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Hirokawa M, Suzuki A. "Immunocytochemistry in Cytology: Myth or Reality": Unraveling the Myth - Immunocytochemistry Applications in Thyroid Lesions. Acta Cytol 2024:1-9. [PMID: 39004076 DOI: 10.1159/000540366] [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: 04/30/2024] [Accepted: 07/10/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Fine-needle aspiration cytology serves as an important preoperative diagnostic tool for thyroid nodules. Despite its excellent diagnostic accuracy, diagnoses based solely on morphological observation can be challenging. Therefore, various ancillary diagnostic techniques have been applied, including immunocytochemistry (ICC). This review discusses the application and evaluation of ICC in thyroid fine needle aspiration. SUMMARY Currently, three immunostaining preparation methods are available for cytological materials: liquid-based cytology, cell block, and cell transfer. ICC proves valuable in scenarios such as tumour diagnosis, assessment of differentiation and grading of carcinomas, estimation of primary organs in metastatic carcinomas, and detection of gene abnormalities. However, ICC, while useful, is not as accurate as immunohistochemistry and is more difficult to evaluate. KEY MESSAGES If the pitfalls and limitations are understood and effectively navigated, ICC could play a significant role in decreasing the non-diagnostic rate, thus leading to more accurate and valuable diagnoses and reductions in the re-aspiration rate.
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Affiliation(s)
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
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Castellana M, Virili C, Paone G, Scappaticcio L, Piccardo A, Giovanella L, Trimboli P. Ultrasound systems for risk stratification of thyroid nodules prompt inappropriate biopsy in autonomously functioning thyroid nodules. Clin Endocrinol (Oxf) 2020; 93:67-75. [PMID: 32319108 DOI: 10.1111/cen.14204] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/27/2020] [Accepted: 03/12/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Ultrasound (US) risk stratification systems (RSSs) have been developed to reduce the number of unnecessary fine-needle aspiration (FNA) biopsies in patients with thyroid nodules. Autonomously functioning thyroid nodules (AFTN) account for 5%-10% of palpable lesions and are very rarely malignant. The present study was undertaken to investigate how RSSs classify AFTNs and whether RSSs are able to avoid unnecessary FNA biopsies in such cases. METHODS Patients with AFTN who had undergone US, scintigraphy and thyroid function evaluation from December 2016 to December 2017 were selected. US images were retrospectively reviewed and AFTN reclassified according to AACE/ACE/AME, ACR-TIRADS, ATA, BTA, EU-TIRADS, K-TIRADS and TIRADS. Risk class and indication for FNA were assessed. RESULTS A number of 87 AFTNs from 85 consecutive patients were enrolled. A median diameter of 22 mm (range 10-59) was found, with an ovoid isoechoic nodule being the most frequent US presentation. When AFTNs were reclassified according to US RSSs, the most common categories were low and intermediate risk. AFTNs were assessed as being at high risk/high suspicion/malignant in 1%-9%, with good agreement among AACE/ACE/AME, ATA, EU-TIRADS, K-TIRADS and TIRADS. Remarkably, FNA was indicated in 27%-90% of AFTNs. A statistically significant difference among the systems was found; 8% of cases were nonclassifiable by one or more US RSS. CONCLUSIONS Ultrasound RSSs prompt inappropriate FNA in a significant number of patients with AFTN.
