thy5 group patients. Conclusions Rates of malignancy varied considerably from those in the published literature. Each centre should be able to quote a local malignancy rate during patient counselling. It is also prudent for all units performing thyroid diagnostics to investigate the factors that might lead to inaccuracies in reporting.
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Affiliation(s)
- Ahmad K Abou-Foul
- Department of Otolaryngology/Head and Neck Surgery, Royal Stoke University Hospital, Stoke-On-Trent, GBR
| | - Jameel Muzaffar
- Department of Otolaryngology/Head and Neck Surgery, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, GBR
| | - Emmanuel Diakos
- Department of Otolaryngology/Head and Neck Surgery, Walsall Manor Hospital, Walsall, GBR
| | - James E Best
- Department of Oncology, Worcestershire Acute Hospitals National Health Service (NHS) Trust, Worcester, GBR
| | - Navid Momtahan
- Department of Cellular Pathology, Royal Wolverhampton National Health Service (NHS) Trust, Wolverhampton, GBR
| | - Sharan Jayaram
- Department of Otolaryngology/Head and Neck Surgery, Lancashire Teaching Hospitals National Health Service (NHS) Foundation Trust, Preston, GBR
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Sonographic Features Differentiating Follicular Thyroid Cancer from Follicular Adenoma-A Meta-Analysis. Cancers (Basel) 2021; 13:cancers13050938. [PMID: 33668130 PMCID: PMC7956257 DOI: 10.3390/cancers13050938] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The risk of thyroid malignancy assessment may include certain ultrasound features. The analysis is lacking for the differentiation of follicular thyroid adenomas and cancers (FTAs and FTCs). Our meta-analysis aimed to identify sonographic features suggesting malignancy in the case of follicular lesions, potentially differentiating FTA and FTC. Based on twenty studies describing sonographic features of 10,215 nodules, we found that the most crucial feature associated with an increased risk of FTC were tumor protrusion (odds ratios—OR = 10.19), microcalcifications or mixed type of calcifications: 6.09, irregular margins: 5.11, marked hypoechogenicity: 4.59, and irregular shape: 3.6. Abstract Certain ultrasound features are associated with an increased risk of thyroid malignancy. However, they were studied mainly in papillary thyroid cancers (PTCs); these results cannot be simply extrapolated for the differentiation of follicular thyroid adenomas and cancers (FTAs and FTCs). The aim of our study was to perform a meta-analysis to identify sonographic features suggesting malignancy in the case of follicular lesions, potentially differentiating FTA and FTC. We searched thirteen databases from January 2006 to December 2020 to find all relevant, full-text journal articles written in English. Analyses assessed the accuracy of malignancy detection in case of follicular lesions, potentially differentiating FTA and FTC included the odds ratio (OR), sensitivity, specificity, positive and negative predictive values. A random-effects model was used to summarize collected data. Twenty studies describing sonographic features of 10,215 nodules met the inclusion criteria. The highest overall ORs to increase the risk of malignancy were calculated for tumor protrusion (OR = 10.19; 95% confidence interval: 2.62–39.71), microcalcifications or mixed type of calcifications (coexisting micro and macrocalcifications): 6.09 (3.22–11.50), irregular margins: 5.11 (2.90–8.99), marked hypoechogenicity: 4.59 (3.23–6.54), and irregular shape: 3.6 (1.19–10.92). The most crucial feature associated with an increased risk of FTC is capsule protrusion, followed by the presence of calcifications, irrespectively of their type.
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Wong KS, Angell TE, Barletta JA, Krane JF. Hürthle cell lesions of the thyroid: Progress made and challenges remaining. Cancer Cytopathol 2020; 129:347-362. [PMID: 33108684 DOI: 10.1002/cncy.22375] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/31/2022]
Abstract
Hürthle cell-predominant thyroid fine needle aspirations (FNA) are encountered frequently in routine practice, yet they are often challenging to diagnose accurately and are associated with significant interobserver variability. This is largely due to the ubiquity of Hürthle cells in thyroid pathology, ranging from nonneoplastic conditions to aggressive malignancies. Although limitations in cytomorphologic diagnoses likely will remain for the foreseeable future, our knowledge of the molecular pathogenesis of Hürthle cell neoplasia and application of molecular testing to cytologic material have increased dramatically within the past decade. This review provides context behind the challenges in diagnosis of Hürthle cell lesions and summarizes the more recent advances in diagnostic tools.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Trevor E Angell
- Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey F Krane
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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10
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Hahn SY, Shin JH, Oh YL, Park KW. Ultrasound-Guided Core Needle Biopsy Techniques for Intermediate or Low Suspicion Thyroid Nodules: Which Method is Effective for Diagnosis? Korean J Radiol 2020; 20:1454-1461. [PMID: 31544370 PMCID: PMC6757004 DOI: 10.3348/kjr.2018.0841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 06/18/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Young Lyun Oh
- Department of Pathology, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ko Woon Park
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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11
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Sharma M, Mahore S. A Comparison of the Diagnostic Efficiency of Guided Fine Needle Aspiration Cytology Versus Conventional Fine Needle Aspiration Cytology of the Thyroid. Indian J Otolaryngol Head Neck Surg 2019; 71:152-156. [PMID: 31741951 DOI: 10.1007/s12070-017-1163-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 07/17/2017] [Indexed: 11/26/2022] Open
Abstract
Fine needle aspiration cytology (FNAC) is possibly the most useful investigation for the thyroid. However, conventional FNAC (C-FNAC) is limited by a high rate of inadequate samples. Ultrasound guided FNAC (US-FNAC) has been proposed as an alternative. This study aims to estimate the measures of diagnostic accuracy of FNAC as well as to compare US-FNAC against C-FNAC. Patients who underwent FNAC at our for a period of 5 years were selected. This comprised of 237 C-FNAC cases and 173 US-FNAC cases. Out of these 410 cases, 129 cases had cyto-histological correlation. The proportion of inadequate samples, malignant cases as well as indeterminate cases were compared between US-FNAC and C-FNAC. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios for positive and negative results and odds ratio were estimated for overall FNAC as well as US-FNAC and C-FNAC patients. US-FNAC has a significantly lower proportion of inadequate samples (0.58 vs. 15.19%), as well as a lower proportion of indeterminate samples (1.7 vs. 7.6%) and a higher proportion of malignant cases (6.4 vs. 2.1%). When the inadequate samples were excluded, the results for tests of diagnostic effectiveness for overall FNAC, US-FNAC and C-FNAC respectively ranged between 66.67 and 80% for sensitivity, between 86.05 and 100% for specificity, between 45.45 and 100% for PPV and between 97.37 and 98.7% for NPV. FNAC is a useful test for differentiating malignant from benign lesions. When inadequate samples are excluded, both US-FNAC and C-FNAC are accurate diagnostic tests. However, US-FNAC is a more useful test since it results in a lower number of inadequate samples. Also, US-FNAC results in a greater yield of malignancy and a lower percentage of indeterminates, possibly due to additional information received from ultrasound examination.
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Affiliation(s)
| | - Sadhana Mahore
- 2Department of Pathology, N.K.P. Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
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12
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Słowińska-Klencka D, Wysocka-Konieczna K, Woźniak-Oseła E, Sporny S, Popowicz B, Sopiński J, Kaczka K, Kuzdak K, Pomorski L, Klencki M. Thyroid nodules with Hürthle cells: the malignancy risk in relation to the FNA outcome category. J Endocrinol Invest 2019; 42:1319-1327. [PMID: 31077094 PMCID: PMC6790181 DOI: 10.1007/s40618-019-01055-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/02/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE The aim was to find whether the presence of Hürthle cells (HC) in a smear influences the categorization of FNA results or the risk of malignancy (RoM) of particular categories of cytological diagnosis. METHODS 25,220 FNA performed in a single center in years 2005-2017 were analyzed. Almost all the examined patients were exposed to moderate iodine deficiency for most of their lives. The distribution of FNA outcome categories was compared between two groups: with or without HC (HC and non-HC). The RoM was evaluated on the basis of postoperative histopathological examination (3082 patients). RESULTS HC were found in 7.5% of diagnostic FNA. HC nodules were classified into categories II (78.2% vs. 91.9%, p < 0.0000) and VI (0.4% vs. 1.2%, p = 0.0017) less often than non-HC nodules, but more frequently to categories III (14.4% vs. 5.8%, p < 0.0000), IV (11.2% vs. 0.9%, p < 0.0000) and V (1.5% vs. 0.8%, p = 0.0013). There were no significant differences in RoM between HC and non-HC nodules. The RoM in HC and non-HC nodules of particular categories of the Bethesda system was as follows: II: 1.8% vs. 0.8%, III: 9.7% vs. 3.8% when only the last FNA was considered and 10.8% vs. 6.4% when the category III in any performed FNA was considered; IV: 12.7% vs. 10.9%; V: 41.7% vs. 58.2%; and VI: 100% vs. 96.9%. CONCLUSIONS HC nodules are classified into categories of equivocal cytological outcomes more often than nodules without HC. Nevertheless, the presence of HC in a smear does not significantly affect the RoM of FNA categories.
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Affiliation(s)
- D Słowińska-Klencka
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Pomorska Str 251, 92-213, Lodz, Poland.
| | - K Wysocka-Konieczna
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Pomorska Str 251, 92-213, Lodz, Poland
| | - E Woźniak-Oseła
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Pomorska Str 251, 92-213, Lodz, Poland
| | - S Sporny
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Pomorska Str 251, 92-213, Lodz, Poland
| | - B Popowicz
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Pomorska Str 251, 92-213, Lodz, Poland
| | - J Sopiński
- Department of Endocrinological, General and Oncological Surgery, Chair of Endocrinology, Medical University of Lodz, Pabianicka Str 62, 91-513, Lodz, Poland
| | - K Kaczka
- Department of Endocrinological, General and Oncological Surgery, Chair of Endocrinology, Medical University of Lodz, Pabianicka Str 62, 91-513, Lodz, Poland
| | - K Kuzdak
- Department of General and Oncological Surgery, Chair of Surgical Clinical Sciences, Medical University of Lodz, Pomorska Str 251, 92-213, Lodz, Poland
| | - L Pomorski
- Department of General and Oncological Surgery, Chair of Surgical Clinical Sciences, Medical University of Lodz, Pomorska Str 251, 92-213, Lodz, Poland
| | - M Klencki
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Pomorska Str 251, 92-213, Lodz, Poland
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Strain Elastography as a Valuable Diagnosis Tool in Intermediate Cytology (Bethesda III) Thyroid Nodules. Diagnostics (Basel) 2019; 9:diagnostics9030119. [PMID: 31540296 PMCID: PMC6787586 DOI: 10.3390/diagnostics9030119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 01/21/2023] Open
Abstract
Fine needle aspiration (FNA) is considered the gold standard in the diagnostic of thyroid nodules. Using the recommended BETHESDA reporting system, up to 20% of results are classified as intermediate cytology. As there is no consensus whether ultrasound evaluation, lobectomy or surgery is the best treatment option, intermediate cytology results are considered a grey zone of the FNA. The main aim of our study was to evaluate the performance of combined advanced ultrasound techniques in the process of diagnosis and evaluation of the intermediate cytology cases after FNA. We evaluated 54 consecutive cases with intermediate cytology on FNA, using conventional B-mode ultrasound (2B), and strain elastography, using a linear multifrequency 6-13 MHz linear probe (Hitachi Prerius Machine, Hitachi Inc, Japan). All nodules were classified with our Thyroid Imaging Report and Data System (TI-RADS) proposed model, considering: vertical appearance, with antero-posterior diameter bigger than the transvers diameter, the so called taller than wide shape, irregular borders, intranodular inhomogeneity, marked hypoecogenicity, micro calcifications, the presence of suspect lymph nodes, and increased stiffness as suspicious for malignancy. The classification outcomes were compared with the pathology results, considered the gold standard diagnosis. The prevalence of cancer was 28.8%, with 13/45 cases having a clear diagnostic of cancer. Six cases were diagnosed with borderline follicular neoplasia, a category with unclear evolution, also considered as malignant in the analysis of the imaging results. In total, 16/19 cancer cases had increased stiffness on elastography. The cancer prevalence increased with TI-RADS category, being 25% in TI-RADS 4b category and 92.8% in TI-RADS 5 category. The AUROC (Area Under Receiver Operating Curve) of elastography alone, in differentiation of malignant thyroid nodules was 74.9%; the combination of elastographic and conventional ultrasound characteristics generated an even better AUROC, of 84.5%. The combined conventional ultrasound and elastography identified thyroid cancer in cases with intermediate cytology with a sensitivity of 89.5% with a specificity of 50%. High risk thyroid nodules, identified by combined high risk conventional ultrasound characteristics and increased stiffness, on strain elastography, are highly predictive for malignancy, in the intermediate cytology cases.
