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Saraph S, Cohen H, Ronen O. Effect of needle gauge on thyroid FNA diagnostic rate. Endocrine 2021; 74:625-631. [PMID: 34146249 DOI: 10.1007/s12020-021-02797-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Thyroid Bethesda classification system provides 6 diagnostic categories, the first being a sample deemed non-diagnostic or insufficient and requiring a subsequent second biopsy. Our objective was to evaluate differences in non-diagnostic fine needle aspiration (FNA) of thyroid nodules conducted with a 23-gauge(G) needle vs. those conducted with a 25 G needle. METHODS Data from 298 aspiration procedures using either 23 G or 25 G needles were collected, including cytological findings, ultrasound characteristics and patient demographics. The samples were classified as diagnostic or non-diagnostic according to final cytology. RESULTS There was no statistically significant difference between the 25 G and 23 G needles in terms of non-diagnostic rates (35.7%, 31.9%; p = 0.494). Nodules defined as cystic had higher non-diagnostic rates (p < 0.05). Older patients as well as cystic nodules were associated with a higher non-diagnostic rate (OR = 1.018, p = 0.047, OR = 13.533, p = 0.0001, respectively), while nodule size was associated with lower non-diagnostic rates (OR = 0.747, p = 0.017). CONCLUSIONS The use of 25 G needle did not produce a lower non-diagnostic rate when compared to 23 G needle. Larger nodules might increase diagnostic rates, while older patients and cystic nodules are prone to inadequate samples. Patients and caregivers should be aware that FNA of small or cystic nodules as well as nodules in older patients may result in a higher non-diagnostic rate. Further research comparing other needles gauges should be conducted.
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Affiliation(s)
- Sivan Saraph
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Hector Cohen
- Department of Pathology, Galilee Medical Center, Nahariya, Israel
| | - Ohad Ronen
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel.
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Liu Z, Sui S, Su P, Zhang X, Hu J, Sun F, Han B. The effect of implementing pre-surgical ultrasound-guided fine-needle aspiration biopsy on thyroid surgery, a 6-year interrupted time series analysis in Qilu Hospital of Shandong University. Gland Surg 2020; 9:1716-1723. [PMID: 33224849 DOI: 10.21037/gs-20-348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Thyroid fine-needle aspiration biopsy (FNAB) is not well developed in most of the large academic hospitals in China, including Qilu Hospital of Shandong University. Ultrasound-guided FNAB (UG-FNAB) was initiated as a pre-surgical diagnostic method in 2015 in Qilu Hospital, and the current study evaluates its impact on the number of thyroid surgeries and the ratio of malignancy (ROM) in surgically resected cases, comparing the post and pre-UG-FNAB periods. Methods Thyroid surgery and UG-FNAB data for the study period (Jan 2013 to Dec 2018) were collected from the hospital information system (HIS). A natural experimental approach using segmented linear regression was performed on the interrupted time-series (ITS) data to estimate the level-change of the number and the trend-change of ROM of surgically resected cases following the implementation of UG-FNAB diagnosis. Results The number of UG-FNAB cases in Qilu Hospital increased rapidly from 1,367 in 2015 to 3,402 in 2018, with an average annual increase of 678 cases. Comparing the pre-UG-FNAB and post-UG-FNAB periods, the overall ROM of thyroid resections increased from 58.7% to 73.2% (P<0.01). Due to the implementation of UG-FNAB, the regression line of surgical cases showed an inflection point in March 2015, and the slope of the regression line of post-intervention was lower than that of pre-intervention. For each additional month, the ROM in thyroid surgical cases increased by 0.389% (P<0.01). After excluding the influence of time, the ROM in surgically resected thyroid cases increased by 4.781% due to the application of the UG-FNAB examination (P<0.01). Conclusions This successful implementation of UG-FNAB further improved overall ROMs in surgically resected cases particularly as we acquired further experience with the procedure and reduced unnecessary diagnostic surgeries for patients with benign and borderline lesions.