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Affiliation(s)
- Marco Castellana
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Camilla Virili
- Science and Medico-Surgical Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Gaetano Paone
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Lorenzo Scappaticcio
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Unit of Endocrinology and Metabolic Diseases, University of Campania L. Vanvitelli, Naples, Italy
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. Ospedali Galliera, Galliera Hospital, Genoa, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università di Lugano (USI), Lugano, Switzerland
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Castellana M, Piccardo A, Virili C, Scappaticcio L, Grani G, Durante C, Giovanella L, Trimboli P. Can ultrasound systems for risk stratification of thyroid nodules identify follicular carcinoma? Cancer Cytopathol 2020; 128:250-259. [PMID: 31899594 DOI: 10.1002/cncy.22235] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/30/2019] [Accepted: 10/15/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Ultrasound (US) risk stratification systems (RSSs) have been developed to reduce the number of unnecessary fine needle aspirations (FNAs) of thyroid nodules. These systems were designed primarily to identify papillary thyroid carcinomas, thus their performance on follicular thyroid carcinoma (FTC) is debatable. The present study was undertaken to investigate the accuracy of RSSs in selecting FTCs for FNA. METHODS Patients with FTC who underwent US examinations between 2012 and 2018 in 2 institutions were selected. US images were reviewed retrospectively, and FTCs were reclassified according to the American Association of Clinical Endocrinologist/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME), American College of Radiology (ACR-TIRADS), 2015 American Thyroid Association, British Thyroid Association, European Thyroid Association, Korean Society of Thyroid Radiology and Korean Society of Radiology, and Thyroid Imaging Reporting and Data System (TIRADS). Risk class and indication for FNA were assessed. RESULTS Forty-five FTCs from 45 consecutive patients were included in the study. The median tumor diameter was 32 mm (range, 11-100), and ovoid isoechoic nodule with or without lobulated margins was the most frequent presentation. When FTCs were classified according to RSSs, the most common categories were intermediate and high risk, though 1 case in 3 was not classifiable. FTCs were classified as high risk/high suspicion/malignant in 11% to 74% of cases, with a statistically significant difference among the systems. FNA was indicated in 69% to 100% of cases, with good agreement among AACE/ACE/AME, ACR-TIRADS, and TIRADS. CONCLUSION Current RSSs show high performance in selecting FTCs for FNA. This result is mainly due to the dimensional RSSs cutoffs indicating FNA. On the contrary, given the reported unsuspicious echo-structural presentation of FTC and the recognized limitation of cytological assessment to detect it, caution is advised when using US to manage cytologically indeterminate nodules.
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Affiliation(s)
- Marco Castellana
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Genoa, Italy
| | - Camilla Virili
- Science and Medico-Surgical Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Scappaticcio
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Unit of Endocrinology and Metabolic Diseases, University of Campania L. Vanvitelli, Naples, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Rossi ED, Pantanowitz L, Faquin WC. The Role of Molecular Testing for the Indeterminate Thyroid FNA. Genes (Basel) 2019; 10:genes10100736. [PMID: 31547603 PMCID: PMC6826845 DOI: 10.3390/genes10100736] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 01/21/2023] Open
Abstract
Thyroid nodules are common in the adult population where a majority are benign and only 4.0% to 6.5% are malignant. Fine needle aspiration (FNA) is a key method used in the early stages to evaluate and triage patients with thyroid nodules. While a definitive cytological diagnosis is provided in more than 70–75% of all thyroid FNA cases, the group of indeterminate lesions offers a challenge in terms of interpretation and clinical management. Molecular testing platforms have been developed, are recognized as an option by the 2015 American Thyroid Association Guidelines, and are frequently used in conjunction with FNA as an integral part of the cytologic evaluation. In this review, the utility of molecular testing options for nodules assigned to the group of indeterminate thyroid FNAs is described.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, 00168 Rome, Italy.
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA.