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14
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Lee HS, Lee JW, Park JH, Kim WS, Han HS, Lee SE. Comprehensive analysis for diagnosis of preoperative non-invasive follicular thyroid neoplasm with papillary-like nuclear features. PLoS One 2019; 14:e0218046. [PMID: 31276506 PMCID: PMC6611592 DOI: 10.1371/journal.pone.0218046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/24/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The current paradigm in the treatment of patients with non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a diagnostic lobectomy rather than complete thyroidectomy and postoperative radioiodine treatment. Consequently, preoperative diagnosis of NIFTP is considered to be important. METHODS We performed the comprehensive analysis for diagnosis of preoperative 20 NIFTPs in comparison with 41 invasive encapsulated follicular papillary thyroid carcinomas (I-EFVPTCs) using the Korean Thyroid Imaging Reporting and Data System (K-TIRADS), Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), and molecular analysis for BRAF and RAS mutations. RESULTS K-TIRADS 3 was identified as the most common sonographic diagnosis in both NIFTP and I-EFVPTC. Unlike I-EFVPTC, K-TIRADS 5 was not identified in NIFTP. AUS/FLUS was the most common cytopathological diagnosis and none of the cases were classified as malignant category in both groups, although the difference in distribution was not significant between the groups. BRAF mutation was not found in NIFTP but was present in 9.8% of cases in I-EFVPTC. The frequency of RAS mutation in I-EFVPTCs was twice as high as that of NIFTP. Wild-type BRAF and RAS in NIFTP was significantly higher than I-EFVPTC. CONCLUSION The existence of overlapping features between the groups was evident, hence conclusive distinction between radiology, cytology and molecular analysis could not be achieved. Apparently, the diagnosis of NIFTP based on comprehensive analysis was not confirmable but could perceive or at least favor the diagnosis of NIFTP.
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Affiliation(s)
- Hye Seung Lee
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae-Wook Lee
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Park
- Department of Hemato-Oncology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Wan-Seop Kim
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hye Seung Han
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seung Eun Lee
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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15
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Fukuhara T, Matsuda E, Donishi R, Koyama S, Miyake N, Fujiwara K, Takeuchi H. Clinical efficacy of novel elastography using acoustic radiation force impulse (ARFI) for diagnosis of malignant thyroid nodules. Laryngoscope Investig Otolaryngol 2018; 3:319-325. [PMID: 30186965 PMCID: PMC6119802 DOI: 10.1002/lio2.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/14/2018] [Accepted: 04/02/2018] [Indexed: 12/21/2022] Open
Abstract
Objective Acoustic radiation force impulse (ARFI) imaging is a recent ultrasound elastography technique; consequently, its efficacy is not fully known. In this study, we compared ARFI imaging with conventional strain elastography (SE) and shear wave velocities (SWVs) to evaluate the utility of ARFI imaging for diagnosing thyroid nodules. Subjects and Methods In this study we examined 233 thyroid nodules (183 benign nodules and 50 malignant nodules) isolated from human patients. The nodules were evaluated with SE and ARFI imaging, and SWVs of the nodules were simultaneously measured. ARFI images were classified using a four‐point score based on grayscale intensity of the images. The sensitivity, specificity, and diagnostic accuracy were compared between SE and ARFI imaging. Finally, SWVs for each score of SE and ARFI imaging were compared. Results The new scoring system for ARFI imaging can be divided into four virtual touch imaging (VTI) scores. Nodules with a VTI score of 3 or 4 as determined by ARFI imaging were determined to be malignant. The sensitivity, specificity, and diagnostic accuracy, respectively, were 63.2%, 66.3%, and 65.6% for SE, compared with 80.0%, 86.3%, and 85.0% for ARFI imaging. The median SWVs of the nodules were 1.57 m/s, 1.73 m/s, 1.88 m/s, and 2.09 m/s for VTI scores of 1, 2, 3, and 4, respectively. The SWVs of VTI scores 3 and 4 were significantly higher than those of VTI scores 1 and 2. Conclusions The diagnostic accuracy of ARFI imaging for differentiating malignant thyroid nodules was higher than that of SE. The VTI scores of the nodules accurately reflected their SWVs. Level of Evidence 4
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Affiliation(s)
- Takahiro Fukuhara
- Department of Otolaryngology, Head and Neck Surgery Tottori University Faculty of Medicine Yonago Japan
| | - Eriko Matsuda
- Department of Otolaryngology, Head and Neck Surgery Tottori University Faculty of Medicine Yonago Japan
| | - Ryohei Donishi
- Department of Otolaryngology, Head and Neck Surgery Tottori University Faculty of Medicine Yonago Japan
| | - Satoshi Koyama
- Department of Otolaryngology, Head and Neck Surgery Tottori University Faculty of Medicine Yonago Japan
| | - Naritomo Miyake
- Department of Otolaryngology, Head and Neck Surgery Tottori University Faculty of Medicine Yonago Japan
| | - Kazunori Fujiwara
- Department of Otolaryngology, Head and Neck Surgery Tottori University Faculty of Medicine Yonago Japan
| | - Hiromi Takeuchi
- Department of Otolaryngology, Head and Neck Surgery Tottori University Faculty of Medicine Yonago Japan
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16
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Hahn SY, Shin JH, Ko EY, Bae JM, Choi JS, Park KW. Complementary Role of Elastography Using Carotid Artery Pulsation in the Ultrasonographic Assessment of Thyroid Nodules: A Prospective Study. Korean J Radiol 2018; 19:992-999. [PMID: 30174489 PMCID: PMC6082762 DOI: 10.3348/kjr.2018.19.5.992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/19/2018] [Indexed: 12/26/2022] Open
Abstract
Objective The aim of this study was to evaluate the diagnostic performance of gray-scale ultrasonography (US), Doppler scan, and elastography using carotid artery pulsation in the diagnosis of thyroid nodules and to find a complementary role of elastography. Materials and Methods A total 197 thyroid nodules with 91 malignant and 106 benign pathologic results from 187 patients (41 males and 146 females; age range, 20-83 years; mean age, 49.4 years) were included in this prospective study. The gray-scale, Doppler US images, elastography with elasticity contrast index (ECI), and stiffness color were assessed. The diagnostic performances of each dataset were assessed in order to differentiate benign from malignant thyroid nodules. Results The optimal cut-off value of the ECI was 1.71. The area under receiver operating characteristic curve (Az value) was 0.821 for gray-scale US, 0.661 for the ECI, 0.592 for stiffness color, and 0.539 for Doppler US. The Az value for a combined assessment of gray-scale US and the ECI was higher than that for the gray-scale US alone; however, there was no statistical difference between the two (p = 0.219). The median ECI values of follicular thyroid carcinoma (FTC) and follicular variant of papillary thyroid carcinoma (FVPTC) were significantly lower than those of the other malignant lesions (p = 0.005). Meanwhile, the diffuse sclerosing variant of PTC and a metastatic nodule showed the two highest median values of the ECI. Conclusion For differentiating thyroid nodules, the diagnostic performances of the combination of gray-scale US and elastography with the ECI were similar to, but not superior, to those of gray-scale US alone. FVPTC and FTC have a significantly lower ECI value than those of the other malignant lesions.
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Affiliation(s)
- Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jung Min Bae
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Ji Soo Choi
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Ko Woon Park
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
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17
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Alexander V, Rudd J, Walker D, Wong G, Lunt A, Hamakarim Z, Bell S, Balfour A, Davis J, Pitkin L, Pelser A. Thy 3F and 3a malignancy rate, a multisite regional retrospective case series. Ann R Coll Surg Engl 2018; 100:545-550. [PMID: 29968505 DOI: 10.1308/rcsann.2018.0103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction The aim of this study was to ascertain the incidence of thyroid cancer for patients categorised as Thy3, 3a or 3f across four tertiary thyroid multidisciplinary centres in the UK. Material and methods This is a retrospective case series examining patients who presented with a thyroid nodule and diagnosed as Thy3, 3a or 3f according to the Royal College of Pathologists modified British Thyroid Association and Royal College of Physicians Thy system. Results In total, 395 patients were included in this study. Of these, 136 turned out to have benign thyroid disease and 24 had micropapillary thyroid carcinomas. The overall rate of thyroid malignancy was 28.8%. For each subcategory, the rate of malignancy was Thy3 24.7.7%, Thy3a 30.4% and Thy3f 29.2. However, the incidence of thyroid malignancy varied considerably between the four centres (Thy 3f 18-54%). Discussion The diagnosis of thyroid cancer is evolving but detection for malignancy for indeterminate nodules remains below 50% for most centres around the world. In 2014, the British Thyroid Association subdivided the original Thy3 category into Thy3a and Thy3f and recommended a more conservative approach to management for Thy3a nodules. Despite this, only two centres yielded a higher conversion rate of malignancy in the new higher graded Thy3f group compared with Thy3a. Conclusion It is debateable whether the new 'Thy3' subcategories are more useful than the original. Local thyroid malignancy rates may also be more useful than national averages to inform treatment decisions.