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Affiliation(s)
- Zhiyan Liu
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Department of Pathology, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Shaofeng Sui
- Department of Occupational and Environmental Health Monitoring and Assessment, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Peng Su
- Department of Pathology, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Xiaofang Zhang
- Department of Pathology, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Jing Hu
- Department of Pathology, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Feifei Sun
- Department of Pathology, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Bo Han
- Department of Pathology, Qilu Hospital of Shandong University, Shandong University, Jinan, China
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Abstract
BACKGROUND Previous clinical studies have reported that ultrasound-guided fine needle aspiration cytology (UGFNAC) can be used for the diagnosis of thyroid nodules (TN) effectively. However, no study has systematically explored its diagnosis accuracy in patients with TN. Thus, this study will assess its diagnosis accuracy for TN. METHODS We will perform a comprehensive literature search from the following databases from their inceptions to the present without language restrictions: MEDILINE, EMBASE, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will consider all case-controlled studies investigating the impacts of UGFNAC diagnosis for patients with TN for inclusion. Two authors will independently carry out study selection, data collection, and methodological quality assessment. Quality Assessment of Diagnostic Accuracy Studies tool will be used for methodological quality evaluation. We will use RevMan V.5.3 and Stata V.12.0 software to perform statistical analysis. RESULTS We will apply sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio to judge the diagnostic accuracy of UGFNAC for TN. CONCLUSION The results of this study will provide latest evidence for the diagnostic accuracy of UGFNAC for TN. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019138805.
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Affiliation(s)
- Jing Wang
- Department of Endocrine and Metabolism
| | - Jing Liu
- Department of Laboratory, The First Hospital of Yulin, Yulin
| | - Zhe Liu
- Department of Cardiology, Yanan University Affiliated Hospital, Baota District, Yan’an, China
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Paja M, del Cura JL, Zabala R, Korta I, Ugalde A, López JI. Core-needle biopsy in thyroid nodules: performance, accuracy, and complications. Eur Radiol 2019; 29:4889-4896. [DOI: 10.1007/s00330-019-06038-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/23/2018] [Accepted: 01/23/2019] [Indexed: 12/14/2022]
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Zhu R, Liu Z, Jiao R, Zhang C, Yu Q, Han S, Duan Z. Updates on the pathogenesis of advanced lung cancer-induced cachexia. Thorac Cancer 2018; 10:8-16. [PMID: 30461213 PMCID: PMC6312840 DOI: 10.1111/1759-7714.12910] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 12/15/2022] Open
Abstract
Advanced lung cancer is becoming a chronic disease threatening human life and health. Cachexia has been recognized as the most common problem associated with advanced lung cancer. Lung cancer‐induced cachexia seriously affects patients’ quality of life. The present article summarizes the pathogenesis of advanced lung cancer‐induced cachexia from three aspects: anorexia, cytokines, and energy and metabolic abnormalities. In addition, the present article proposes corresponding nursing measures based on cachexia pathogenesis to improve the quality of life and survival rate of cachectic patients with advanced lung cancer by combining continuously advancing treatment regimens and effective nursing. The present article also provides references for healthcare professionals when administering related treatments and nursing care.
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Affiliation(s)
- Ruifang Zhu
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Zhihong Liu
- Department of Respiratory and Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ran Jiao
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Chichen Zhang
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Qi Yu
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Shifan Han
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Zhiguang Duan
- School of Nursing, Shanxi Medical University, Taiyuan, China
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Thyroid Nodules With Nondiagnostic Cytologic Results: Follow-Up Management Using Ultrasound Patterns Based on the 2015 American Thyroid Association Guidelines. AJR Am J Roentgenol 2017; 210:412-417. [PMID: 29091005 DOI: 10.2214/ajr.17.18532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the malignancy rate of nodules with nondiagnostic cytologic results based on the American Thyroid Association (ATA) ultrasound (US) patterns and to suggest management guidelines for these nodules. MATERIALS AND METHODS From January 2013 to December 2014, 441 nodules (≥ 1 cm) were found in 437 patients with nondiagnostic results of ultrasound (US)-guided fine-needle aspiration biopsy (nondiagnostic nodules). A total of 191 nodules that were cytopathologically confirmed or were smaller (> 3 mm) at follow-up US were enrolled. The US findings of each nodule were reviewed. One radiologist classified the nodules into the following five categories according to the 2015 ATA guidelines: high, intermediate, low, and very low suspicion for malignancy and benign. The reference standard was histopathologic confirmation. Nodules that were smaller at follow-up US were considered benign. The malignancy rate of each category was calculated. RESULTS Among a total 191 nodules, 20 (10.5%) were malignant. Solid composition, marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape were more frequently seen in malignant nodules (all p < 0.001). The malignancy rate of nodules with very low suspicion of malignancy was 0% (0/58); low, 0% (0/45); intermediate, 10.3% (6/58); and high, 46.7% (14/30) (p < 0.001). CONCLUSION When US findings of thyroid nodules are assessed according to the 2015 ATA guidelines, nondiagnostic thyroid nodules with very-low- or low-suspicion US patterns can be followed up with US. Nondiagnostic nodules with intermediate or highly suspicious US patterns should be evaluated with repeat US-guided fine-needle aspiration biopsy.
