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Maia A, Carvalho B, Vale J, Curado M, Ryan C, Polónia A, Eloy C. One nodule-one punction-one slide: Optimizing thyroid fine-needle aspiration for a digital workflow. Cytopathology 2023. [PMID: 37983929 DOI: 10.1111/cyt.13338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Interventional pathologists have expanded their expertise by acquiring proficiency in ultrasound-guided thyroid fine-needle aspiration biopsy (FNAB) and are now required to optimize punction procedures due to low resources and digital workflows. The aim of this study is to compare FNAB sample adequacy in two series with one versus two slides available for cytopathological analysis and its influence on diagnosis categorization, time taken to reach a final diagnosis, scanning time and size of the digital files produced. METHODS Patients were retrospectively selected based on the sampling of thyroid nodules using either two glass slides (two-slide group) or one slide only (one-slide group) and cytological diagnosis was performed using the second edition of the Bethesda system. For each group, the initial 15 cases were sorted to be scanned. RESULTS From a total of 713 procedures, 328 were sampled into two slides and 385 on one slide only. No significant differences were found regarding nodule size, location or EU-TIRADS classification between the two groups. The one-slide group did not exhibit a higher prevalence of non-diagnostic or atypia of undetermined significance (AUS) categories. As expected, the mean time taken to finalize diagnoses in cases where only one slide was prepared was 1.2 days faster. Scanning time and total file size were also significantly smaller in the one-slide group. CONCLUSIONS Adopting the 'one nodule-one puncture-one slide' strategy for thyroid FNAB optimization enhances procedural efficiency in digital workflows, leading to cost savings without compromising diagnostic accuracy.
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Affiliation(s)
- Ariana Maia
- Endocrinology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Bárbara Carvalho
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (IPATIMUP), Porto, Portugal
| | - João Vale
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (IPATIMUP), Porto, Portugal
- Department of Pathological, Cytological and Tanathological Anatomy, School of Health of Polytechnic Institute of Porto (ESS | P.PORTO), Porto, Portugal
| | - Mónica Curado
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (IPATIMUP), Porto, Portugal
- Department of Pathological, Cytological and Tanathological Anatomy, School of Health of Polytechnic Institute of Porto (ESS | P.PORTO), Porto, Portugal
| | - Carmel Ryan
- Pathology Department, St Marks Hospital, Harrow, United Kingdom
| | - António Polónia
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (IPATIMUP), Porto, Portugal
- Glycobiology in cancer, i3S-Instituto de Investigação e Inovação em Saúde, Porto, Portugal
- Departamento de sistemas biofuncionais do corpo humano da Escola de Medicina e Ciências Biomédicas, Instituto de Investigação, Inovação e Desenvolvimento, Fundação Fernando Pessoa (FP-I3ID), Porto, Portugal
| | - Catarina Eloy
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (IPATIMUP), Porto, Portugal
- Pathology Department, Medical Faculty of University of Porto, Porto, Portugal
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Hosseini SM, Stewart JM. Cytopathology assistance for optimizing interventional diagnostic procedures. Semin Diagn Pathol 2022; 39:389-393. [DOI: 10.1053/j.semdp.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/18/2022] [Accepted: 06/09/2022] [Indexed: 11/11/2022]
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Liu W, Wang S, Xia X, Guo M. A Proposed Heterogeneous Ensemble Algorithm Model for Predicting Central Lymph Node Metastasis in Papillary Thyroid Cancer. Int J Gen Med 2022; 15:4717-4732. [PMID: 35571287 PMCID: PMC9091701 DOI: 10.2147/ijgm.s365725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To develop a heterogeneous ensemble algorithm model to precisely predict central lymph node metastasis (CLNM), which can provide a reference value on controversial topics of performing prophylactic central lymph node dissection for patients with papillary thyroid cancer (PTC). Methods The study included patients with PTC who underwent an initial thyroid resection in a single-center medical institution between January 2014 and December 2018. A total of 18 variables, including clinical features and ultrasound (US) features, were used in the univariate analysis, multivariate analysis, and feature selection and were also used to develop a heterogeneous ensemble model based on five basic machine learning models, including extreme gradient boosting, k-nearest neighbors, random forest, gradient boosting, and AdaBoost. Moreover, a partial dependent plot was used to explain the heterogeneous ensemble model. Results The area under the receiver operating characteristic curve of the heterogeneous ensemble algorithm model was 0.67, which is significantly better than that of the basic machine models in predicting CLNM. All machine learning models performed better than US. Based on multivariate analysis and receiver operating characteristic curve analysis, age ≤33 years, tumor size ≥0.8 cm, US-suspected CLNM, and microcalcification were risk factors for CLNM, and anti-thyroid peroxidase antibody and serum thyroglobulin levels were favorable factors for CLNM. Conclusion The proposed heterogeneous ensemble algorithm model may be optimal tool to predict CLNM by integrating clinical and US features.