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Affiliation(s)
- V Alexander
- William Harvey Hospital, East Kent Hospitals University NHS Trust , Willesborough, Ashford , UK
| | - J Rudd
- Medway Foundation Trust, Medway Maritime Hospital , Gillingham , UK
| | - D Walker
- Royal Surrey County Hospital , Guildford , UK
| | - G Wong
- Brighton and Sussex University Hospitals NHS Trust , Brighton , UK
| | - A Lunt
- Brighton and Sussex University Hospitals NHS Trust , Brighton , UK
| | - Z Hamakarim
- Medway Foundation Trust, Medway Maritime Hospital , Gillingham , UK
| | - S Bell
- Medway Foundation Trust, Medway Maritime Hospital , Gillingham , UK
| | - A Balfour
- William Harvey Hospital, East Kent Hospitals University NHS Trust , Willesborough, Ashford , UK
| | - J Davis
- Medway Foundation Trust, Medway Maritime Hospital , Gillingham , UK
| | - L Pitkin
- Royal Surrey County Hospital , Guildford , UK
| | - A Pelser
- Brighton and Sussex University Hospitals NHS Trust , Brighton , UK
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Valderrabano P, McIver B. Evaluation and Management of Indeterminate Thyroid Nodules: The Revolution of Risk Stratification Beyond Cytological Diagnosis. Cancer Control 2018; 24:1073274817729231. [PMID: 28975825 PMCID: PMC5937245 DOI: 10.1177/1073274817729231] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
In accordance with National Guidelines, we currently follow a linear approach to the diagnosis of thyroid nodules, with management decision based primarily on a cytological diagnosis following fine-needle aspiration biopsy. However, 25% of these biopsies render an indeterminate cytology, leaving uncertainty regarding appropriate management. Individualizing the risk of malignancy of these nodules could improve their management significantly. We summarize the current evidence on the relevance of clinical information, radiological features, cytological features, and molecular markers tests results and describe how these can be integrated to personalize the management of thyroid nodules with indeterminate cytology. Several factors can be used to stratify the risk of malignancy in thyroid nodules with indeterminate cytology. Male gender, large tumors (>4 cm), suspicious sonographic patterns, and the presence of nuclear atypia on the cytology are all associated with an increased cancer prevalence. The added value of current molecular markers in the risk stratification process needs further study because their performance seems compromised in some clinical settings and remains to be validated in others. Risk stratification is possible in thyroid nodules with indeterminate cytology using data that are often underused by current guidelines. Future guidelines should integrate these factors and personalize the recommended diagnostic and therapeutic approaches accordingly.
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Affiliation(s)
- Pablo Valderrabano
- 1 Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Bryan McIver
- 1 Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Valderrabano P, Khazai L, Thompson ZJ, Sharpe SC, Tarasova VD, Otto KJ, Hallanger-Johnson JE, Wadsworth JT, Wenig BM, Chung CH, Centeno BA, McIver B. Cancer Risk Associated with Nuclear Atypia in Cytologically Indeterminate Thyroid Nodules: A Systematic Review and Meta-Analysis. Thyroid 2018; 28:210-219. [PMID: 29160163 PMCID: PMC7869885 DOI: 10.1089/thy.2017.0419] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Indeterminate categories of thyroid cytopathology (categories B-III and B-IV of the Bethesda system) are integrated by a heterogeneous spectrum of cytological scenarios that are generally clustered for analysis and management recommendations. It has been suggested that aspirates exhibiting nuclear atypia have a higher risk of malignancy. This study aimed to assess whether cytologically indeterminate thyroid nodules with nuclear atypia have a significantly higher cancer risk than those without nuclear atypia. METHODS On June 30, 2016, PubMed and EMBASE were searched for articles in English or Spanish using a search strategy developed by an endocrinologist and a librarian. Case reports were excluded, and no date limits were used. The references of all included studies were also screened for relevant missing studies. Studies were included if the prevalences of malignancy of cytologically indeterminate thyroid nodules with histological confirmation with and without nuclear atypia were reported. Studies were excluded if they had: (i) nodules suspicious for malignancy; (ii) nodules with non-indeterminate (B-III or B-IV) cytology on repeated biopsy, if performed; (iii) nodules not consecutively evaluated; or (iv) cohorts overlapping with another larger series. Two investigators independently assessed the eligibility and risk of bias of the studies. PRISMA and MOOSE guidelines were followed. Summary data were extracted from published reports by one investigator and independently reviewed by another. Data were pooled using a random-effects model. Heterogeneity was explored using subgroup analysis and mixed-effect model meta-regression. The odds ratio for malignancy of cytologically indeterminate thyroid nodules with nuclear atypia over cytologically indeterminate thyroid nodules without nuclear atypia was calculated. RESULTS Of 2571 retrieved studies, 20 were eligible. The meta-analysis was conducted on summary data of 3532 cytologically indeterminate thyroid nodules: 1162 with and 2370 without nuclear atypia. The odds ratio for malignancy in cytologically indeterminate thyroid nodules with nuclear atypia was 3.63 [confidence interval 3.06-4.35]. There was no evidence of publication bias, and heterogeneity was insignificant (I2 < 0.01%, p = 0.40). CONCLUSIONS Nuclear atypia is a significant indicator of malignancy in cytologically indeterminate thyroid nodules and needs to be standardized and implemented into clinical practice.
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Affiliation(s)
- Pablo Valderrabano
- Department of Head and Neck—Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Laila Khazai
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Zachary J. Thompson
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Susan C. Sharpe
- Department of Biomedical Library, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Valentina D. Tarasova
- Department of Head and Neck—Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kristen J. Otto
- Department of Head and Neck—Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Julie E. Hallanger-Johnson
- Department of Head and Neck—Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - J. Trad Wadsworth
- Department of Head and Neck—Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Bruce M. Wenig
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Christine H. Chung
- Department of Head and Neck—Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Barbara A. Centeno
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Bryan McIver
- Department of Head and Neck—Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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Dietrich CF, Barr RG, Farrokh A, Dighe M, Hocke M, Jenssen C, Dong Y, Saftoiu A, Havre RF. Strain Elastography - How To Do It? Ultrasound Int Open 2017; 3:E137-E149. [PMID: 29226273 DOI: 10.1055/s-0043-119412] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 12/11/2022] Open
Abstract
Tissue stiffness assessed by palpation for diagnosing pathology has been used for thousands of years. Ultrasound elastography has been developed more recently to display similar information on tissue stiffness as an image. There are two main types of ultrasound elastography, strain and shear wave. Strain elastography is a qualitative technique and provides information on the relative stiffness between one tissue and another. Shear wave elastography is a quantitative method and provides an estimated value of the tissue stiffness that can be expressed in either the shear wave speed through the tissues in meters/second, or converted to the Young's modulus making some assumptions and expressed in kPa. Each technique has its advantages and disadvantages and they are often complimentary to each other in clinical practice. This article reviews the principles, technique, and interpretation of strain elastography in various organs. It describes how to optimize technique, while pitfalls and artifacts are also discussed.
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Affiliation(s)
| | - Richard G Barr
- Radiology, Northeastern Ohio Medical University, Rootstown, United States
| | - André Farrokh
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Manjiri Dighe
- Department of Biology, University of Washington, Radiology, Seattle, United States
| | - Michael Hocke
- HELIOS Klinikum Meiningen, Internal Medicine II, Meiningen, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Klinik für Innere Medizin, Wriezen, Germany
| | - Yi Dong
- Zhongshan Hospital, Ultrasound, Shanghai, China
| | - Adrian Saftoiu
- University of Medicine and Pharmacy of Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania
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Valderrabano P, Khazai L, Thompson ZJ, Leon ME, Otto KJ, Hallanger-Johnson JE, Wadsworth JT, Wenig BM, Chung CH, Centeno BA, McIver B. Cancer Risk Stratification of Indeterminate Thyroid Nodules: A Cytological Approach. Thyroid 2017; 27:1277-1284. [PMID: 28806881 PMCID: PMC6112164 DOI: 10.1089/thy.2017.0221] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Management recommendations for thyroid nodules rely primarily on the cytological diagnosis. However, 25% of biopsies render an indeterminate cytology for which management decision is more challenging due to heterogeneity of the specimens. This study aimed to stratify the cancer risk through subcategorization of indeterminate cytology. METHODS The indeterminate cytological specimens (Bethesda-III or IV) of 518 thyroid nodules consecutively evaluated at our academic cancer center between October 2008 and September 2015, blinded to the histological outcome, were retrospectively reviewed. Cytological specimens were subclassified into four groups: aspirates exhibiting nuclear atypia (n = 158; 31%); architectural atypia (n = 222; 43%); oncocytic features (n = 120; 23%); or other types of atypia (n = 18; 3%). The prevalence of malignancy and odds ratio for malignancy were calculated in 323 nodules with histological confirmation. RESULTS The prevalence of malignancy was 26% overall (20% in Bethesda-III and 29% in Bethesda-IV; p = 0.07), and 47%, 12%, 24%, and 25% for aspirates with nuclear atypia, architectural atypia, oncocytic features, or other types of atypia, respectively. The OR of nuclear atypia over architectural atypia was 6.4 (3.4-12.2; p < 0.001), and 2.7 over oncocytic features (1.4-5.1; p = 0.01), whereas the OR of architectural atypia over oncocytic features was 0.4 (0.2-0.9; p = 0.03). Results were similar for Bethesda-III and IV aspirates when analyzed independently. Furthermore, cytological subcategories improved cytology-histology correlation, as they were associated with distinct profiles of histological diagnoses (p < 0.001). CONCLUSIONS Cytological subcategories can effectively stratify the risk of malignancy of thyroid nodules with indeterminate cytology and improve cytology-histology correlation.
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Affiliation(s)
- Pablo Valderrabano
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Address correspondence to:Pablo Valderrabano, MDDepartment of Head and Neck-Endocrine OncologyH. Lee Moffitt Cancer Center and Research Institute12902 Magnolia DriveTampa, FL 33612
| | - Laila Khazai
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Zachary J. Thompson
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Marino E. Leon
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kristen J. Otto
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Julie E. Hallanger-Johnson
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - J. Trad Wadsworth
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Bruce M. Wenig
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Christine H. Chung
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Barbara A. Centeno
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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22
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Comparative analysis of diagnostic performance, feasibility and cost of different test-methods for thyroid nodules with indeterminate cytology. Oncotarget 2017; 8:49421-49442. [PMID: 28472764 PMCID: PMC5564779 DOI: 10.18632/oncotarget.17220] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/22/2017] [Indexed: 01/07/2023] Open
Abstract
Since it is impossible to recognize malignancy at fine needle aspiration (FNA) cytology in indeterminate thyroid nodules, surgery is recommended for all of them. However, cancer rate at final histology is <30%. Many different test-methods have been proposed to increase diagnostic accuracy in such lesions, including Galectin-3-ICC (GAL-3-ICC), BRAF mutation analysis (BRAF), Gene Expression Classifier (GEC) alone and GEC+BRAF, mutation/fusion (M/F) panel, alone, M/F panel+miRNA GEC, and M/F panel by next generation sequencing (NGS), FDG-PET/CT, MIBI-Scan and TSHR mRNA blood assay.We performed systematic reviews and meta-analyses to compare their features, feasibility, diagnostic performance and cost. GEC, GEC+BRAF, M/F panel+miRNA GEC and M/F panel by NGS were the best in ruling-out malignancy (sensitivity = 90%, 89%, 89% and 90% respectively). BRAF and M/F panel alone and by NGS were the best in ruling-in malignancy (specificity = 100%, 93% and 93%). The M/F by NGS showed the highest accuracy (92%) and BRAF the highest diagnostic odds ratio (DOR) (247). GAL-3-ICC performed well as rule-out (sensitivity = 83%) and rule-in test (specificity = 85%), with good accuracy (84%) and high DOR (27) and is one of the cheapest (113 USD) and easiest one to be performed in different clinical settings.In conclusion, the more accurate molecular-based test-methods are still expensive and restricted to few, highly specialized and centralized laboratories. GAL-3-ICC, although limited by some false negatives, represents the most suitable screening test-method to be applied on a large-scale basis in the diagnostic algorithm of indeterminate thyroid lesions.