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Repeated nondiagnostic result of thyroid fine-needle aspiration biopsy. Contemp Oncol (Pozn) 2017; 20:491-495. [PMID: 28239289 PMCID: PMC5320464 DOI: 10.5114/wo.2016.65611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/26/2016] [Indexed: 01/21/2023] Open
Abstract
Aim of the study Fine-needle aspiration biopsy (FNAB) is the most accurate and cost-effective method to evaluate the risk of malignancy of thyroid nodules, but approximately 1–24% of FNABs generate a nondiagnostic result (ND-FNAB). The aim of this study was to determine the predictive factors of a repeated nondiagnostic result of FNAB. Material and methods A total of 4018 FNABs performed in a territorial referral centre were analysed, of which 288 (7.17%) were nondiagnostic. Medical records were available for 245 biopsies performed in 228 patients. The retrospective analysis of factors that may influence a repeat ND-FNAB, including demographic, clinical and ultrasound characteristics, was performed. Results A repeat FNAB was performed in 159 nodules giving a diagnostic result in 79.2% of cases. The time between the biopsies ranged from 1 to 611 days (mean 154.4, median 119). The timing of a repeat FNAB did not significantly alter the diagnostic output (p = 0.29). In the univariate analysis, significant predictors of a repeat ND-FNAB were older patient age (p = 0.02), L-thyroxine supplementation (p = 0.05), and a history of 131I therapy (p < 0.0001). In the multivariate analysis, only a history of 131I therapy was a statistically significant risk factor for a repeat ND-FNAB (p = 0.002). Conclusions Patients with a history of 131I therapy and ND-FNAB should undergo periodic ultrasonographic assessment rather than a repeat biopsy. The interval between repeated FNABs recommended by guidelines does not affect the diagnostic output.
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Espinosa De Ycaza AE, Lowe KM, Dean DS, Castro MR, Fatourechi V, Ryder M, Morris JC, Stan MN. Risk of Malignancy in Thyroid Nodules with Non-Diagnostic Fine-Needle Aspiration: A Retrospective Cohort Study. Thyroid 2016; 26:1598-1604. [PMID: 27549368 PMCID: PMC5105349 DOI: 10.1089/thy.2016.0096] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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 Fine-needle aspiration (FNA) of thyroid nodules is commonly performed, and despite the use of ultrasound (US) guidance, the rate of non-diagnostic FNAs is still significant. The risk of malignancy of thyroid nodules with a non-diagnostic FNA is not clearly defined. However, most studies exclude the majority of patients without a repeat biopsy or surgery, thus increasing the likelihood of selection bias. The aims of this study were to determine the malignancy risk in nodules with an initial non-diagnostic FNA, and to identify the factors associated with malignancy. METHODS This was a retrospective cohort study of patients with thyroid nodules who underwent US-guided FNA between 2004 and 2010 and had a non-diagnostic result. Patients were followed until confirmatory diagnosis of the nature of the nodule was made. The outcome of malignant or benign disease was based on one of the following: (i) final surgical pathology following thyroidectomy; (ii) repeat biopsy; (iii) clinically, based on repeat ultrasound performed at least three years following biopsy; or (iv) report of thyroid status for patients without follow-up visits contacted by mail. RESULTS There were 699 nodules from 665 patients included. The mean age was 59 ± 15 years, and 71.7% were women. There was complete follow-up of 495 nodules. After a median follow-up of 2.7 years, thyroid cancer was found in 15 nodules. The prevalence of malignancy was 3% (15/495). The presence of nodular calcifications was the strongest predictor of thyroid malignancy (odds ratio 5.03 [confidence interval 1.8-14.7]). Initial nodule size was inversely associated with malignancy (odds ratio 0.55 [confidence interval 0.28-0.93]). However, the 193 patients without follow-up had smaller nodules compared with those included in the analysis. None of the patients with repeatedly non-diagnostic results were diagnosed with thyroid cancer at follow-up. CONCLUSION The prevalence of thyroid cancer in nodules with non-diagnostic results is lower than the malignancy rate in thyroid nodules in general, but not negligible. They should be followed as per guidelines with heightened suspicion for nodules containing calcifications. Nodules with repeatedly non-diagnostic FNA results especially in the absence of calcifications have a low risk of malignancy and may be observed.