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Castellana M, Trimboli P, Piccardo A, Giovanella L, Treglia G. Performance of 18F-FDG PET/CT in Selecting Thyroid Nodules with Indeterminate Fine-Needle Aspiration Cytology for Surgery. A Systematic Review and a Meta-Analysis. J Clin Med 2019; 8:jcm8091333. [PMID: 31466411 PMCID: PMC6780221 DOI: 10.3390/jcm8091333] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/16/2019] [Accepted: 08/27/2019] [Indexed: 12/17/2022] Open
Abstract
Thyroid nodules with indeterminate fine-needle aspiration cytology (FNA) represent a major challenge in clinical practice. We conducted a systematic review and meta-analysis evaluating the ability of hybrid imaging using fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to appropriately select these nodules for surgery. PubMed, CENTRAL, Scopus, and Web of Science were searched until July 2019. Original articles reporting data on the performance of 18F-FDG PET/CT in thyroid nodules with indeterminate FNA were included. Summary operating points including 95% confidence interval values (95% CI) were estimated using a random-effects model. Out of 786 retrieved papers, eight studies evaluating 104 malignant and 327 benign thyroid nodules were included. The pooled positive and negative likelihood ratios (LR+ and LR-) and diagnostic odds ratio (DOR) of 18F-FDG PET/CT were 1.7 (95% CI: 1.4-2.0), 0.4 (95% CI: 0.2-0.7), and 3.5 (95% CI: 1.7-7.1), respectively. No heterogeneity was found for LR+ and DOR. In patients with thyroid nodules with indeterminate FNA, 18F-FDG PET/CT has a moderate ability to correctly discriminate malignant from benign lesions and could represent a reliable option to reduce unnecessary diagnostic surgeries. However, further studies using standardized criteria for interpretation are needed to confirm the reproducibility of these findings.
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Affiliation(s)
- Marco Castellana
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, IT-70124 Bari, Italy
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, Galliera Hospital, IT-16128 Genoa, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland
- Department of Nuclear Medicine, University Hospital of Zürich and University of Zürich, CH-8091 Zürich, Switzerland
| | - Giorgio Treglia
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland.
- Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland.
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland.
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Ippolito D, Galimberti S, Leni D, Vacirca F, Nasr A, Bragazzi NL, Spiga S, Schiavone V, Pincelli AI, Garancini M, Leone BE, Pagni F. Use of Shear Wave Elastography in the Sonographic Triage of Thyroid Nodules: Feasibility Study in a Series of Lesions Already Selected for Fine Needle Aspiration. JOURNAL OF ULTRASOUND IN MEDICINE 2019; 38:1713-1720. [PMID: 30480833 DOI: 10.1002/jum.14857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/15/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the application of shear wave elastography (SWE) in the routine management of thyroid nodules, as a possible additional tool to the standard sonographic triage. METHODS A total of 248 consecutive patients scheduled for ultrasound-guided thyroid fine-needle aspiration were included in the study. The presence of a pure colloid lesion was an exclusion criterion. Absolute and relative SWE stiffness measurements on color-coded elastograms, expressed in kilopascals and meters per second, were correlated with radiologic and pathologic features. RESULTS SWE values in thyroid nodules were significantly higher than normal thyroid tissue (P = .0001), proving the different elastic properties of the pathologic tissues. Regarding the radiologic characteristics of the nodules, SWE highest values were associated with the largest lesions (P = .0105) but independent from sonographic and Doppler findings. The SWE elasticity was not influenced by the characteristics of the biopsy smears. The final correlation between the SWE results and the pathologic diagnoses showed a trend in stiffness from tender tumors (follicular adenoma) to papillary thyroid carcinoma (P = .016). CONCLUSIONS SWE allows the identification of nodules within normal parenchyma; however, the present study does not confirm the potential role in differentiating between benign and malignant thyroid nodules.