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23
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Schneider DF, Cherney Stafford LM, Brys N, Greenberg CC, Balentine CJ, Elfenbein DM, Pitt SC. GAUGING THE EXTENT OF THYROIDECTOMY FOR INDETERMINATE THYROID NODULES: AN ONCOLOGIC PERSPECTIVE. Endocr Pract 2017; 23:442-450. [PMID: 28095042 PMCID: PMC5403583 DOI: 10.4158/ep161540.or] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Increasing emphasis is being placed on appropriateness of care and avoidance of over- and under-treatment. Indeterminate thyroid nodules (ITNs) present a particular risk for this problem because cancer found via diagnostic lobectomy (DL) often requires a completion thyroidectomy (CT). However, initial total thyroidectomy (TT) for benign ITN results in lifelong thyroid hormone replacement. We sought to measure the accuracy and factors associated with the extent of initial thyroidectomy for ITN. METHODS We queried a single institution thyroid surgery database for all adult patients undergoing an initial operation for ITN. Multivariate logistic regression identified factors associated with either oncologic under- or overtreatment at initial operation. RESULTS There were 639 patients with ITN. The median age was 52 (range, 18 to 93) years, 78.4% were female, and final pathology revealed a cancer >1 cm in 24.7%. The most common cytology was follicular neoplasm (45.1%) followed by Hürthle cell neoplasm (20.2%). CT or initial oncologic undertreatment was required in 58 patients (9.3%). Excluding those with goiters, 19.0% were treated with TT for benign final pathology. Multivariate analysis failed to identify any factor that independently predicted the need for CT. Female gender was associated with TT in benign disease (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.0 to 4.5; P = .05). Age >45 years predicted correct initial use of DL (OR, 2.6; 95% CI, 1.2 to 5.7; P = .02). Suspicious for papillary thyroid carcinoma (OR, 5.7; 95% CI, 2.1 to 15.3; P<.01) and frozen section (OR, 9.7; 95% CI, 2.5 to 38.6; P<.01) were associated with oncologically appropriate initial TT. The highest frequency of CT occurred in patients with follicular lesion of undetermined significance (11.6%). TT for benign final pathology occurred most frequently in patients with a Hürthle cell neoplasm (24.8%). CONCLUSION In patients with ITN, nearly 30% received an inappropriate extent of initial thyroidectomy from an oncologic standpoint. Tools to pre-operatively identify both benign and malignant disease can assist in the complex decision making to gauge the proper extent of initial surgery for ITN. ABBREVIATIONS ATA = American Thyroid Association AUS = atypia of undetermined significance CI = confidence interval CT = completion thyroidectomy FLUS = follicular lesion of undetermined significance ITN = indeterminate thyroid nodule OR = odds ratio PTC = papillary thyroid carcinoma TT = total thyroidectomy.
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Affiliation(s)
- David F. Schneider
- Department of Surgery and the Wisconsin Surgical Outcomes Research Program, Unversity of Wisconsin, Madison, WI
| | - Linda M. Cherney Stafford
- Department of Surgery and the Wisconsin Surgical Outcomes Research Program, Unversity of Wisconsin, Madison, WI
| | | | - Caprice C. Greenberg
- Department of Surgery and the Wisconsin Surgical Outcomes Research Program, Unversity of Wisconsin, Madison, WI
| | - Courtney J. Balentine
- Department of Surgery and the Wisconsin Surgical Outcomes Research Program, Unversity of Wisconsin, Madison, WI
| | - Dawn M. Elfenbein
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Susan C. Pitt
- Department of Surgery and the Wisconsin Surgical Outcomes Research Program, Unversity of Wisconsin, Madison, WI
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24
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Sciacchitano S, Lavra L, Ulivieri A, Magi F, Porcelli T, Amendola S, De Francesco GP, Bellotti C, Trovato MC, Salehi LB, Bartolazzi A. Combined clinical and ultrasound follow-up assists in malignancy detection in Galectin-3 negative Thy-3 thyroid nodules. Endocrine 2016; 54:139-147. [PMID: 26475496 DOI: 10.1007/s12020-015-0774-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/08/2015] [Indexed: 12/29/2022]
Abstract
The use of galectin-3 ThyroTest in the preoperative evaluation of cytologically indeterminate (Thy-3) thyroid nodules has been largely validated by retrospective and prospective multicentre studies. Here we report the results of galectin-3 ThyroTest routinely applied in the management of Thy-3 nodules in combination with clinical and ultrasonography (US) examination, in which galectin-3 positive nodules were directly referred to surgery whereas galectin-3 negative lesions were considered for clinical and US long-term follow-up. A cohort of 331 patients, bearing 340 thyroid Thy-3 nodules, was enrolled and subjected to galectin-3 expression analysis. A total of 256 galectin-3 negative nodules were directed to periodical clinical and US examination, while 84 galectin-3 positive cases were referred to surgery. Excluding 63 dropout patients plus 15 patients that were operated because of clinical reasons the remaining 176 galectin-3 negative nodules were followed with clinical and US examination for an average period of 31 months. During the follow-up, the volume of galectin-3 negative nodules was unchanged in 85 cases (48 %), reduced in 47 (27 %), and increased in 44 (25 %). Based on combined clinical features and US follow-up results, a total of 36 out of 191 galectin-3 negative nodules (19 %) were referred to surgery, with a final histological finding of 28 benign lesions, three follicular tumor of uncertain malignant potential (FT-UMP), and five malignant lesions, corresponding to a 7 % false negative rate. In the group of 84 galectin-3 positive nodules, we detected 65 thyroid cancers with a prevalence of 77 %, 12 FT-UMPs, and 7 false positive lesions, corresponding to a 4 % false positive rate. A total of 150 patients were not operated and are still under clinical and US monitoring while surgery was performed in 118 patients with a final 70 thyroid cancers diagnosed, corresponding to a 59 % prevalence of malignancy detected at surgery and to a 26 % prevalence of malignancy among the entire Thy-3 nodule population. Galectin-3 ThyroTest is an easy and cheap diagnostic procedure that integrates conventional fine-needle-aspiration cytology, reduces the number of unnecessary thyroidectomies and increases the rate of malignancy at surgery. Clinical and US follow-up of galectin-3 negative lesions allows to further reduce false negative cases.
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Affiliation(s)
- Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena n. 324, 00161, Rome, Italy.
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy.
| | - Luca Lavra
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy
| | - Alessandra Ulivieri
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy
| | - Fiorenza Magi
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy
| | - Tommaso Porcelli
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena n. 324, 00161, Rome, Italy
| | - Stefano Amendola
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena n. 324, 00161, Rome, Italy
| | - Gian Paolo De Francesco
- Department of Oncological Science, Breast Unit, St Andrea University Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy
| | - Carlo Bellotti
- Operative Unit Surgery of Thyroid and Parathyroid, Sapienza University of Rome, S. Andrea Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy
| | - Maria Concetta Trovato
- Department of Clinical and Experimental Medicine, University of Messina, Policlinico Universitario "G. Martino", via Consolare Valeria, Gazzi, 98125, Messina, Italy
| | - Leila B Salehi
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy
- Department of Biopathology and Diagnostic Imaging, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
| | - Armando Bartolazzi
- Laboratory of Surgical and Experimental Pathology, St Andrea University Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy
- Department of Oncology-Pathology, Cancer Center Karolinska Universitetssjukhuset Solna, 17176, Stockholm, Sweden
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Wiyanto J, Kartamihardja AHS, Nugrahadi T. Can Ultrasound Predict Malignancy in Patient with Thyroid Cold Nodule? World J Nucl Med 2016; 15:179-83. [PMID: 27651738 PMCID: PMC5020791 DOI: 10.4103/1450-1147.174704] [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] [Indexed: 11/06/2022] Open
Abstract
Thyroid nodule is one of the most common endocrine diseases in the world; it occurs in 4–7% of the general population. Depending on the method of discovery, 4–8% nodules are discovered using palpation, 10–41% with ultrasound (US), and 50% through autopsy where only 20% or less of cold thyroid nodules are caused by cancerous lesions. The aim of this study was to assess US as supporting modality for thyroid scintigraphy to predict malignancy in patient with thyroid cold nodules. In a retrospective study between 2009 and 2013, we analyzed 399 subjects with cold thyroid nodule, where 39 subjects (36 women and 3 men) presented with malignant thyroid cold nodule and 19 subjects underwent US. The US showed malignancy parameters in 8 (42.11%) subjects, while the rest of the 11 (57.89%) subject were benign. Out of all the subjects who underwent US in this study, only 8 (42.11%) subjects shown malignancy characteristics in cold thyroid nodule with papillary thyroid cancer (PTC). That means US parameters of malignant thyroid nodule do not always show up in malignant cold thyroid nodule.
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Affiliation(s)
- Joko Wiyanto
- Department of Nuclear Medicine and Molecular Imaging, Dr. Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Trias Nugrahadi
- Department of Nuclear Medicine and Molecular Imaging, Dr. Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
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26
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Anuradha C, Manipadam MT, Asha HS, Dukhabandhu N, Abraham D, Paul MJ. Can New Ultrasound Signs Help in Identifying Follicular Variant of Papillary Carcinoma of Thyroid? - A Pilot Study. Ultrasound Int Open 2016; 2:E47-53. [PMID: 27689170 PMCID: PMC5032849 DOI: 10.1055/s-0036-1582304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 02/19/2016] [Indexed: 10/21/2022] Open
Abstract
AIM To describe two new ultrasound signs for thyroid nodules - "nodule in nodule" and "hypoechoic internal septae" and assess their usefulness in differentiating follicular variant of papillary thyroid carcinoma (FVPTC) from benign thyroid nodules (BTN). METHODOLOGY Ultrasound findings of 210 patients with histopathologically proven FVPTC (68 nodules, M:F=13:47 with mean age of 39.5±11.9 years) and BTN (165 nodules, (M:F=41:109 with mean age of 44±11.3 years) were retrospectively reviewed from PACS by a single radiologist blinded to the final diagnosis. Logistic regression analysis was performed to identify the best predictors of FVPTC and their diagnostic performance was assessed. RESULTS The "nodule in nodule" sign was seen in 80.9% of FVPTC and only 12.1% of BTN. The "hypoechoic internal septae" sign was seen in 44.1% of FVPTC and 17% of BTN. Younger patients, heterogeneous echotexture, nodule in nodule sign, thick incomplete non-uniform halo and presence of significant nodes were the best predictors of FVPTC (p<0.05). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and relative risk for FVPTC given as odds ratio (95% CI) for heterogeneous echotexture and nodule in nodule sign which were the best 2 predictors of FVPTC were 91.2%, 81.8%, 67.3%, 95.7%, 84.5%, 46.5 (18.5-117.4) and 80.9%, 87.7%, 74.3%, 91.2%, 86.2%, 32.5 (15.04-70.2), respectively. There was improvement in the specificity (91.5%) and accuracy (86.6%) when a combined criterion of heterogeneous echotexture and nodule in nodule sign was applied to predict FVPTC. CONCLUSION The "nodule in nodule" sign is common in FVPTC and when combined with heterogeneous echotexture can differentiate FVPTC and BTN with high specificity.
