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Latia M, Borlea A, Mihuta MS, Neagoe OC, Stoian D. Impact of ultrasound elastography in evaluating Bethesda category IV thyroid nodules with histopathological correlation. Front Endocrinol (Lausanne) 2024; 15:1393982. [PMID: 38863927 PMCID: PMC11165070 DOI: 10.3389/fendo.2024.1393982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
Introduction Fine needle aspiration (FNA) is the gold standard method recommended in the diagnosis of thyroid nodules. Bethesda IV cytology results are identified in 7-9% of nodules investigated through FNA, with reported malignancy rate in a wide range of 10-40%. The recommended treatment is either surgical or risk additional molecular testing before surgery. However, a large number of nodules belonging to this category (60-80%) are observed to be benign after surgical excision, which can put the patient at risk of unnecessary surgical morbidity. This study aimed to assess the diagnostic performance of conventional ultrasound, the ACR TI-RADS score and elastography in cases of Bethesda IV cytology on FNA. Methods We evaluated ninety-seven consecutive cases with Bethesda category IV results on FNA by using conventional B-mode ultrasound, qualitative strain or shear-wave elastography (Hitachi Preirus Machine, Hitachi Inc., Japan and Aixplorer Mach 30 Supersonic Imagine, Aix-en-Provence, France) and all nodules were classified according to the ACR TI-RADS system. Conventional ultrasound was used to categorize the nodules as potentially malignant based on the following features: hypoechogenicity, inhomogeneity, a taller than wide shape, irregular margins, presence of microcalcifications, an interrupted thyroid capsule and suspicious cervical lymph nodes. Elastography classified nodules with increased stiffness as suspicious for malignancy. Results We considered pathology results as the gold standard diagnosis, finding that 32 out of 97 nodules were carcinomas (33%) and 65 out of 97 were benign nodules (67%). The benign group included twenty cases of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Finally, we compared ultrasound data with pathology results, which showed that nineteen out of the 32 malignant nodules presented with increased stiffness on elastography (p=0.0002). On conventional ultrasound, we found that microcalcifications (p=0.007), hypoechogenicity and irregular margins (p=0.006) are features which can distinguish between benign and malignant nodules with statistical significance. Discussion Integrating elastography as a parameter of the ACR TI-RADS score in the evaluation of Bethesda category IV nodules showed a sensitivity of 90.62% in detecting thyroid cancer cases (p=0.006). We can conclude that elastographic stiffness as an addition to high risk features observed on conventional ultrasound improves the detection of malignant nodules in cases with Bethesda IV cytology.
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Affiliation(s)
- Monica Latia
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Dr. D Medical Center, Center for Advanced Ultrasound Evaluation, Timisoara, Romania
| | - Andreea Borlea
- Dr. D Medical Center, Center for Advanced Ultrasound Evaluation, Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- 2 Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Monica Simina Mihuta
- Dr. D Medical Center, Center for Advanced Ultrasound Evaluation, Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Octavian Constantin Neagoe
- Dr. D Medical Center, Center for Advanced Ultrasound Evaluation, Timisoara, Romania
- 1 Department of Surgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Second Clinic of General Surgery and Surgical Oncology, Emergency Clinical Municipal Hospital, Timisoara, Romania
| | - Dana Stoian
- Dr. D Medical Center, Center for Advanced Ultrasound Evaluation, Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- 2 Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Endocrinology Unit, Pius Brinzeu Emergency Clinical Hospital, Timisoara, Romania
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Alyusuf EY, Alhmayin L, Albasri E, Enani J, Altuwaijri H, Alsomali N, Arafah MA, Alyusuf Z, Jammah AA, Ekhzaimy AA, Alzahrani AS. Ultrasonographic predictors of thyroid cancer in Bethesda III and IV thyroid nodules. Front Endocrinol (Lausanne) 2024; 15:1326134. [PMID: 38405143 PMCID: PMC10884110 DOI: 10.3389/fendo.2024.1326134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Background Bethesda III and IV thyroid nodules continue to be difficult to manage. Although molecular testing may assist in decision-making, it is expensive, not widely available, and not without pitfalls. The objective of this study is to assess whether certain thyroid ultrasonographic features may predict the