Evaluation of thyroid lesions by fine-needle aspiration cytology based on Bethesda system for reporting thyroid cytopathology classification among the population of South Bihar

Enhancing diagnostic precision in thyroid nodule assessment: evaluating the efficacy of a novel cell preservation technique in fine-needle aspiration cytology

Objectives

This study aimed to evaluate the effectiveness of thyroid fine needle aspiration cytology (FNAC) using a novel-cell preserving matrix called Cytomatrix in improving diagnostic accuracy for thyroid nodules.

Materials and methods

Fifty patients undergoing thyroidectomy were enrolled and FNAC was performed on the excised thyroid glands, with the collected sample being placed on the Cytomatrix. The results were compared with histopathological analysis, and diagnostic performance was assessed statistically.

Results

Cytomatrix demonstrated an accuracy of 96%, sensitivity of 84.61%, and specificity of 100%. Concordance between cytological and histopathological findings highlighted Cytomatrix's potential to enhance thyroid FNAC accuracy.

Conclusion

FNAC using Cytomatrix shows promise in improving diagnostic accuracy for thyroid nodules. Its application, marked by faster processing and efficient resource utilization, coupled with the preservation of cellular architecture, holds considerable potential in enhancing cytological diagnosis, thus optimizing patient management strategies.

Recurrent Cervical Lymphadenitis Responding to Antibiotics Turned Out to Be Lymphoma on Biopsy: A Case Report

Recurrent cervical lymphadenitis is a common clinical presentation often managed with empiric antibiotic therapy. However, despite antibiotic treatment, persistent lymphadenopathy warrants consideration of alternative etiologies, including malignancy. We present the case of a 71-year-old female with recurrent cervical lymphadenitis that initially responded to antibiotics but was ultimately diagnosed as lymphoma upon biopsy. Despite conservative management, the patient's symptoms persisted, prompting surgical excision of the lymph node. Histopathological examination confirmed the lymphoma diagnosis, highlighting the importance of considering malignancy in cases of persistent lymphadenitis. This case underscores the significance of prompt evaluation, including biopsy, to ensure timely diagnosis and appropriate management in patients with recurrent cervical lymphadenitis.

Incidence and Malignancy Rates in Thyroid Nodules in North-East Indian Population by Bethesda System: A Single Institutional Experience of 3 Years

Suvamoy ChakrabortyIntroduction  Goiter is one of the most common conditions encountered clinically (up to 60% of population) with thyroid malignancy being one of the most common endocrine malignancies. The American Thyroid Association has advocated the need for validation of the Bethesda system of fine needle aspiration cytology (FNAC) in each center. The risk of malignancy (ROM) for Bethesda categories in the Indian population is limited. Objective  As there are variations in the effectiveness of FNAC, this study aims to study the role of FNAC in evaluating thyroid nodules, estimating the risk of malignancy in thyroid nodules in the North-East Indian population, and correlating the FNAC findings with HPE (histopathological examination). Materials and Methods  A total of 110 patients with thyroid nodules had visited the Department of Otorhinolaryngology during 2017-2020. Case records were retrieved, out of which only 66 patients had both FNAC and HPE reports. The FNAC of 66 patients were studied. Statistical Analysis  Data were analyzed using STATA V14. Fischer's exact test was used to determine the association of Bethesda system in diagnosing thyroid malignancy. The percentage agreement between the FNAC and HPE was calculated using the Kappa statistics. The diagnostic validity of FNAC in the diagnosis of malignant thyroid nodule was reported. Results  The sensitivity, specificity, PPV, and NPV of FNAC in diagnosing thyroid malignancy were 52%, 94.3%, 89%, and 69% respectively. The risk of malignancy (ROM) for Bethesda I to VI categories in our study was 20%, 25%, 67%, 40%, 78%, and 100% respectively ( p -value < 0.001, Fischer's exact test). Conclusion  A specificity of 94.3% and PPV of 89% of FNAC makes it a good reliable tool in ruling in malignancy in our population. The higher ROM in indeterminate categories necessitates the need to consider thyroidectomy with or without intraoperative frozen section analysis in our population. Similar higher ROM has been reported in a few other Indian studies. These findings may suggest an increased ROM for Bethesda categories III and IV in the Indian population; however, the statement needs further validation from large multicentric studies with research to find the reason for the increased risk.