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Affiliation(s)
- C. Anuradha
- Radiology, Christian Medical College, Vellore, India
| | | | - H. S. Asha
- Endocrinology, Christian Medical College, Vellore, India
| | - N. Dukhabandhu
- Endocrinology, Christian Medical College, Vellore, India
| | - D. Abraham
- Endocrine Surgery, Christian Medical College, Vellore, India
| | - M. J. Paul
- Endocrine Surgery, Christian Medical College, Vellore, India
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27
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Hong IK, Kim JH, Cho YU, Park SY, Kim SJ. Clinicopathological factors increased the risk of malignancy in thyroid nodules with atypical or follicular lesions of undetermined significance (AUS/FLUS) risk factor of malignancy in thyroid nodule with AUS/FLUS. Ann Surg Treat Res 2016; 90:201-6. [PMID: 27073790 PMCID: PMC4826982 DOI: 10.4174/astr.2016.90.4.201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/04/2015] [Accepted: 12/31/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Ultrasound-guided fine needle aspiration (US-FNA) in thyroid nodules is presently most commonly used to identify whether these nodules are benign or malignant. However, atypical or follicular lesions of undetermined significance (AUS/FLUS), as categorized in the Bethesda System for reporting the results of FNA, cannot be classified as benign or malignant. Therefore, several clinical factors should be considered to assess the risk of malignancy in patients with AUS/FLUS. The purpose of the present study was to determine which clinical factor increased the risk of malignancy in patients with AUS/FLUS. METHODS A retrospective study was done on 129 patients with fine needle aspiration categorized as AUS/FLUS from January 2011 through April 2015. Univariate and multivariate analyses were performed to assess the independent effect of risk factors such as age, sex, size of nodule, atypical descriptors, and ultrasonography criteria for malignancy. RESULTS We identified that the presence of spiculated margin (odds ratio [OR], 5.655; 95% confidence interval [CI], 2.114-15.131; P = 0.001), nuclear grooving (OR, 3.697; 95% CI, 1.409-9.701; P = 0.008), irregular nuclei (OR, 3.903; 95% CI, 1.442-10.560; P = 0.001) were shown to be significantly related to malignancy on univariate and multivariate analyses. CONCLUSION We recommend that surgical resection of thyroid nodules be considered in patients with AUS/FLUS showing the histologic findings such as nuclear grooving, irregular nuclei along with spiculated margin of ultrasonographic finding.
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Affiliation(s)
- In Ki Hong
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Jun Ho Kim
- Department of Radiology, Inha University School of Medicine, Incheon, Korea
| | - Young Up Cho
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Shin-Young Park
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Sei Joong Kim
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
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28
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Jeon EJ, Jeong YJ, Park SH, Cho CH, Shon HS, Jung ED. Ultrasonographic Characteristics of the Follicular Variant Papillary Thyroid Cancer According to the Tumor Size. J Korean Med Sci 2016; 31:397-402. [PMID: 26955240 PMCID: PMC4779864 DOI: 10.3346/jkms.2016.31.3.397] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 11/09/2015] [Indexed: 11/20/2022] Open
Abstract
Follicular variant papillary thyroid cancer (FVPTC) is the second most common subtype after conventional PTC. We compared ultrasonographic (US) features of FVPTC to those of conventional PTC according to tumor size. We reviewed US findings, pathologic reports, and medical charts of 249 PTC patients with surgically proven disease (83 FVPTCs, 166 conventional PTCs) at our institution from January 2007 to December 2012. FVPTCs were divided into PTC-like and follicular neoplasm (FN)-like based on sonographic characteristics. PTC-like features were defined as having at least one malignant feature (taller-than-wide shape, infiltrative margin, marked hypoechogenicity, and micro-calcifications), whereas FN-like cancers showed oval solid features without malignant features. FVPTCs showed a higher rate of FN-like features than conventional PTCs. Of 166 conventional PTCs, 13 (7.8%) had FN-like features and 153 (92.2%) had PTC-like features, whereas of the 83 FVPTCs, 31 (37.3%) had FN-like features and 52 (62.7%) had PTC-like features. Macro-FVPTCs showed a higher rate of FN-like features than micro-FVPTCs (P < 0.001). Of 21 macro-FVPTCs, 18 (85.7%) had FN-like features and 3 (14.3%) had PTC-like features, whereas of the 62 micro-FVPTCs, 13 (21%) had FN-like features and 49 (79%) had PTC-like features. There were no differences in multifocality, extrathyroidal invasion, and lymph node metastasis between PTC-like FVPTCs and FN-like FVPTCs. FVPTCs showed fewer sonographic malignant features than conventional PTCs. In particular, FVPTCs larger than 1 cm had a more frequent benign sonographic appearance. Therefore, if fine-needle aspiration result is suspicious for PTC in a nodule larger than 1 cm with no suspicious US features, the possibility of FVPTC might be considered.
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Affiliation(s)
- Eon Ju Jeon
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Young Ju Jeong
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sung Hwan Park
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Chang Ho Cho
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ho Sang Shon
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Eui Dal Jung
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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29
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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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Jena A, Patnayak R, Prakash J, Sachan A, Suresh V, Lakshmi AY. Malignancy in solitary thyroid nodule: A clinicoradiopathological evaluation. Indian J Endocrinol Metab 2015; 19:498-503. [PMID: 26180765 PMCID: PMC4481656 DOI: 10.4103/2230-8210.159056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Thyroid nodules are common. They can be either benign or malignant. Solitary thyroid nodules (STN) have a high likelihood of being malignant. They should be characterized properly for optimum management. MATERIALS AND METHODS In this study, we have analyzed our departmental data over a period of 5 years. All the patients who presented to the outpatient department with a clinically detected STN were included in the study group. Our approach was individualized. Preoperative ultrasonography (USG) and fine-needle aspiration cytology were planned in all these patients. Hemi thyroidectomy and total thyroidectomy with and without neck dissection were performed wherever appropriate. RESULTS There were 162 cases of clinically detected STN. USG findings were available in 146 cases. Postoperative histopathology was reported as malignant in 58 cases. Malignant STN was more likely in males. Ultrasonographically detected solid STN were more prone for malignancy as compared to multinodular goiter (P = 0.000) Presence of micro calcification and cervical lymphadenopathy were more commonly noted in malignant thyroid swellings. CONCLUSION Solitary thyroid nodules do have a high likelihood of harboring a malignancy. Solid echogenicity, micro calcification and cervical lymphadenopathy on USG were seen more frequently in malignant nodules.
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Affiliation(s)
- Amitabh Jena
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Rashmi Patnayak
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Jaya Prakash
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Alok Sachan
- Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V. Suresh
- Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Amarchala Yadagiri Lakshmi
- Department of Radiology, Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Garino F, Deandrea M, Motta M, Mormile A, Ragazzoni F, Palestini N, Freddi M, Gasparri G, Sgotto E, Pacchioni D, Limone PP. Diagnostic performance of elastography in cytologically indeterminate thyroid nodules. Endocrine 2015; 49:175-83. [PMID: 25273318 DOI: 10.1007/s12020-014-0438-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/23/2014] [Indexed: 12/11/2022]
Abstract
Cytological examination of material from fine-needle aspiration biopsy is the mainstay of diagnosis of thyroid nodules, thanks to its remarkable accuracy and scarcity of complications. However, follicular lesions (also called indeterminate lesions or Thy3 in the current classification), a heterogeneous group of lesions in which cytology is unable to give a definitive diagnosis to, represent its main limit. Elastography has been proposed as a potential diagnostic tool to define the risk of malignancy in the aforementioned nodules, but at present there is no conclusive data due to the small number of specifically addressed studies and the lack of concordance among them. The objective of our study was to evaluate the role of real-time elastography (RTE) for refining diagnosis of Thy3 nodules, by integrating diagnostic information provided by traditional ultrasound (US). The study included 108 patients with Thy3 nodules awaiting for surgery, which were evaluated by US (considering hypoecogenicity, irregular margins, microcalcifications, halo sign, and intranodular vascularization) and RTE. Nodules were classified at RTE using a four-class color scale. At histologic examination, 75 nodules were benign and 33 malignant. As expected, none of the ultrasound parameters alone was adequate in predicting malignancy or benignity of the nodules; in the presence of at least two US risk factors, we obtained 61 % sensitivity, 83 % specificity, and 77 % accuracy with 6.8 OR (95 % CI 2.4-20.4). RTE scores 3 and 4 showed 76 % sensitivity, 88 % specificity, 74 % PPV, and 89 % NPV with diagnostic accuracy of 84 %; the data are statistically significant (p < 0.0001) with a OR of 21.9 (95 % CI 7.1-76). By combining RTE with US parameters, the presence of at least 2 characters of suspicion had 88 % sensitivity and 94 % NPV with 23.8 OR (95 % CI 7-106.3). The use of combined RTE and US leads to the identification of two patients subpopulations which have a significantly different malignancy risk (6 vs. 63 %); further studies are needed to verify if it is possible to send only the first group to thyroidectomy and the other to follow-up.