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Affiliation(s)
| | - Stefania Galimberti
- Center of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, Monza, Italy
| | - Davide Leni
- Radiology, Department of Medicine and Surgery, Monza, Italy
| | | | - Ahmed Nasr
- Pathology, Department of Medicine and Surgery, Monza, Italy
| | - Nicola Luigi Bragazzi
- Postgraduate School of Public Health, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Sara Spiga
- Radiology, Department of Medicine and Surgery, Monza, Italy
| | | | | | - Mattia Garancini
- Department of Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | | | - Fabio Pagni
- Pathology, Department of Medicine and Surgery, Monza, Italy
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Kumari KA, Jadhav PD, Prasad C, Smitha NV, Jojo A, Manjula VD. Diagnostic Efficacy of Ultrasound-Guided Fine Needle Aspiration Combined with the Bethesda System of Reporting. J Cytol 2019; 36:101-105. [PMID: 30992645 PMCID: PMC6425777 DOI: 10.4103/joc.joc_168_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Image-guided fine needle aspiration cytology (FNAC) is emerging as an important diagnostic tool in the evaluation of thyroid swellings. Aim: This study aims to assess the efficacy of ultrasound (US)-guided FNAC combined with “The Bethesda system' of reporting as a primary screening test for all thyroid lesions. Settings and Design: A prospective cohort study was made and all the US-guided FNACs done were followed up to find out the histopathological diagnoses wherever surgery was done. Materials and Methods: In all, 1050 patients who underwent US-guided FNAC were studied during a period of 1 year. Age, sex, cytological features, and histological diagnoses were analyzed. Statistical analyses of all the findings were done to derive conclusions. Results: Of the 1050 patients, only 10.5% underwent surgery. Higher than expected rate (as per the Bethesda system) of malignancy was noted with the so-called grey zone lesions. The test results revealed a high level of sensitivity, specificity, and diagnostic accuracy. Conclusion: The study showed that The Bethesda System of Reporting Thyroid Cytology provides effective communication between clinician and pathologists thereby enabling clear management strategies. We also concluded that US-guided FNACs offer better results compared with palpation-guided FNACs.
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Affiliation(s)
- K Ajitha Kumari
- Department of Pathology, Believers Church Medical College, Thiruvalla, Kerala, India
| | - Poonam D Jadhav
- Department of Pathology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Chaya Prasad
- Department of Pathology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - N V Smitha
- Department of Pathology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Annie Jojo
- Department of Pathology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - V D Manjula
- Department of Community Medicine, Government Medical College, Idukki, Kerala, India
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Piga I, Casano S, Smith A, Tettamanti S, Leni D, Capitoli G, Pincelli AI, Scardilli M, Galimberti S, Magni F, Pagni F. Update on: proteome analysis in thyroid pathology - part II: overview of technical and clinical enhancement of proteomic investigation of the thyroid lesions. Expert Rev Proteomics 2018; 15:937-948. [PMID: 30290700 DOI: 10.1080/14789450.2018.1532793] [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] [Indexed: 12/11/2022]
Abstract
INTRODUCTION An accurate diagnostic classification of thyroid lesions remains an important clinical aspect that needs to be addressed in order to avoid 'diagnostic' thyroidectomies. Among the several 'omics' techniques, proteomics is playing a pivotal role in the search for diagnostic markers. In recent years, different approaches have been used, taking advantage of the technical improvements related to mass spectrometry that have occurred. Areas covered: The review provides an update of the recent findings in diagnostic classification, in genetic definition and in the investigation of thyroid lesions based on different proteomics approaches and on different type of specimens: cytological, surgical and biofluid samples. A brief section will discuss how these findings can be integrated with those obtained by metabolomics investigations. Expert commentary: Among the several proteomics approaches able to deepen our knowledge of the molecular alterations of the different thyroid lesions, MALDI-MSI is strongly emerging above all. In fact, MS-imaging has also been demonstrated to be capable of distinguishing thyroid lesions, based on their different molecular signatures, using cytological specimens. The possibility to use the material obtained by the fine needle aspiration makes MALDI-MSI a highly promising technology that could be implemented into the clinical and pathological units.