Interobserver variability in inconclusive diagnostic categories of thyroid fine needle aspiration cytology: An urban-based tertiary hospital experience

INTRODUCTION

Thyroid nodules are typical lesions, usually non-malignant, and surgery is unnecessary in most patients. However, distinguishing between benign and malignant is challenging. Fine needle aspiration cytology (FNAC) is considered a primary diagnostic and prognostic tool with an effective cost for evaluating thyroid enlargement. Unfortunately, using FNAC to diagnose inconclusive lesions in the category III-Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS) based on TBSRTC classification is a problematic issue. This study aimed to evaluate the interobserver variability of AUS/FLUS interpretation among pathologists.

METHODS

A retro-observational study: previous 127 AUS/FLUS cases were enrolled. Seventy-two cases met inclusion criteria and were then reclassified by different anatomical pathologists under blinded-design assignments. The concordance among pathologists and the percent alteration of the risk of malignancy (ROM) were compared to the original reports and histological diagnosis.

RESULTS

About 72 % of AUS/FLUS cases were changed after the reclassification. Approximately 46 % were changed to benign while 12.5 % were reclassified as carcinoma. Moreover, 30 % of those original AUS/FLUS were histologically diagnosed as malignant or carcinoma lesions. The concordances among consensus diagnosis and results from each pathologist are acceptable, Kappa(s) were 0.674 to 0.898 (p < 0.001) and Spearman correlations were 0.820 to 0.957 (p < 0.0001).

CONCLUSION

There are substantial interobserver differences and changes in cytological diagnosis when re-evaluation is performed by multiple pathologists using TBSRTC. A second or third opinion should be sought routinely to establish a consensus diagnosis as a supplement to the initial diagnosis of AUS/FLUS. The reclassification reduces medical expenses and the rate of unnecessary surgery, especially in patients with cytologically confirmed benign thyroid nodules. Preoperative molecular evaluation is a promising method for assisting in the diagnosis of thyroid nodules, but additional research is necessary.

BRAF V600E mutation and the Bethesda System for Reporting Thyroid Cytopathology of fine-needle aspiration biopsy for distinguishing benign from malignant thyroid nodules

BACKGROUND

The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) predicts the risk of malignancy for the different categories of the ultrasound-guided fine-needle aspiration biopsy (FNAB). The objective of this study is to investigate the efficiencies of the v-raf murine sarcoma viral oncogene homolog B1 (BRAF) V600E mutation test and the TBSRTC categories in distinguishing between benign and malignant thyroid nodules.

METHODS

In this study, 362 ultrasound-guided fine-needle aspiration (FNA) samples from 344 patients aged from 17 to 76 years old were retrospectively reviewed. The patients were classified into six groups (I-VI) according to the TBSRTC system. The amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) was used to evaluate the BRAF V600E mutation level in total 362 samples. Among of the 344 patients, 128 patients (131 thyroid nodules) who underwent surgeries were followed by histopathological examination. The predictive values of the BRAF V600E mutation test and TBSRTC categories were evaluated in these 131 thyroid nodules.

RESULTS

The median ages of the patients in the TBSRTC IV-VI group were smaller than those in the TBSRTC I-III groups. The proportion of nodules over 1 cm was larger than it in the TBSRTC IV group compared to the other groups. Significant differences in BRAF V600E mutation were observed (P < .001) among these six groups. The sensitivity (89.57%) for the detection of malignant thyroid nodules, negative predictive value (NPV; 45.45%) for the detection of benign nodules, and accuracy (86.26%) for distinguishing between benign and malignant thyroid nodules increased by combining the BRAF V600E mutation test and TBSRTC system when compared with the BRAF V600E mutation test and TBSRTC system respectively. The BRAF V600E mutation test alone demonstrated the increased positive predictive value (PPV; 98.91%) and specificity (93.75%) for the detection of malignant thyroid nodules compared to the TBSRTC method (alone or in combination with the BRAF V600E method).

CONCLUSION

In summary, significant differences in age, nodule diameter, and BRAF V600E mutation were noted among the six categories of the TBSRTC system. The combination of the BRAF V600E mutation test and TBSRTC system demonstrated increases in the NPV, sensitivity, and accuracy, while the BRAF V600E method proved superiority to the TBSRTC system with regard to the PPV and specificity.

Malignancy rates in thyroid nodules classified as Bethesda categories III and IV; a subcontinent perspective

BACKGROUND

Bethesda category III and IV thyroid nodules fall in the indeterminate risk of malignancy category. These nodules have been a relatively elusive entity to manage as previous studies have shown a wide variation in malignancy rates in different regions and institutions across the world. However, data from the subcontinent with regards to this is scarce.