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Affiliation(s)
- Francesca Garino
- Division of Endocrinology Diabetes and Metabolism, Department of Medicine, A.O. Ordine Mauriziano, Largo Turati 62, 10128, Turin, Italy,
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Remonti LR, Kramer CK, Leitão CB, Pinto LCF, Gross JL. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid 2015; 25:538-50. [PMID: 25747526 PMCID: PMC4447137 DOI: 10.1089/thy.2014.0353] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Thyroid nodules are a common finding in the general population, and their detection is increasing with the widespread use of ultrasound (US). Thyroid cancer is found in 5-15% of cases depending on sex, age, and exposure to other risk factors. Some US parameters have been associated with increased risk of malignancy. However, no characteristic seems sufficiently reliable in isolation to diagnose malignancy. The objective of this meta-analysis was to evaluate the diagnostic performance of US features for thyroid malignancy in patients with unselected thyroid nodules and nodules with indeterminate fine-needle aspiration (FNA) cytology. METHODS Electronic databases were reviewed for studies published prior to July 2012 that evaluated US features of thyroid nodules and reported postoperative histopathologic diagnosis. A manual search of references of review and key articles, and previous meta-analyses was also performed. A separate meta-analysis was performed including only nodules with indeterminate cytology. Analyzed features were solid structure, hypoechogenicity, irregular margins, absence of halo, microcalcifications, central vascularization, solitary nodule, heterogeneity, taller than wide shape, and absence of elasticity. RESULTS Fifty-two observational studies (12,786 nodules) were included. Nine studies included nodules with indeterminate cytology as a separate category, comprising 1851 nodules. In unselected nodules, all US features were significantly associated with malignancy with an odds ratio varying from 1.78 to 35.7, and microcalcifications, irregular margins, and a taller than wide shape had high specificities (Sp; 87.8%, 83.1%, 96.6%) and positive likelihood ratios (LHR; 3.26, 2.99, 8.07). Absence of elasticity was the single feature with the best diagnostic performance (sensitivity 87.9%, Sp 86.2%, and positive LHR 6.39). The presence of central vascularization was the most specific US feature in nodules with indeterminate cytology (Sp 96% and positive LHR 2.13). CONCLUSIONS US features in isolation do not provide reliable information to select nodules that should have a FNA performed. A combination of US characteristics with higher likelihood ratios and consequently with higher post-test probabilities of malignancy-microcalcifications, or a taller than wide shape, or irregular margins, or absence of elasticity-will probably identify nodules with an increased risk for malignancy. Further studies are required to standardize elastography techniques and evaluate outcomes, especially in nodules with an indeterminate cytology.
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Affiliation(s)
- Luciana Reck Remonti
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Lana Catani F. Pinto
- Department of Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jorge Luiz Gross
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Trimboli P, Crescenzi A. Thyroid core needle biopsy: taking stock of the situation. Endocrine 2015; 48:779-85. [PMID: 25129650 DOI: 10.1007/s12020-014-0382-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/01/2014] [Indexed: 01/08/2023]
Abstract
Recently, the microhistologic evaluation by core needle biopsy (CNB) has been reported as high accurate to diagnose thyroid nodules with previous indeterminate or not adequate fine-needle aspiration cytology. In addition, sparse data have been reported regarding the use of CNB in other conditions. Aim of this review was to furnish the state of the art of this topic by summarizing published data about the diagnostic performance of CNB in thyroid lesions, and provide an easy to use reference for clinical practice. Sources encompass studies published through May 2014. Original articles were investigated and following specific aspects were discussed: 1. The "large" needle biopsy in 90's; 2. Complications by and patient's comfort with thyroid CNB; 3. Advantages provided by examination of a microhistologic sample of thyroid nodule; 4. Use of CNB in thyroid nodules with previous not adequate (Thy 1/Class 1/Category I) cytology; 5. Use of CNB in thyroid neoplasms (Thy 3/Class 3/Category III-IV) cytology; 6. Use of CNB in specific ultrasonographic presentations of thyroid nodules or in patients with peculiar clinical contexts; 7. First-line approach by CNB in thyroid nodules; 8. Immunohistochemistry and molecular tests on CNB samples; and 9. Future perspective.
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Affiliation(s)
- Pierpaolo Trimboli
- Section of Endocrinology and Diabetology, Ospedale Israelitico, Via Fulda 14, 00148, Rome, Italy,
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Thyroid nodule ultrasound: technical advances and future horizons. Insights Imaging 2015; 6:173-88. [PMID: 25736837 PMCID: PMC4376820 DOI: 10.1007/s13244-015-0398-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/28/2015] [Accepted: 02/04/2015] [Indexed: 01/19/2023] Open
Abstract
UNLABELLED Thyroid nodules are extremely common and the vast majority are non-malignant; therefore the accurate discrimination of a benign lesion from malignancy is challenging. Ultrasound (US) characterisation has become the key component of many thyroid nodule guidelines and is primarily based on the detection of key features by high-resolution US. The thyroid imager should be familiar with the strengths and limitations of this modality and understand the technical factors that create and alter the imaging characteristics. Specific advances in high-resolution US are discussed with reference to individual features of thyroid cancer and benign disease. Potential roles for three-dimensional thyroid ultrasound and computer-aided diagnosis are also considered. The second section provides an overview of current evidence regarding thyroid ultrasound elastography (USE). USE is a novel imaging technique that quantifies tissue elasticity (stiffness) non-invasively and has potential utility because cancers cause tissue stiffening. In recent years, there has been much research into the value of thyroid USE for distinguishing benign and malignant nodules. Preliminary findings from multiple pilot studies and meta-analyses are promising and suggest that USE can augment the anatomical detail provided by high-resolution US. However, a definite role remains controversial and is discussed. TEACHING POINTS • High-resolution US characterises thyroid nodules by demonstration of specific anatomical features • Technical advances heavily influence the key US features of thyroid nodules • Most papillary carcinomas appear stiffer than benign thyroid nodules on US elastography (USE) • Thyroid USE is controversial because of variation in the reported accuracies for malignancy • Combined grey-scale US/USE may lower the FNAC rate in benign nodules.
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The role of elastosonography, gray-scale and colour flow Doppler sonography in prediction of malignancy in thyroid nodules. Radiol Oncol 2014; 48:348-53. [PMID: 25435847 PMCID: PMC4230554 DOI: 10.2478/raon-2014-0007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/27/2014] [Indexed: 12/03/2022] Open
Abstract
Background Ultrasound is as a noninvasive method commonly used in the work-up of thyroid nodules. This study aimed to evaluate the usefulness of sonographic and elastosonographic parameters in the discrimination of malignancy. Patients and methods. 150 thyroid nodules were evaluated by gray-scale, Doppler and elastosonography. The cytological analysis revealed that 141 nodules were benign and 9 were malignant. Results Orientation of the nodule was the only sonographic parameter associated with malignancy (p = 0.003). In the strain ratio analysis the best cut-off point was 1.935 to discriminate malignancy (p = 0.000), with 100% sensitivity, 76% specificity, 100% negative predictive value, 78.5% positive predictive value and 78% accuracy rate. There was a statistically significant correlation between the elasticity score and malignancy (p = 0.001). Most of the benign nodules had score 2 and 3, none of them displayed score 5. On the other hand, none of the malignant nodules had score 1 and 2, most of them displaying score 5. Conclusions A change in the diagnostic algorithm of the thyroid nodules should be considered integrating the elastosonographic analysis.
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Nardi F, Basolo F, Crescenzi A, Fadda G, Frasoldati A, Orlandi F, Palombini L, Papini E, Zini M, Pontecorvi A, Vitti P. Italian consensus for the classification and reporting of thyroid cytology. J Endocrinol Invest 2014; 37:593-9. [PMID: 24789536 DOI: 10.1007/s40618-014-0062-0] [Citation(s) in RCA: 279] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/07/2014] [Indexed: 02/06/2023]
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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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Ryu YJ, Jung YS, Yoon HC, Hwang MJ, Shin SH, Cho JS, Lee JS, Kim HK, Kang HC, Lim HS, Yoon JH, Park MH. Atypia of undetermined significance on thyroid fine needle aspiration: surgical outcome and risk factors for malignancy. Ann Surg Treat Res 2014; 86:109-14. [PMID: 24761418 PMCID: PMC3994624 DOI: 10.4174/astr.2014.86.3.109] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 11/20/2013] [Accepted: 12/04/2013] [Indexed: 01/21/2023] Open
Abstract
Purpose This study was performed to analyze the surgical pathology results of the "atypia of undetermined significance" (AUS) category from thyroid fine needle aspiration (FNA) and to describe the characteristics to distinguish a malignant from a benign nodule. Methods A retrospective analysis was done on 116 patients who underwent thyroid surgery from December 2008 to December 2012, following a diagnosis of AUS from preoperative thyroid FNA. We investigated the age, gender, size and site of the nodules, ultrasonographic criteria, cytological features, the number of atypia results after repeated FNAs, surgical method, and final pathologic results. Results Sixty-five out of 116 patients underwent total thyroidectomy and the rest had partial thyroidectomy. The final pathologic results were 41 malignancies (35.3%) and 75 benign diseases (64.7%). AUS was divided into group 1: 'cannot rule out malignancy' or group 2: 'cannot rule out follicular neoplasm'. After surgery, group 1 revealed papillary thyroid cancer in most cases and group 2 revealed follicular adenoma in most cases. Age over 40 years, ultrasonographic findings suggestive of malignancy, more than 2 results of atypia from repeated FNAs and nodules less than 2 centimeters were risk factors for malignancy on univariate analysis. Multivariate analysis showed that ultrasonographic findings suggestive of malignancy was a significant risk factor for malignancy. Conclusion For proper evaluation of the risk for malignancy in thyroid AUS patients, the ultrasonographic criteria should be considered along with other clinicopathological findings such as age, nodule size, number of atypia, cytologic features.
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Affiliation(s)
- Young Jae Ryu
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | | | - Hyun Chul Yoon
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Min Jung Hwang
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sun Hyoung Shin
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jin Seong Cho
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Shin Lee
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Jung Han Yoon
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Min Ho Park
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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Tutuncu Y, Berker D, Isik S, Akbaba G, Ozuguz U, Kucukler FK, Göcmen E, Yalcın Y, Aydin Y, Guler S. The frequency of malignancy and the relationship between malignancy and ultrasonographic features of thyroid nodules with indeterminate cytology. Endocrine 2014; 45:37-45. [PMID: 23504651 DOI: 10.1007/s12020-013-9922-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 03/06/2013] [Indexed: 10/27/2022]
Abstract
Various approaches are available for the management of nodules that are evaluated to be indeterminate according to the results of thyroid fine needle aspiration biopsy. The present study aimed to determine the rate of malignancy and the ultrasonographic features that could be used as predictor of malignant pathologies at the nodules with indeterminate cytology. A total of 201 patients who underwent total thyroidectomy and whose fine needle aspiration biopsy results were evaluated to be Hurthle cell lesion (n = 99), follicular neoplasm (n = 61) and [corrected] suspicious for malignancy (n = 41) were enrolled in this study. Of these patients, 178 were females (88.6 %) and 23 were males (11.4 %). The rates of malignancy were found to be 33.3 % in the Hurthle cell lesion group, 23.0 % in the follicular neoplasm group and 53.7 % in the suspicious for malignancy group (p = 0.006). The comparison of the ultrasonographic characteristics of the malignant and benign nodules revealed hypoechogenicity and microcalcification to be more common in malignant nodules (34.3 vs. 16.9 %, p = 0.005; 27.1 vs. 13.1 %, p = 0.014; respectively). While 92.3 % of the malignant nodules were ≥1 cm, 82.9 % of the benign nodules were ≥1 cm (p = 0.042). We believe that as the patients at Hurthle cell lesion group have higher risk of malignancy than the patients with Follicular Neoplasia so total thyroidectomy will be suitable for these patients. [corrected]. In addition, microcalcification and hypoechoic nodules at patients with indeterminate cytology can be related with increased risk of malignancy. [corrected].