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Affiliation(s)
- Wenfei Liu
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Shoufei Wang
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Xiaotian Xia
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
- Correspondence: Xiaotian Xia; Minggao Guo, Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600 Yishan Road, Shanghai, People’s Republic of China, Tel +8618930172917; +8618930172912, Email ;
| | - Minggao Guo
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
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Abstract
Thyroid nodules are extremely prevalent among older adults, and pose a challenge due to the frequency in which they are incidentally encountered. Approximately 5% of all nodules are malignant. Ultrasound is the first line tool to evaluate thyroid nodules, and can help identify nodules that are high-risk for malignancy. Fine needle aspiration (FNA) is an excellent low-risk procedure used to evaluate suspicious thyroid nodules and identify thyroid malignancy. It is performed with a 22-27-gauge needle under ultrasound guidance. Core needle biopsy (CNB) is usually not required; however, it can be helpful if FNA is non-diagnostic or inconclusive. On-site pathologist evaluation can help determine which patients need additional sampling. CNB is usually performed with a trocar technique using an 18-gauge biopsy device under ultrasound guidance. Complications from thyroid biopsy are rare, and the most common complications are discomfort, small to moderate hematoma, and insufficient sampling. Although rare, a rapidly expanding large hematoma can cause airway compression requiring intubation and surgery to preserve the airway and achieve hemostasis. Following biopsy, approximately 10.8% of thyroid nodules will require surgical excision.
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Affiliation(s)
- Tyler Smith
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology, University of Utah School of Medicine, Salt Lake City, UT.
| | - Claire S Kaufman
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology, University of Utah School of Medicine, Salt Lake City, UT.
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Song Q, Tian X, Jiao Z, Yan L, Lan Y, Zhu Y, Luo Y. Value of Conventional Ultrasonography with Contrast-Enhanced Ultrasonography in the Differential Diagnosis of Partial Cystic Thyroid Nodules. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2494-2501. [PMID: 34119357 DOI: 10.1016/j.ultrasmedbio.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
The value of contrast-enhanced ultrasonography (CEUS) in the diagnosis of malignant partial cystic thyroid nodules (PCTNs) remains unclear. Thus, in the present study, the data of patients with pathologically proven PCTNs who underwent CEUS in the Chinese PLA General Hospital from January 2016 to February 2019 were retrospectively reviewed, and the imaging characteristics of benign and malignant PCTNs were compared. A total of 177 PCTNs were enrolled in this study, including 58 (32.7%) malignant nodules and 119 (67.2%) benign nodules. Six characteristics significantly differed between malignant PCTNs and benign PCTNs in univariate comparison: position of the solid portion (χ2 = 17.937, p < 0.001), microcalcifications (χ2 = 81.382, p < 0.001), boundaries (χ2 = 45.486, p < 0.001), echogenicity (χ2 = 11.152, p = 0.004), intensity of enhancement (χ2 = 40.656, p < 0.001) and uniformity of enhancement (χ2 = 19.933, p < 0.001). Among these, microcalcifications, boundaries, position of the solid portion, and uniformity of enhancement were independent risk factors in the multivariate comparison. A logistic regression model for predicting benign and malignant PCTNs was established with a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 89.0% (95% confidence interval [CI]: 0.788-0.961), 91.0% (95% CI: 0.830-0.946), 81.0% (95% CI: 0.715-0.881), 95.0% (95% CI: 0.892-0.974) and 90.0% (95% CI: 0.844-0.938), respectively. The area under the receiver operating characteristic curve was 0.967 (95% CI: 0.944-0.990), which was significantly higher than that of conventional ultrasound only (0.747, 95% CI: 0.663-0.831, Z = 2.090, p = 0.0366). CEUS can be used in the diagnosis of PCTNs, and the four characteristics of malignant PCTNs proven by our study were microcalcifications, unclear boundaries, eccentric distributions of the solid parts and heterogeneous enhancement.
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Affiliation(s)
- Qing Song
- Department of Ultrasound, First Medical Center, General Hospital of Chinese PLA, Haidian District, Beijing, China; Department of Ultrasound, Seventh Medical Center, General Hospital of Chinese PLA, Dongcheng District, Beijing, China
| | - Xiaoqi Tian
- Department of Ultrasound, First Medical Center, General Hospital of Chinese PLA, Haidian District, Beijing, China
| | - Ziyu Jiao
- Department of Ultrasound, First Medical Center, General Hospital of Chinese PLA, Haidian District, Beijing, China
| | - Lin Yan
- Department of Ultrasound, First Medical Center, General Hospital of Chinese PLA, Haidian District, Beijing, China
| | - Yu Lan
- Department of Ultrasound, First Medical Center, General Hospital of Chinese PLA, Haidian District, Beijing, China
| | - Yaqiong Zhu
- Department of Ultrasound, First Medical Center, General Hospital of Chinese PLA, Haidian District, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, General Hospital of Chinese PLA, Haidian District, Beijing, China.