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Affiliation(s)
- Ana E. Espinosa De Ycaza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | | | - Diana S. Dean
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - M. Regina Castro
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Vahab Fatourechi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Mabel Ryder
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - John C. Morris
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Marius N. Stan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
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9
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Park SY, Hahn SY, Shin JH, Ko EY, Oh YL. The Diagnostic Performance of Thyroid US in Each Category of the Bethesda System for Reporting Thyroid Cytopathology. PLoS One 2016; 11:e0155898. [PMID: 27348515 PMCID: PMC4922578 DOI: 10.1371/journal.pone.0155898] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/05/2016] [Indexed: 11/18/2022] Open
Abstract
We aimed to evaluate the diagnostic performance of thyroid ultrasonography (US) in each category of the Bethesda system and analyze false positive/negative findings using US. This retrospective study included 622 thyroid nodules in 592 patients. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and accuracy of US in each category of the Bethesda system were evaluated. False positive/negative cases of US were analyzed. Out of the 622 total thyroid FNAs, 179 (28.8%) were malignant. The malignancy rates for the 6 categories were as follows: I (nondiagnostic): 9.7%, II (benign): 2.5%, III (atypia/follicular lesion of undetermined significance): 37.5%, IV (suspicious for follicular neoplasm): 5.7%, V (suspicious for malignancy): 100%, and VI (malignancy): 100%. The accuracies of US for the 6 categories were 92.5%, 95.6%, 70.8%, 94.3%, 95%, and 92.4% in category order. US showed the lowest sensitivity (50%) in Category IV. Category III demonstrated relatively low sensitivity (66.7%) and specificity (73.3%) due to a high incidence of follicular variant of papillary thyroid carcinoma and a low number of category III nodules. The most optimal performance of US was revealed in Category I with 88.9% sensitivity and 92.9% specificity. In 22 US false positive cases, the most frequent finding was associated with marked hypoechogenicity and the least finding was noncircumscribed margin. The most common US features of 19 false negative cases were circumscribed iso or hypoechoic nodules. These results highlight the excellent diagnostic performance of US in category I of the Bethesda system and the lowest sensitivity of US in category IV. Awareness of US interpreters regarding these pitfalls can minimize false positive/negative diagnoses and prevent unnecessary interventions.
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Affiliation(s)
- So Yoon Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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10
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Ha EJ, Baek JH, Lee JH, Lee HY, Song DE, Kim JK, Shong YK, Hong SJ. A focal marked hypoechogenicity within an isoechoic thyroid nodule: is it a focal malignancy or not? Acta Radiol 2015; 56:814-9. [PMID: 24938659 DOI: 10.1177/0284185114539322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 05/21/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND A marked hypoechogenicity is a reliable criterion for a malignant nodule, whereas isoechogenicity is considered to be a benign ultrasonographic (US) finding. However, there have been no reports to demonstrate whether a focal marked hypoechogenicity within an isoechoic nodule is a focal malignancy. PURPOSE To evaluate whether a focal marked hypoechogenicity within an isoechoic nodule on US examination is a focal malignancy and to correlate US histologic findings using surgical or core needle biopsy (CNB) specimens. MATERIAL AND METHODS From January 2010 to August 2011, 28 consecutive patients (25 women, 3 men; mean age, 52.2 years) with 29 thyroid nodules, which showed a focal marked hypoechogenicity within an isoechoic nodule on US, underwent US-guided CNB for a suspicion of a focal malignancy. All nodules were confirmed by surgery (n = 6) or more than two consecutive US-guided biopsies (n = 23). We evaluated the risk of malignancy, and analyzed histological components which correlated with a focal marked hypoechogenic area within an isoechoic nodule on US. Statistical analysis was performed using the Mann-Whitney U test and Fisher's exact test. RESULTS Of the 29 nodules, 25 were benign (86.2%) and four were malignant (13.8%). The peripheral location of focal marked hypoechogenicity within an isoechoic nodule was the only significant US finding that suggested malignancy (P = 0.03). All benign focal marked hypoechogenicities were histologically composed of severe fibrosis with a few follicular cells with varying frequencies of hemosiderin, calcification, infarction, and granulation tissue. CONCLUSION Although a focal marked hypoechogenicity within an isoechoic nodule is usually benign, the peripheral location of a focal marked hypoechogenicity may be a malignancy. The histologic information obtained by CNB specimen may reduce the needs for repetitive fine needle aspirations or diagnostic surgery.