risk of thyroid cancer in patients with Bethesda III and IV thyroid nodules and be used as additional decision-making tools to complement cytopathological results in deciding on diagnostic thyroidectomy. Methods We retrospectively evaluated the ultrasonographic features of Bethesda categories III and IV thyroid nodules in patients who underwent subsequent thyroidectomy. We used the final histopathological examination of the surgical specimens as the gold-standard test and analyzed individual preoperative ultrasonographic features as predictors of malignancy. Results Of the 278 patients who were diagnosed with Bethesda III and IV thyroid nodules on fine needle aspiration cytology (FNAC), 111 (39.9%) had thyroid cancer, and 167 (59.9%) exhibited benign nodules. The malignancy rate was higher in patients with Bethesda IV nodules (28/50, 56%) than those with Bethesda III nodules (83/228, 36.4%; p=0.016). In univariate analysis, hypoechogenicity (55.6% in malignant vs. 35.3% in benign, p=0.006) and calcifications (54.5 in malignant vs. 35.4% in benign, p=0.008) were significantly different between the benign and malignant pathology groups, whereas the size of the dominant nodule, number of nodules, irregular borders, taller-than-wide shape, and the presence of lymph nodes were comparable between the two groups. These two ultrasonographic features (hypoechogenicity and calcifications) remained significantly associated with the risk of malignancy in multivariate logistic regression analysis (for hypoechogenicity, p=0.014, odds ratio: 2.1, 95% CI:1.0-3.7 and for calcifications, p=0.019, odds ratio: 1.98, 95% CI:1.12-3.50). The sensitivity, specificity, positive and negative predictive values, and accuracy were 31.5%, 83%, 55.6%,64.7%, and 62.6%, for hypoechogenicity, respectively and 32.4%, 82%, 54.5%, 67.8%, and 62%, for calcification, respectively. Conclusions Hypoechogenicity and calcifications in Bethesda III and IV thyroid nodules are strong predictors of thyroid cancer and associated with a two-fold increased risk of malignancy.
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Affiliation(s)
- Ebtihal Y. Alyusuf
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
- Division of Endocrinology, Department of Internal Medicine, Salmanyia Medical Complex, Government Hospitals, Manama, Bahrain
| | - Lama Alhmayin
- Department of Internal Medicine, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Eman Albasri
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Jawaher Enani
- Department of Internal Medicine, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hessa Altuwaijri
- Department of Internal Medicine, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Nora Alsomali
- Department of Internal Medicine, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Maria A. Arafah
- Department of Pathology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Zahra Alyusuf
- Department of Radiology, Salmanyia Medical Complex, Government Hospitals, Manama, Bahrain
| | - Anwar A. Jammah
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Aishah A. Ekhzaimy
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ali S. Alzahrani
- Division of Molecular Endocrinology, Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Vargas-Uricoechea H. Autoimmune Thyroid Disease and Differentiated Thyroid Carcinoma: A Review of the Mechanisms That Explain an Intriguing and Exciting Relationship. World J Oncol 2024; 15:14-27. [PMID: 38274715 PMCID: PMC10807914 DOI: 10.14740/wjon1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/24/2023] [Indexed: 01/27/2024] Open
Abstract
Autoimmune thyroid disease is a complex and highly frequent disease, where a wide variety of genetic, epigenetic and environmental factors (among others) come together and interact, and is characterized by the presence of two clinical outcomes: hypothyroidism (in Hashimoto's thyroiditis) and hyperthyroidism (in Graves-Basedow disease). For its part, differentiated thyroid carcinoma (mainly papillary carcinoma) is the most common type of cancer affecting the thyroid (and one of the most prevalent worldwide). An important co-occurrence between autoimmune thyroid disease and differentiated thyroid carcinoma has been documented. In this article, studies that have evaluated possible associations and relationships between autoimmune thyroid disease and differentiated thyroid cancer are systematically described and summarized. To date, the underlying mechanism that explains this association is inflammation; however, the characteristics and designs of the studies evaluated do not yet allow a causal relationship between the two entities to be established. These aspects have made it difficult to establish "causality" in the continuum of the pathogenesis between both conditions.