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Shi LH, Zhou L, Lei YJ, Xia L, Xie L. Needle tract seeding of papillary thyroid carcinoma after fine-needle capillary biopsy: A case report. World J Clin Cases 2021; 9:3662-3667. [PMID: 34046467 PMCID: PMC8130087 DOI: 10.12998/wjcc.v9.i15.3662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/06/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fine-needle biopsy is an accurate and cost-efficient tool for the assessment of thyroid nodules. It includes two primary methods: Fine-needle capillary biopsy (FNCB) and fine-needle aspiration biopsy. Needle tract seeding (NTS) is a rare complication of thyroid fine-needle biopsy mainly caused by fine-needle aspiration biopsy rather than FNCB. Here, we present an extremely rare case of a papillary thyroid carcinoma (PTC) patient with FNCB-derived NTS.
CASE SUMMARY We report a 32-year-old woman with PTC who showed subcutaneous NTS 1 year after FNCB and thyroidectomy. NTS was diagnosed based on clinical manifestations, biochemistry indices, and imaging (computed tomography and ultrasound). Pathological identification of PTC metastases consistent with the puncture path is the gold standard for diagnosis. Surgical resection was the main method used to treat the disease. After surgery, thyroid function tests and ultrasound scans were performed every 3-6 mo. To date, no evidence of tumor recurrence has been observed.
CONCLUSION FNCB is a safe procedure as NTS is rare, and can be easily removed surgically with no recurrence. Accordingly, NTS should not limit the usefulness of FNCB.
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Affiliation(s)
- Liu-Hong Shi
- Department of Head and Neck Surgery, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Liang Zhou
- Department of Head and Neck Surgery, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Yin-Jiao Lei
- Department of Pathology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Lian Xia
- Department of Nursing, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Lei Xie
- Department of Head and Neck Surgery, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
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Kuzan TY, Güzelbey B, Turan Güzel N, Kuzan BN, Çakır MS, Canbey C. Analysis of intra-observer and inter-observer variability of pathologists for non-benign thyroid fine needle aspiration cytology according to Bethesda system categories. Diagn Cytopathol 2021; 49:850-855. [PMID: 33904631 DOI: 10.1002/dc.24756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 12/16/2022]
Abstract
AIM To examine the intra- and inter-observer variability for non-benign thyroid cytological subcategories according to the Bethesda classification system after the second review. METHODS Between November 2018 and May 2019, thyroid fine needle aspiration biopsies of 381 nodules were retrospectively evaluated. Among them, 74 non-benign (category III-VI) thyroid biopsies, analyzed according to the Bethesda system (pathologist 1:40 vs pathologist 2:34) by two independent pathologists, were reassessed by the same pathologists and by a cytopathologist. In this observer-blinded study, weighted Cohen's kappa was used to assess the intra-observer agreement, and Krippendorff's alpha was used to assess the inter-observer agreement. RESULTS At the first and second evaluations of pathologists 1 and 2, the percentage agreement was 62.5% for pathologist 1 and 58.8% for pathologist 2. The intra-observer agreement was substantial (κ = 0.705) for pathologist 1, and moderate (κ = 0.447) for pathologist 2. In the second evaluation of pathologist 1 and 2, which was compared with the cytopathologist, the agreement percentage of pathologist 1 with the cytopathologist was 50.0%, and that of pathologist 2 was 56.8%. The inter-observer agreement was below the lowest acceptable limit for an overall agreement (α = 0.634) among the three raters. The inter-observer agreement was only acceptable between the cytopathologist and the second pathologist, while it was low between the other raters. In the evaluation of the non-benign nodules, the mean category score of the cytopathologist was 3.22 and lower than both pathologists (3.73 and 3.58, respectively). CONCLUSIONS The intra-observer agreement of pathologists was moderate-to-substantial in the evaluation of non-benign thyroid biopsies according to the Bethesda reporting system. However, the inter-observer agreement was below the lowest acceptable limit when the cytopathologist was taken as a reference.
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Affiliation(s)
- Taha Yusuf Kuzan
- Department of Radiology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Burcu Güzelbey
- Department of Pathology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Nalan Turan Güzel
- Department of Pathology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Beyza Nur Kuzan
- Department of Radiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Mehmet Semih Çakır
- Department of Radiology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ceren Canbey
- Department of Pathology, Istanbul Training and Research Hospital, Istanbul, Turkey
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Todsen T, Bennedbaek FN, Kiss K, Hegedüs L. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Head Neck 2020; 43:1009-1013. [PMID: 33368812 DOI: 10.1002/hed.26598] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 01/21/2023] Open
Abstract
Fine needle aspiration biopsy (FNAB) remains crucial in the evaluation of thyroid nodules with suspicious clinical findings or ultrasound (US) features suggestive of malignancy. The use of US-guidance for FNAB allows real-time visualization of the needle, but is also highly operator-dependent. Physicians from many specialties (endocrinologists, otolaryngologists/endocrine surgeons, nuclear medicine physicians, radiologists, and pathologists) are involved in the diagnostic workup of thyroid nodules and a standardized and meticulous technique for US-FNAB is essential for lowering the yield of nondiagnostic specimens and false-negative results. This video, therefore, demonstrates a well-proved technique and technical tips to increase the diagnostic results from US-FNAB.
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Affiliation(s)
- Tobias Todsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Capital Region, Copenhagen, Denmark
| | | | - Katalin Kiss
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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