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Affiliation(s)
- Isabella Piga
- a Department of Medicine and Surgery , University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit , Vedano al Lambro , Italy.,b Department of Medicine and Surgery , University of Milano-Bicocca, Section of Pathology , Monza , Italy
| | - Stefano Casano
- b Department of Medicine and Surgery , University of Milano-Bicocca, Section of Pathology , Monza , Italy
| | - Andrew Smith
- a Department of Medicine and Surgery , University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit , Vedano al Lambro , Italy
| | - Silvia Tettamanti
- a Department of Medicine and Surgery , University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit , Vedano al Lambro , Italy
| | - Davide Leni
- c Department of Radiology , San Gerardo Hospital , Monza , Italy
| | - Giulia Capitoli
- d Department of Medicine and Surgery , University of Milano-Bicocca, Centre of Biostatistics for Clinical Epidemiology , Monza , Italy
| | | | | | - Stefania Galimberti
- d Department of Medicine and Surgery , University of Milano-Bicocca, Centre of Biostatistics for Clinical Epidemiology , Monza , Italy
| | - Fulvio Magni
- a Department of Medicine and Surgery , University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit , Vedano al Lambro , Italy
| | - Fabio Pagni
- b Department of Medicine and Surgery , University of Milano-Bicocca, Section of Pathology , Monza , Italy
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Bongiovanni M, Papadakis GE, Rouiller N, Marino L, Lamine F, Bisig B, Ziadi S, Sykiotis GP. The Bethesda System for Reporting Thyroid Cytopathology Explained for Practitioners: Frequently Asked Questions. Thyroid 2018; 28:556-565. [PMID: 29591914 DOI: 10.1089/thy.2017.0685] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The recent update of The Bethesda System for Reporting Thyroid Cytology (TBSRTC) is a very important development in the evaluation of thyroid nodules. Clinical experience and scientific literature both show that practitioners performing thyroid fine-needle aspiration are accustomed to basing the clinical management of patients on reports using TBSRTC. Specifically, clinicians are familiar with the percent risk of malignancy corresponding to each TBSRTC diagnostic category (DC), as well as with the respective recommendation for clinical management. However, most clinicians are much less familiar with the specific considerations that lie between a given DC, on the one end, and the respective risk of malignancy and associated management recommendation, on the other end. SUMMARY A deeper understanding of the system can enlighten the clinician's thinking about the specific nodule under examination and can guide the decision-making process in a more meaningful way. Such an understanding can only be developed via close two-way communication between cytopathologists and clinicians. Through this type of interaction in the authors' tertiary medical center, recurring issues of particular importance for clinical practice were identified, which are reported here in the form of 16 frequently asked questions posed by the clinician to the cytopathologist. CONCLUSIONS For each frequently asked question, an answer is provided based on the literature, the authors' experience, the new version of TBSRTC, and the new World Health Organization classification of tumors of endocrine organs.
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Affiliation(s)
- Massimo Bongiovanni
- 1 Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital , Lausanne, Switzerland
| | - Georgios E Papadakis
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Nathalie Rouiller
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Laura Marino
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Faiza Lamine
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Bettina Bisig
- 1 Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital , Lausanne, Switzerland
| | - Sonia Ziadi
- 1 Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital , Lausanne, Switzerland
| | - Gerasimos P Sykiotis
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
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Trimboli P, Paone G, Zatelli MC, Ceriani L, Giovanella L. Real-time elastography in autonomously functioning thyroid nodules: relationship with TSH levels, scintigraphy, and ultrasound patterns. Endocrine 2017; 58:488-494. [PMID: 28285385 DOI: 10.1007/s12020-017-1277-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/24/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Real-time elastography has been proposed to increase the sensitivity of ultrasound and improve the detection of thyroid nodules at risk of malignancy. To date sparse data on real-time elastography assessment of autonomously functioning thyroid nodules exist. Here, we investigated the potential role of real-time elastography in autonomously functioning thyroid nodule assessment. Specifically, the correlation between serum hormones and real-time elastography score, as well as other clinical and ultrasound features, was analyzed. METHODS Patients with autonomously functioning thyroid nodule identified by I-123 scintigraphy from September 2015 to July 2016 and undergoing ultrasound, real-time elastography, and thyroid function evaluation were selected. All autonomously functioning thyroid nodule were classified as RTE I (prevalence of red or green color with blue in up to 25% of the nodule area), RTE II (blue in 25-75%), or RTE III (blue in more than 75%). The association between suppressed thyroid stimulating hormone and patient's age, nodule's size, ultrasound presentation, and real-time elastography scoring was analyzed by Odds Ratio in univariate fashion and multivariate model. RESULTS A number of 47 subjects with single autonomously functioning thyroid nodule were enrolled. Median age of 63 years, median size of 2.0 cm, and suppressed thyroid stimulating hormone levels in 32% of cases were found. Those nodules classified by ultrasound at high risk underwent fine-needle aspiration cytology and cancer was excluded. At real-time elastography evaluation, a 45% of autonomously functioning thyroid nodule had a hard appearance (RTE III) and had thyroid stimulating hormone significantly lower than the other (p < 0.0001). A model of multivariate logistic regression including nodule's size, ultrasound characteristics, and elastographic presentation showed that only RTE III was significantly associated with suppressed thyroid stimulating hormone (Odds Ratio of 50). CONCLUSIONS Autonomously functioning thyroid nodule may have variable elasticity at real-time elastography examination, being hard score associated with reduced/suppressed thyroid stimulating hormone. For clinical practice, the presence of autonomously functioning thyroid nodule should be considered in patients with hard lesions. Also, as quoted by the most recent ATA guidelines, elastography should not be accounted for risk stratification of thyroid nodules.