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Affiliation(s)
- Yasemin Tutuncu
- Department of Surgery, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey,
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Giusti M, Orlandi D, Melle G, Massa B, Silvestri E, Minuto F, Turtulici G. Is there a real diagnostic impact of elastosonography and contrast-enhanced ultrasonography in the management of thyroid nodules? J Zhejiang Univ Sci B 2013; 14:195-206. [PMID: 23463762 DOI: 10.1631/jzus.b1200106] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Ultrasonography (US) and the new applications US elastography (USE) and contrast-enhanced US (CEUS) are used in the screening of thyroid nodules, for which fine-needle aspiration biopsy (FNAB) is the best single diagnostic test. The aim of the study was to compare the sensitivity, specificity, positive predictive value (PPV), and accuracy of the four examinations in nodules with cytological and histological diagnoses. The study used data from US, FNAB, USE (elasticity (ELX 2/1) index), and CEUS (Peak index and time to peak (TTP) index) evaluated in 73 thyroid nodules in 63 consecutive patients likely to undergo surgery. Cytological-histological correlation was available for 38 nodules. No correlation emerged between nodule size and cytological results. A significant (P=0.03) positive correlation between cumulative US findings and cytological results was found. In addition, significant correlations between cumulative US findings and cytology (P=0.02) and between cumulative US findings and histology (P<0.0001) were found. US showed the best specificity and PPV, and FNAB the best sensitivity. There was no significant difference in the ELX 2/1 index, Peak index, or TTP index among nodules subdivided according to cytological scores. No significant correlation was found between ELX 2/1 index, Peak index, and TTP index, on the one hand, and nodule size, US cumulative findings, cytology, and histology on the other hand. The sensitivity of the ELX 2/1 index was high, but its specificity was very low. The accuracy and PPV of USE were lower than those of the other procedures. Only the correlation between Peak index and cumulative US findings reached a value close to significance. Our ultimate aim is to minimise unnecessary thyroidectomy. US and FNAB continue to play a central diagnostic role. The use of a US score showed high specificity and PPV. The specificity of FNAB was low in this selected series because of the numbers of indeterminate cytological responses. USE and CEUS are innovative techniques that need to be standardized. The ELX 2/1 index, Peak index, and TTP index seem to be unrelated to histology. The best statistical data on USE and CEUS concerned their sensitivity and PPV, respectively. At present, USE and CEUS are too time-consuming and of limited utility in selecting patients for surgery.
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Affiliation(s)
- Massimo Giusti
- Endocrine Unit, San Martino University Hospital, Genoa, Italy; Radiology Unit, Evangelico Hospital, Genoa, Italy.
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Nasrollah N, Trimboli P, Guidobaldi L, Cicciarella Modica DD, Ventura C, Ramacciato G, Taccogna S, Romanelli F, Valabrega S, Crescenzi A. Thin core biopsy should help to discriminate thyroid nodules cytologically classified as indeterminate. A new sampling technique. Endocrine 2013; 43:659-65. [PMID: 23070753 DOI: 10.1007/s12020-012-9811-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 09/27/2012] [Indexed: 01/19/2023]
Abstract
Indeterminate neoplasms (IN) represent the gray zone of thyroid cytology in which malignant and benign tumors cannot be discriminated. Recently, the approach by thin core needle biopsy has been proposed. Here we report a new thin core needle biopsy approach in 40 consecutive patients with thyroid IN at cytology. In this study, a 21-G needle was inserted into the nodule, advanced within the lesion, and moved ahead reaching extranodular tissue. The resulting sample allowed to evaluate the cytomorphology of nodular tissue, its relationship with extranodular parenchyma, and the nodule's capsule when present. All biopsies were adequate for diagnosis but one. Of the 39 adequate samples, 5 cases were papillary cancer as confirmed at histology, while 14 nodules avoided surgery because of Hürthle cell hyperplasia in thyroiditis (n = 6) and microfollicular adenomatous hyperplasia (n = 8). The remaining 20 cases were assessed as follicular neoplasms because of encapsulation and were evaluated by immunohistochemistry. Of these, 6 had positive markers in different degree and 1/6 has follicular cancer at histology, while the other 14 were benign after surgery. Overall, this approach by thin core needle biopsy identified benignancy in 14/40 (35 %) IN avoiding surgery. As a conclusion, thin core biopsy should help to discern the nature of thyroid lesions cytologically classified as indeterminate, and it should be used as a complementary test in thyroid nodule assessment.
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Wang HL, Zhang S, Xin XJ, Zhao LH, Li CX, Mu JL, Wei XQ. Application of Real-time Ultrasound Elastography in Diagnosing Benign and Malignant Thyroid Solid Nodules. Cancer Biol Med 2013; 9:124-7. [PMID: 23691467 PMCID: PMC3643650 DOI: 10.3969/j.issn.2095-3941.2012.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 06/04/2012] [Indexed: 11/25/2022] Open
Abstract
Objective Real-time ultrasound elastography (US-E) is a helpful tool in diagnosing thyroid nodules. This study aims to evaluate thyroid solid nodules, to establish the accuracy of US-E in providing information on the nature of these nodules, and to assess the clinical value of elasticity scores (ES) and strain ratio (SR) in differentiating thyroid solid nodules and to explore its distribution characteristics using pathological analysis as reference. Methods Traditional ultrasonography and US-E were performed on 131 thyroid solid nodules (99 benign ones and 32 malignant ones) in 120 patients (78 females and 41 males). Three radiologists evaluated the nodules based on a four-degree elasticity scoring system. The nodules were classified according to the ES as soft (ES 1-2) or hard (ES 3-4). The SR was calculated online. Results The sensitivity and specificity of the ES for thyroid cancer diagnosis were 78% and 80%, respectively. SR values ≥ 2.9 used as a standard to distinguish benign from malignant nodules had a sensitivity of 87% and a specificity of 92%. The SR of the benign lesions was 1.64±1.37, which was significantly different from that of malignant lesions, which was 4.96±2.13 (P<0.01). Conclusions Both the ES and SR were higher in malignant nodules than those in benign ones. Real-time US-E was a useful index in the differential diagnosis of thyroid solid nodules. It can provide quantitative information on thyroid nodule characterization and improve diagnostic confidence.
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Affiliation(s)
- Hai-Ling Wang
- Department of Ultrasonographic Diagnosis and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
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Cantisani V, Ulisse S, Guaitoli E, De Vito C, Caruso R, Mocini R, D’Andrea V, Ascoli V, Antonaci A, Catalano C, Nardi F, Redler A, Ricci P, De Antoni E, Sorrenti S. Q-elastography in the presurgical diagnosis of thyroid nodules with indeterminate cytology. PLoS One 2012; 7:e50725. [PMID: 23209819 PMCID: PMC3510167 DOI: 10.1371/journal.pone.0050725] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 10/24/2012] [Indexed: 12/21/2022] Open
Abstract
Quantitative ultrasound (US) elastography (Q-USE), able to evaluate tissue stiffness has been indicated as a new diagnostic tool to differentiate benign from malignant thyroid lesions. Aim of this prospective study, conducted at the Department of Surgical Sciences, of the “Sapienza” University of Rome, was to evaluate the diagnostic accuracy of Q-USE, compared with US parameters, in thyroid nodules with indeterminate cytology (Thy3).The case study included 140 nodules from 140 consecutive patients. Patient’s thyroid nodules were evaluated by Q-USE, measuring the strain ratio (SR) of stiffness between nodular and surrounding normal thyroid tissue, and conventional US parameters prior fine-needle aspiration cytology. Those with Thy3 diagnosis were included in the study. Forty of the nodules analyzed harbored a malignant lesion. Q-USE demonstrated that malignant nodules have a significant higher stiffness with respect to benign one and an optimun SR cut-off value of 2.05 was individuated following ROC analysis. Univariate analysis showed that hypoechogenicity, irregular margins and SR >2.05 associated with malignancy, with an accuracy of 67.2%, 81,0% and 89.8%, respectively. Data were unaffected by nodule size or thyroiditis. These findings were confirmed in multivariate analysis demonstrating a significant association of the SR and the irregular margins with thyroid nodule’s malignancy. In conclusion, we demonstrated the diagnostic utility of Q-USE in the differential diagnosis of thyroid nodules with indeterminate cytology that, if confirmed, could be of major clinical utility in patients’ presurgical selection.
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Affiliation(s)
- Vito Cantisani
- Department of Radiology, Oncology and Antomy Pathology, “Sapienza” University of Rome, Rome, Italy
| | - Salvatore Ulisse
- Department of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Eleonora Guaitoli
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy
| | - Riccardo Caruso
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Renzo Mocini
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Vito D’Andrea
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Valeria Ascoli
- Department of Radiology, Oncology and Antomy Pathology, “Sapienza” University of Rome, Rome, Italy
| | - Alfredo Antonaci
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiology, Oncology and Antomy Pathology, “Sapienza” University of Rome, Rome, Italy
| | - Francesco Nardi
- Department of Radiology, Oncology and Antomy Pathology, “Sapienza” University of Rome, Rome, Italy
| | - Adriano Redler
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Paolo Ricci
- Department of Radiology, Oncology and Antomy Pathology, “Sapienza” University of Rome, Rome, Italy
| | - Enrico De Antoni
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
- * E-mail:
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Virtual touch tissue quantification of acoustic radiation force impulse: a new ultrasound elastic imaging in the diagnosis of thyroid nodules. PLoS One 2012; 7:e49094. [PMID: 23152855 PMCID: PMC3496737 DOI: 10.1371/journal.pone.0049094] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 10/03/2012] [Indexed: 12/21/2022] Open
Abstract
Objective Virtual touch tissue quantification (VTQ) of acoustic radiation force impulse (ARFI) is a new quantitative technique to measure tissue stiffness. The study was aimed to assess the usefulness of VTQ in the diagnosis of thyroid nodules. Methods 173 pathologically proven thyroid nodules in 142 patients were included and all were examined by conventional ultrasound (US), conventional elasticity imaging (EI) and VTQ of ARFI. The tissue stiffness for VTQ was expressed as shear wave velocity (SWV) (m/s). Receiver-operating characteristic curve (ROC) analyses were performed to assess the diagnostic performance. Intra- and inter-observer reproducibility of VTQ measurement was assessed. Results The SWVs of benign and malignant thyroid nodules were 2.34±1.17 m/s (range: 0.61–9.00 m/s) and 4.82±2.53 m/s (range: 2.32–9.00 m/s) respectively (P<0.001). The mean SWV ratios between each nodule and the adjacent thyroid tissue were 1.19±0.67 (range: 0.31–6.87) for benign and 2.50±1.54 (range: 0.85–6.69) for malignant nodules (P<0.001). ROC analyses indicated that the area under the curve was 0.861 (95% CI : 0.804, 0.918) (P<0.001) for SWV and 0.831(95% CI : 0.761, 0.900)(P<0.001) for the SWV ratio. The cutoff points for the differential diagnosis were 2.87 m/s for SWV and 1.59 for SWV ratio. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for EI were 65.9%, 66.7%, 66.5%, 40.3%, and 85.1%, respectively, and were 63.6%–75%, 82.2%–88.4%, 80.3%–82.1%, 58.9%–65.1%, and 87.7%–90.5%, respectively, for VTQ. The diagnostic value of VTQ is the highest for nodules >20 mm and lowest for those ≤10 mm. The correlation coefficients were 0.904 for intraobserver measurement and 0.864 for interobserver measurement. Conclusions VTQ of ARFI provides quantitative and reproducible information about the tissue stiffness, which is useful for the differentiation between benign and malignant thyroid nodules. The diagnostic performance of VTQ is higher than that of conventional EI.