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Affiliation(s)
- Hernando Vargas-Uricoechea
- Metabolic Diseases Study Group, Department of Internal Medicine, Universidad del Cauca, Popayan, Colombia.
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Riju J, Thomas N, Paul TV, Abraham DT, Pai R, Prabhu AJ, Jacob PM, Rajan R, Michael RC, Tirkey AJ, Ramalingam N, Asha HS, Kapoor N. Role of Genetic Testing in the Management of Indeterminate Thyroid Nodules in the Indian Setting. Indian J Endocrinol Metab 2024; 28:3-10. [PMID: 38533287 PMCID: PMC10962768 DOI: 10.4103/ijem.ijem_415_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/15/2023] [Accepted: 01/20/2024] [Indexed: 03/28/2024] Open
Abstract
The increased detection of thyroid nodules in the human population has led to an increase in the number of thyroid surgeries without an improvement in survival outcomes. Though the choice for surgery is straightforward in malignant thyroid nodules, the decision is far more complex in those nodules that get categorized into indeterminate thyroid nodules (ITN) by fine needle aspiration. Therefore, there is a pressing need to develop a tool that will aid in decision-making among the ITN. In this context, the development of various molecular testing (MT) panels has helped to confirm or rule out malignancy, reducing unnecessary surgeries and potentially guiding the extent of surgery as well. Currently, such tests are widely used among the Western population but these MT panels are not used by the South Asian population because of non-availability of validated panels and the high cost involved. There is a need to develop a suitable panel which is population-specific and validate the same. In this review, we would focus on current trends in the management of ITN among the South Asian population and how to develop a novel MT panel which is cost-effective, with high diagnostic accuracy obviating the need for expensive panels that already exist.
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Affiliation(s)
- Jeyashanth Riju
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas V. Paul
- Department of Endocrinology Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepak Thomas Abraham
- Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rekha Pai
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anne J. Prabhu
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Remya Rajan
- Department of Endocrinology Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajiv C. Michael
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amit Jiwan Tirkey
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Natarajan Ramalingam
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Hesarghatta S. Asha
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
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Xing Z, Qiu Y, Zhu J, Su A, Wu W. Diagnostic performance of ultrasound risk stratification systems on thyroid nodules cytologically classified as indeterminate: a systematic review and meta-analysis. Ultrasonography 2023; 42:518-531. [PMID: 37697824 PMCID: PMC10555695 DOI: 10.14366/usg.23055] [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: 03/27/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 09/13/2023] Open
Abstract
PURPOSE Ultrasound (US) risk stratification systems (RSSs) are increasingly being utilized for the optimal management of thyroid nodules, including those with indeterminate cytology. The goal of this study was to evaluate the category-based diagnostic performance of US RSSs in identifying malignancy in indeterminate nodules. METHODS This systematic review and meta-analysis was registered on PROSPERO (CRD42021266195). PubMed, EMBASE, and Web of Science were searched through December 1, 2022. Original articles reporting data on the performance of US RSSs for indeterminate nodules were included. The numbers of nodules classified as true negative, true positive, false negative, and false positive were extracted. RESULTS Thirty-three studies evaluating 7,225 indeterminate thyroid nodules were included. The diagnostic accuracy was quantitatively synthesized using a Bayesian bivariate model based on the integrated nested Laplace approximation in R. For the intermediate- to high-risk category, the sensitivity levels of the American College of Radiology, the American Thyroid Association, the European Thyroid Association, the Korean Thyroid Association/Korean Society of Thyroid Radiology, and Kwak et al. were found to be 0.80, 0.72, 0.76, 0.96, and 0.97, respectively. The corresponding specificity measurements were 0.36, 0.50, 0.49, 0.28, and 0.17. Furthermore, for the high-risk category, the sensitivity values were 0.40, 0.46, 0.55, 0.47, and 0.10, while the specificity levels were 0.91, 0.90, 0.71, 0.91, and 0.99, respectively. CONCLUSION The overall diagnostic performance of the US RSSs was moderate in the differentiation of indeterminate nodules.