AIM AND OBJECTIVE

This study aimed to determine the characteristics and malignancy rates of cytology proven Bethesda Category III and IV thyroid nodules and its association with clinical, histopathological and laboratory variables, in the regional population.

METHOD

A retrospective search was performed on all patients with thyroid nodules who presented to this hospital, from January 2011 to September 2018. Patients who had cytology proven Bethesda category III and IV thyroid nodules that underwent surgery were included in the study.

RESULTS

Malignancy in Bethesda Category III and Bethesda Category IV thyroid nodules was 29.6% and 47.1%, respectively. There was no significant association determined between malignancy rate and various clinical, histopathological, and radiological characteristics.

CONCLUSION

The malignancy rates in Bethesda category III and IV thyroid nodules in this study are significantly higher than that initially suggested by the Bethesda consensus publication but is comparable to international data present.

Indian experience of AUS/FLUS diagnosis: is it different from rest of Asia and the West?-A systematic review and meta-analysis

Background

Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is the most heterogeneous subcategory of the Bethesda system for thyroid cytopathology with laid down permissible limits of frequency and risk of malignancy (ROM). Due to differences in thyroid clinical practice worldwide, variations have been found in frequency, resection rates (RR) and ROM. Therefore, this systematic review and meta-analysis of AUS/FLUS across different regions was conducted and comparison of data from India was done with the rest of Asia and the West.

Methods

We searched PubMed and Google search engines from January 2009-Dec 2019 using terms "AUS Thyroid" and "FLUS Thyroid". Meta-analysis was performed using DerSimonian-Laird method and 95% confidence intervals were calculated using random effects model. Independent samples t-test was used to compare frequency, RR, and ROM of AUS/FLUS between India, rest of Asia and the West.

Results

Out of 15,000 studies on internet, 60 (18 Indian, 12 Asian and 30 Western) were included. Total aspirates were 201,657; 14,279 Indian, 62,448 Asian, 124,930 Western. Pooled estimates were: frequency 7.3% (6.3-8.3%), RR 41.9% (37.4-46.6%), ROM 33.3% (26.8-39.9%). Pooled prevalence of rate did not vary significantly across the three regions. Pooled prevalence of RR was highest in India (52.9%) and lowest in rest of Asia (26.5%); of ROM was highest in Asia (45.9%), lowest in the West (26.3%) (P<0.01). Statistical analysis demonstrated publication bias, limited to Indian and Western studies. Papillary thyroid carcinoma was the most common surgical diagnosis (87.9%; 1,082/1,231).

Conclusions

This meta-analysis showed differences in thyroid clinical practice followed in India, rest of Asia and the West. Although pooled prevalence of rate of AUS/FLUS was similar across the three, pooled RR and ROM varied. AUS/FLUS nodules were more frequently resected in Indian and Western studies than in rest of Asia. ROM was higher than recommended values in all three areas, being intermediate for India.

Thyroid Cytology in India: Contemporary Review and Meta-analysis

Fine-needle aspiration cytology (FNAC) is a screening test for triaging thyroid nodules, aiding in subsequent clinical management. However, the advantages have been overshadowed by the multiplicity of reporting systems and a wide range of nomenclature used. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was formulated in 2007, to give the world a uniform thyroid cytology reporting system, facilitating easy interpretation by the clinicians. Here, we review the status of thyroid FNAC in India in terms of various reporting systems used including a meta-analysis of the previously published data. An extensive literature search was performed using internet search engines. The reports with detailed classification system used in thyroid cytology were included. The meta-analysis of published data was compared with the implied risk of malignancy by TBSRTC. More than 50 studies were retrieved and evaluated. TBSRTC is currently the most widely used reporting system with different studies showing good efficacy and interobserver concordance. Ancillary techniques have, as of now, limited applicability and acceptability in thyroid cytology in India. Twenty-eight published articles met the criteria for inclusion in the meta-analysis. When compared with TBSRTC recommendations, the meta-analysis showed a higher risk of malignancy for categories I and III. Thyroid FNAC is practiced all over India. TBSRTC has found widespread acceptance, with most institutions using this system for routine thyroid cytology reporting. However, reasons for a high malignancy risk for categories I and III need to be looked into. Various possible contributing factors are discussed in the review.