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Affiliation(s)
- Eun Ju Ha
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ha Young Lee
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jae Kyun Kim
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Young Kee Shong
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Suck Joon Hong
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Lee YH, Baek JH, Jung SL, Kwak JY, Kim JH, Shin JH. Ultrasound-guided fine needle aspiration of thyroid nodules: a consensus statement by the korean society of thyroid radiology. Korean J Radiol 2015; 16:391-401. [PMID: 25741201 PMCID: PMC4347275 DOI: 10.3348/kjr.2015.16.2.391] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/15/2014] [Indexed: 12/11/2022] Open
Abstract
Ultrasound (US)-guided fine needle aspiration (US-FNA) has played a crucial role in managing patients with thyroid nodules, owing to its safety and accuracy. However, even with US guidance, nondiagnostic sampling and infrequent complications still occur after FNA. Accordingly, the Task Force on US-FNA of the Korean Society of Thyroid Radiology has provided consensus recommendations for the US-FNA technique and related issues to improve diagnostic yield. These detailed procedures are based on a comprehensive analysis of the current literature and from the consensus of experts.
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Affiliation(s)
- Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan 425-707, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - So Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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Shin DY, Lee YK, Kim KJ, Park KH, Hwang S, Park SH, Kim EK, Kwon HJ, Lee EJ. Thyroid cancers with benign-looking sonographic features have different lymph node metastatic risk and histologic subtypes according to nodule size. Endocr Pathol 2014; 25:378-84. [PMID: 25182219 DOI: 10.1007/s12022-014-9327-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A decision to perform fine needle aspiration (FNA) on thyroid nodules mainly depends on sonographic features. We investigated if lymph node metastasis (LNM) risk differed by tumor size of thyroid cancers without suspicious sonographic features. Three hundred sixty patients with thyroid cancers with benign looking sonographic features were grouped by nodule size on ultrasonography (US) (≤ or >1 cm). The clinicopathologic parameters were compared between the groups. A multivariate analysis was performed to discover the independent factors predicting the presence of LNM. The nodules greater than 10 mm on US (n = 157) demonstrated a larger tumor size on histology (17.9 ± 14.5 vs. 5.6 ± 2.4 mm, P < 0.001), a lower frequency of classical papillary thyroid carcinoma (PTC) (58.6 vs. 87.2 %, P < 0.001), and a higher frequency of follicular variant PTC and follicular thyroid carcinoma (19.7 and 17.8 % vs. 9.4 and 1.5 %, respectively, P < 0.01). In subgroup analysis of 269 patients with classical PTC, the larger nodule size on US was associated with a higher prevalence of LNM (28.3 vs. 14.7 %, P = 0.007). A multivariate analysis revealed that classical PTC, extrathyroidal extension, and the US nodule size >10 mm were independent predictive factors of LNM after adjusting for age, sex, TSH level, and multifocality. Thyroid cancers larger than 10 mm with benign US features are more likely to be nonclassical PTC than those with smaller diameters. The larger ones also have an increased risk of LNM in classical PTC. These cases require a more aggressive approach to FNA.
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Affiliation(s)
- Dong Yeob Shin
- Division of Endocrinology and Metabolism, Departments of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
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13
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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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Rosário PW, Ward LS, Carvalho GA, Graf H, Maciel RMB, Maciel LMZ, Maia AL, Vaisman M. Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus. ACTA ACUST UNITED AC 2013; 57:240-64. [DOI: 10.1590/s0004-27302013000400002] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Indexed: 12/11/2022]
Abstract
Thyroid nodules are frequent findings, especially when sensitive imaging methods are used. Although thyroid cancer is relatively rare, its incidence is increasing, particularly in terms of small tumors, which have an uncertain clinical relevance. Most patients with differentiated thyroid cancer exhibit satisfactory clinical outcomes when treatment is appropriate, and their mortality rate is similar to that of the overall population. However, relapse occurs in a considerable fraction of these patients, and some patients stop responding to conventional treatment and eventually die from their disease. Therefore, the challenge is how to identify the individuals who require more aggressive disease management while sparing the majority of patients from unnecessary treatments and procedures. We have updated the Brazilian Consensus that was published in 2007, emphasizing the diagnostic and therapeutic advances that the participants, representing several Brazilian university centers, consider most relevant in clinical practice. The formulation of the present guidelines was based on the participants' experience and a review of the relevant literature.
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Affiliation(s)
| | | | | | - Hans Graf
- Universidade Federal do Paraná, Brazil
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