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Affiliation(s)
- Zhichao Xing
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxuan Qiu
- Ultrasound Department, West China Hospital, Sichuan University, Chengdu, China
| | - Jingqiang Zhu
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Anping Su
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wenshuang Wu
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
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Antonia TD, Maria LI, Ancuta-Augustina GG. Preoperative evaluation of thyroid nodules - Diagnosis and management strategies. Pathol Res Pract 2023; 246:154516. [PMID: 37196471 DOI: 10.1016/j.prp.2023.154516] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/06/2023] [Indexed: 05/19/2023]
Abstract
Thyroid cancer is the most common endocrine malignancy, with increasing incidence over the past few decades. Fine needle aspiration (FNA) biopsy is the gold standard for preoperative diagnosis of thyroid malignancies. Nevertheless, this method renders indeterminate results in up to 30% of the cases. Therefore, these patients are often referred to unnecessary surgery to establish the diagnosis. To improve the accuracy of preoperative diagnosis, several other ways, such as ultrasonography, elastography, immunohistochemical analysis, genetic testing, and core needle biopsy, have been developed and can be used either in association with or as an alternative to FNA. This review aims to evaluate all these diagnostic tools to determine the most appropriate way of managing thyroid nodules and subsequently improve the selection of cases referred to surgery.
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Affiliation(s)
- Tapoi Dana Antonia
- Carol Davila University of Medicine and Pharmacy, Department of Pathology, Bucharest, Romania; University Emergency Hospital, Department of Pathology, Bucharest, Romania
| | - Lambrescu Ioana Maria
- Carol Davila University of Medicine and Pharmacy, Department of Cellular and Molecular Biology and Histology, Bucharest, Romania; Victor Babes National Institute of Pathology, Bucharest, Romania.
| | - Gheorghisan-Galateanu Ancuta-Augustina
- Carol Davila University of Medicine and Pharmacy, Department of Cellular and Molecular Biology and Histology, Bucharest, Romania; CI Parhon National Institute of Endocrinology, Bucharest, Romania
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Chakraborty S, Balakrishnan MC, Raphael V, Tamuli P, Deka A. Incidence and Malignancy Rates in Thyroid Nodules in North-East Indian Population by Bethesda System: A Single Institutional Experience of 3 Years. South Asian J Cancer 2023; 12:166-172. [PMID: 37969686 PMCID: PMC10635768 DOI: 10.1055/s-0042-1757776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
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.
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Affiliation(s)
- Suvamoy Chakraborty
- Department of Otorhinolaryngology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Manu C. Balakrishnan
- Department of Otorhinolaryngology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Vandana Raphael
- Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Prachurya Tamuli
- Department of Otorhinolaryngology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Anuradha Deka
- Department of Otorhinolaryngology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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Zhou L, Zheng LL, Zhang CJ, Wei HF, Xu LL, Zhang MR, Li Q, He GF, Ghamor-Amegavi EP, Li SY. Comparison of S-Detect and thyroid imaging reporting and data system classifications in the diagnosis of cytologically indeterminate thyroid nodules. Front Endocrinol (Lausanne) 2023; 14:1098031. [PMID: 36761203 PMCID: PMC9902707 DOI: 10.3389/fendo.2023.1098031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the value of S-Detect for predicting the malignant risk of cytologically indeterminate thyroid nodules (CITNs). METHODS The preoperative prediction of 159 CITNs (Bethesda III, IV and V) were performed using S-Detect, Thyroid Imaging Reporting and Data System of American College of Radiology (ACR TI-RADS) and Chinese TI-RADS (C-TIRADS). First, Linear-by-Linear Association test and chi-square test were used to analyze the malignant risk of CITNs. McNemar's test and receiver operating characteristic