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Affiliation(s)
- Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | - Gaetano Paone
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Maria Chiara Zatelli
- Department of Medical Sciences, Section of Endocrinology & Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Luca Ceriani
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Decaussin-Petrucci M, Descotes F, Depaepe L, Lapras V, Denier ML, Borson-Chazot F, Lifante JC, Lopez J. Molecular testing of BRAF, RAS and TERT on thyroid FNAs with indeterminate cytology improves diagnostic accuracy. Cytopathology 2017; 28:482-487. [PMID: 29094776 DOI: 10.1111/cyt.12493] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Liquid-based (LB)-FNA is widely recognized as a reliable diagnostic method to evaluate thyroid nodules. However, up to 30% of LB-FNA remain indeterminate according to the Bethesda system. Use of molecular biomarkers has been recommended to improve its pathological accuracy but implementation of these tests in clinical practice may be difficult. Here, we evaluated feasibility and performance of molecular profiling in routine practice by testing LB-FNA for BRAF, N/HRAS and TERT mutations. METHODS We studied a large prospective cohort of 326 cases, including 61 atypia of undetermined significance, 124 follicular neoplasms, 72 suspicious for malignancy and 69 malignant cases. Diagnosis of malignancy was confirmed by histology on paired surgical specimen. RESULTS Mutated LB-FNAs were significantly associated with malignancy regardless of the cytological classification. Overall sensitivity was 60% and specificity 89%. Importantly, in atypia of undetermined significance and follicular neoplasm patients undergoing surgery according to the Bethesda guidelines, negative predictive values were 85.4% and 90% respectively. TERT promoter mutation was rare but very specific for malignancy (5.5%) suggesting that it could be of interest in patients with indeterminate cytology. CONCLUSIONS Mutation profiling can be successfully performed on thyroid LB-FNA without any dedicated sample in a pathology laboratory. It is an easy way to improve diagnostic accuracy of routine LB-FNA and may help to better select patients for surgery and to avoid unnecessary thyroidectomies.