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Maia FFR, Zantut-Wittmann DE. Thyroid nodule management: clinical, ultrasound and cytopathological parameters for predicting malignancy. Clinics (Sao Paulo) 2012; 67:945-54. [PMID: 22948464 PMCID: PMC3416902 DOI: 10.6061/clinics/2012(08)15] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 03/19/2012] [Indexed: 01/21/2023] Open
Abstract
Although fine-needle aspiration cytology is considered to be the reference method for evaluating thyroid nodules, the results are inaccurate in approximately 10-30% of cases. Several studies have attempted to predict the risk of malignancy in thyroid nodules based on age, nodularity, thyrotropin values, thyroid autoimmune disease, hot/cold nodule status, and ultrasound parameters. However, no consensus has been found, and none of these parameters has significantly affected patient management. The management of indeterminate thyroid nodules and re-biopsies of nodules with initially benign cytological results remain important and controversial topics of discussion. The Bethesda cytological system and several studies on the use of molecular markers to predict malignancy from cytological samples of thyroid nodules need further clarification. More in-depth discussions among and continuous education of the specialists involved in treating thyroid disease are necessary to improve the management of these patients. This review aims to examine the clinical, laboratory, ultrasound, and scintigraphic parameters that can be used for thyroid nodule management.
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Affiliation(s)
- Frederico F R Maia
- Endocrinology Division, Department of Internal Medicine, University of Campinas, São Paulo, SP, Brazil
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Chiu CG, Yao R, Chan SK, Strugnell SS, Bugis S, Irvine R, Anderson D, Walker B, Jones SJ, Wiseman SM. Hemithyroidectomy is the preferred initial operative approach for an indeterminate fine needle aspiration biopsy diagnosis. Can J Surg 2012; 55:191-8. [PMID: 22630062 DOI: 10.1503/cjs.034510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Fine needle aspiration biopsy represents the critical initial diagnostic test used for evaluation of thyroid nodules. Our objectives were to determine the cytological distribution, the utility of clinicopathologic characteristics for predicting malignancy and the true proportion of cancer among individuals who presented with indeterminate cytology and had undergone thyroid surgery for suspicion of cancer. METHODS We retrospectively reviewed 1040 consecutive primary thyroid operations carried out over an 8-year period at a tertiary care endocrine referral centre. Follicular neoplasm (FN), Hürthle cell neoplasm (HN), neoplasms suspicious for but not diagnostic of papillary carcinoma (IP) and neoplasms with cellular atypia (IA) were reviewed. RESULTS In all, 380 individuals presented with cytologically indeterminate thyroid nodules. Of these, 252 (66%) patients had FN, 47 (12%) HN, 44 (12%) IP, 26 (7%) IA and 11 (4%) had mixed diagnoses. Biopsied lesions were found to be malignant on pathological evaluation in 102 (27%) patients: 49 (19%) with FN, 11 (23%) HN, 28 (64%) IP and 9 (35%) with IA. Hemithyroidectomy was adequate definitive treatment in 196 of 225 (87%) patients with FN and 39 of 42 (93%) with HN. Significant associations with a cancer diagnosis were identified for smaller tumour size in patients with FN (p = 0.004) and right thyroid lobe location in patients with IP (p = 0.012), although these factors were nonsignificant in the corrected analyses for multiple comparisons. CONCLUSION In a review of the experience at a Canadian centre, 4 operations were carried out to identify each cancer, and hemithyroidectomy was the optimal initial and definitive surgical approach for most patients.
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Affiliation(s)
- Connie G Chiu
- St. Paul's Hospital, Department of Surgery, University of British Columbia, Vancouver, BC
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Romei C, Elisei R. RET/PTC Translocations and Clinico-Pathological Features in Human Papillary Thyroid Carcinoma. Front Endocrinol (Lausanne) 2012; 3:54. [PMID: 22654872 PMCID: PMC3356050 DOI: 10.3389/fendo.2012.00054] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 03/26/2012] [Indexed: 12/27/2022] Open
Abstract
Thyroid carcinoma is the most frequent endocrine cancer accounting for 5-10% of thyroid nodules. Papillary histotype (PTC) is the most prevalent form accounting for 80% of all thyroid carcinoma. Although much is known about its epidemiology, pathogenesis, clinical, and biological behavior, the only documented risk factor for PTC is the ionizing radiation exposure. Rearrangements of the Rearranged during Transfection (RET) proto-oncogene are found in PTC and have been shown to play a pathogenic role. The first RET rearrangement, named RET/PTC, was discovered in 1987. This rearrangement constitutively activates the transcription of the RET tyrosine-kinase domain in follicular cell, thus triggering the signaling along the MAPK pathway and an uncontrolled proliferation. Up to now, 13 different types of RET/PTC rearrangements have been reported but the two most common are RET/PTC1 and RET/PTC3. Ionizing radiations are responsible for the generation of RET/PTC rearrangements, as supported by in vitro studies and by the evidence that RET/PTC, and particularly RET/PTC3, are highly prevalent in radiation induced PTC. However, many thyroid tumors without any history of radiation exposure harbor similar RET rearrangements. The overall prevalence of RET/PTC rearrangements varies from 20 to 70% of PTCs and they are more frequent in childhood than in adulthood thyroid cancer. Controversial data have been reported on the relationship between RET/PTC rearrangements and the PTC prognosis. RET/PTC3 is usually associated with a more aggressive phenotype and in particular with a greater tumor size, the solid variant, and a more advanced stage at diagnosis which are all poor prognostic factors. In contrast, RET/PTC1 rearrangement does not correlate with any clinical-pathological characteristics of PTC. Moreover, the RET protein and mRNA expression level did not show any correlation with the outcome of patients with PTC and no correlation between RET/PTC rearrangements and the expression level of the thyroid differentiation genes was observed. Recently, a diagnostic role of RET/PTC rearrangements has been proposed. It can be searched for in the mRNA extracted from cytological sample especially in case with indeterminate cytology. However, both the fact that it can be present in a not negligible percentage of benign cases and the technical challenge in extracting mRNA from cytological material makes this procedure not applicable at routine level, at least for the moment.
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Affiliation(s)
- Cristina Romei
- Department of Endocrinology and Metabolism, WHO Collaborating Center for the Study and Treatment of Thyroid Diseases and Other Endocrine and Metabolic DisordersUniversity of Pisa, Pisa, Italy
| | - Rossella Elisei
- Department of Endocrinology and Metabolism, WHO Collaborating Center for the Study and Treatment of Thyroid Diseases and Other Endocrine and Metabolic DisordersUniversity of Pisa, Pisa, Italy
- *Correspondence: Rossella Elisei, Department of Endocrinology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy. e-mail:
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Lee MJ, Hong SW, Chung WY, Kwak JY, Kim MJ, Kim EK. Cytological results of ultrasound-guided fine-needle aspiration cytology for thyroid nodules: emphasis on correlation with sonographic findings. Yonsei Med J 2011; 52:838-44. [PMID: 21786450 PMCID: PMC3159940 DOI: 10.3349/ymj.2011.52.5.838] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To compare the cytological results of ultrasound-guided fine-needle aspiration (US-FNA) cytology of thyroid nodules to sonographic findings and determine whether US findings are helpful in the interpretation of cytological results. MATERIALS AND METHODS Among the thyroid nodules that underwent US-FNA cytology, we included the 819 nodules which had a conclusive diagnosis. Final diagnosis was based on pathology from surgery, repeated FNA cytology or follow-up of more than one year. Cytological results were divided into five groups: benign, indeterminate (follicular or Hurthle cell neoplasm), suspicious for malignancy, malignant, and inadequate. US findings were categorized as benign or suspicious. Cytological results and US categories were analyzed. RESULTS Final diagnosis was concluded upon in 819 nodules based on pathology (n=311), repeated FNA cytology (n=204) and follow-up (n=304), of which 634 were benign and 185 were malignant. There were 560 benign nodules, 141 malignant nodules, 49 nodules with inadequate results, 21 with indeterminate results, and 48 that were suspicious for malignancy. The positive and negative predictive values of the US categories were 59.1% and 97.0%, and those of the cytological results were 93.7% and 98.9%. The US categories were significantly correlated with final diagnosis in the benign (p=0.014) and suspicious for malignancy (p<0.001) cytological result groups, but not in the inadequate and indeterminate cytological results groups. The false positive and negative rates of cytological results were 1.9% and 3.2%. CONCLUSION Sonographic findings can be useful when used alongside cytological results, especially in nodules with cytological results that are benign or suspicious for malignancy.
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Affiliation(s)
- Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Won Hong
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Woung Youn Chung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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50
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Gheri RG, Romoli E, Vezzosi V, Ragghianti B, Bianchi S, Pedercini S, Dainelli F, Panconesi R. Follicular nodules (THY3) of the thyroid: we recommend surgery. J Endocrinol Invest 2011; 34:e183-7. [PMID: 21169729 DOI: 10.3275/7416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To determine the need of total thyrodectomy for patients with follicular nodules of thyroid. SUBJECTS AND METHODS From January 2005 through June 2008, 2249 consecutive patients (438 males, 1811 females; mean age 54 yr, range 9-87) with thyroid nodules were submitted to 2518 ultrasound-guided fine-needle aspiration (USgFNA) for cytological examination. USgFNA were performed by experienced surgeon (RP) and endocrinologist (RGG) under ultra- sonographyc guidance, using a 10-MHz linear transducer. Liquid-based cytology was used. RESULTS All cytological samples were classified in 5 diagnostic classes (THY1, THY2, THY3, THY4, THY5) in agreement with the British Thyroid Association (BTA); 1.4% specimen were classified as THY5, 2.1% as THY4, 7.6% as THY3, 79.5% as THY2 and 9.4% as THY1. In 97% of THY5 patients, malignancy was found. Among THY4 patients, 95.5% were positive for thyroid tumor. Among THY3 patients, malignancy was found in 29.1%. THY3 patients with thyroid tumors were younger than those with benign lesions (46 ± 14.1 yr vs 50 ± 13.8 yr; p<0.05, t test). No statistical difference was found neither in malignancy frequency among men and women nor in mean size of nodules (24 ± 11.8 mm malignant vs 23 ± 9.4 mm benign). CONCLUSIONS this study provides evidence that USgFNA offers a very sensitive and accurate method in reducing THY1 samples and in detecting malignancy (>95% both in THY5 and THY4, and >29% in THY3 lesions). Our proposal is to submit to total thyroidectomy all patients with THY5 and THY4 lesions and THY3 thyroid nodule >1 cm.
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Affiliation(s)
- R G Gheri
- Endocrine Unit, Medical Department, San Giuseppe Hospital, AUSL11 Tuscany Region - National Health Service, Empoli (Florence), Italy.
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