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Affiliation(s)
- M Decaussin-Petrucci
- Pathology department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.,Cancer Research Center of Lyon, INSERM1052 CNRS5286, Université de Lyon, Lyon, France
| | - F Descotes
- Biochemistry and molecular biology department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - L Depaepe
- Pathology department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - V Lapras
- Radiology department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - M-L Denier
- Radiology department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - F Borson-Chazot
- Endocrinology department, Groupement hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - J-C Lifante
- Endocrine surgery department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - J Lopez
- Biochemistry and molecular biology department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.,Cancer Research Center of Lyon, INSERM1052 CNRS5286, Université de Lyon, Lyon, France
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12
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Yi KI, Ahn S, Park DY, Lee JC, Lee BJ, Wang SG, Cha W. False-positive cytopathology results for papillary thyroid carcinoma: A trap for thyroid surgeons. Clin Otolaryngol 2017; 42:1153-1160. [PMID: 28130940 DOI: 10.1111/coa.12840] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Current preoperative diagnosis of thyroid nodules remains imperfect despite recent advances in cytopathology and molecular diagnostics. False positivity in preoperative fine-needle aspiration cytology (FNAC) may lead to overtreatment of patients, including total thyroidectomy, and sometimes to lawsuits for misdiagnosis and malpractice. In this study, we analysed clinical characteristics and pathologic findings in patients with false positivity for papillary thyroid carcinoma (PTC) in FNAC. METHODS We retrospectively reviewed permanent pathology results from 3788 patients who underwent thyroid surgery. Among them, 48 patients had lesions that were deemed suspicious or positive (Bethesda class V or VI) for PTC in preoperative FNAC. We reviewed clinic-pathologic data, radiologic findings and surgical planning in these patients. RESULTS The prevalence of pathologic thyroiditis was significantly higher among patients with false-positive FNAC results than in those with confirmed PTC (54.2% vs 9.2%, P<.001). The analysis of the permanent pathology reports showed that 26 patients had chronic lymphocytic thyroiditis and 22 patients had no evidence of thyroiditis. Among the patients without pathologic thyroiditis, 19 patients (86.4%) had nodular hyperplasia and three (13.6%) had follicular adenoma, while among the patients with pathologic thyroiditis, seven (26.9%) had no nodule, 14 (53.8%) had nodular hyperplasia, two (7.7%) had hyalinized nodules, two (7.7%) had follicular adenoma and one (3.8%) had a hyalinizing trabecular tumour. In 42 patients, the extent of surgery (total thyroidectomy or hemithyroidectomy) was to be determined according to the intra-operative frozen section biopsy results. Among them, four (10.5%) had inconclusive frozen section results, and 38 (90.5%) had benign results on frozen section. CONCLUSIONS Patient counselling about the possibility of false positivity is still important. And the presence of thyroiditis might create confusion in the interpretation of cytopathologic results.
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Affiliation(s)
- K-I Yi
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - S Ahn
- Department of Pathology, Pusan National University Hospital, Busan, Korea
| | - D Y Park
- Department of Pathology, Pusan National University Hospital, Busan, Korea
| | - J-C Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Yangsan, Gyeongnam, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam, South Korea
| | - B-J Lee
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Yangsan, Gyeongnam, Korea
| | - S-G Wang
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Yangsan, Gyeongnam, Korea
| | - W Cha
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Yangsan, Gyeongnam, Korea
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Abstract
Despite its identification in 1997, the functions of the MEN1 gene-the main gene underlying multiple endocrine neoplasia type 1 syndrome-are not yet fully understood. In addition, unlike the RET-MEN2 causative gene-no hot-spot mutational areas or genotype-phenotype correlations have been identified. More than 1,300 MEN1 gene mutations have been reported and are mostly "private" (family specific). Even when mutations are shared at an intra- or inter-familial level, the spectrum of clinical presentation is highly variable, even in identical twins. Despite these inherent limitations for genetic counseling, identifying MEN1 mutations in individual carriers offers them the opportunity to have lifelong clinical surveillance schemes aimed at revealing MEN1-associated tumors and lesions, dictates the timing and scope of surgical procedures, and facilitates specific mutation analysis of relatives to define presymptomatic carriers.
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Affiliation(s)
- Alberto Falchetti
- EndOsMet Unit, Villa Donatello, Piazzale Donatello 2, Florence 50100, Italy; Hercolani Clinical Center, Via D'Azeglio 46, Bologna 40136, Italy
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14
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Wise O, Howard MR. Thyroid cytology: a review of current international reporting systems and emerging developments. Cytopathology 2016; 27:161-7. [DOI: 10.1111/cyt.12346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 12/27/2022]
Affiliation(s)
- O. Wise
- Department of Cellular Pathology; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - M. R. Howard
- Department of Histopathology; Brighton and Sussex University Hospitals NHS Trust; Brighton UK
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