curve were used to compare the diagnostic efficacy of S-Detect and the two TI-RADS classifications for CITNs. In addition, the McNemar's test was used to compare the diagnostic accuracy of the above three methods for different pathological types of nodules. RESULTS The maximum diameter of the benign nodules was significantly larger than that of malignant nodules [0.88(0.57-1.42) vs 0.57(0.46-0.81), P=0.002]. The risk of malignant CITNs in Bethesda system and the two TI-RADS classifications increased with grade (all P for trend<0.001). In all the enrolled CITNs, the diagnostic results of S-Detect were significantly different from those of ACR TI-RADS and C-TIRADS, respectively (P=0.021 and P=0.007). The sensitivity and accuracy of S-Detect [95.9%(90.1%-98.5%) and 88.1%(81.7%-92.5%)] were higher than those of ACR TI-RADS [87.6%(80.1%-92.7%) and 81.8%(74.7%-87.3%)] (P=0.006 and P=0.021) and C-TIRADS [84.3%(76.3%-90.0%) and 78.6%(71.3%-84.5%)] (P=0.001 and P=0.001). Moreover, the negative predictive value and the area under curve value of S-Detect [82.8% (63.5%-93.5%) and 0.795%(0.724%-0.855%)] was higher than that of C-TIRADS [54.8%(38.8%-69.8%) and 0.724%(0.648%-0.792%] (P=0.024 and P=0.035). However, the specificity and positive predictive value of S-Detect were similar to those of ACR TI-RADS (P=1.000 and P=0.154) and C-TIRADS (P=1.000 and P=0.072). There was no significant difference in all the evaluated indicators between ACR TI-RADS and C-TIRADS (all P>0.05). The diagnostic accuracy of S-Detect (97.4%) for papillary thyroid carcinoma (PTC) was higher than that of ACR TI-RADS (90.4%) and C-TIRADS (87.8%) (P=0.021 and P=0.003). CONCLUSION The diagnostic performance of S-Detect in differentiating CITNs was similar to ACR TI-RADS and superior to C-TIRADS, especially for PTC.
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Affiliation(s)
- Ling Zhou
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lin-Lin Zheng
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chuan-Ju Zhang
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hong-Fen Wei
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li-Long Xu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mu-Rui Zhang
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiang Li
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gao-Fei He
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | | | - Shi-Yan Li
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Pereira C. Malignancy Rates in Thyroid Nodules Classified as Bethesda III and IV; Correlating Fine Needle Aspiration Cytology with Histopathology. Prague Med Rep 2022; 123:243-249. [DOI: 10.14712/23362936.2022.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Fine needle aspiration cytology (FNAC) is an integral part in the diagnostic work up of thyroid nodules. FNAC reports are based on Bethesda system for thyroid cytopathology which is one of the most commonly used systems worldwide. The main objective of the present study was to evaluate the malignancy rates in Bethesda category III and IV thyroid nodules over a six-year period. 642 thyroid FNAC were performed over a six-year period. The medical records of all these patients were reviewed using electronic patient records. Cases reported to have Bethesda category III and IV were included in the study. Data for these patients were reviewed to determine the relationship between these categories and thyroid cancer. There were 41 cases of category III of which 19 underwent surgery and the malignancy rates were found to be 26.3%. Category IV consisted of 50 cases of which 45 underwent surgery and the malignancy rates were 26.6%. The results from our study are similar to findings in larger multicentric studies which found that malignancy rates for Bethesda category III and IV were 10–30% and 25–40%, respectively.
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Erdogan-Durmus S, Balta H, Demirtas R, Kurt A. Malignancy Rates of Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS) Cases: A Tertiary Center Study. ACTA ENDOCRINOLOGICA-BUCHAREST 2021; 17:77-82. [PMID: 34539913 DOI: 10.4183/aeb.2021.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aim To evaluate the malignancy rates of Atypia of undetermined significance /follicular lesion of undetermined significance (AUS/FLUS) cases in the light of clinical and sonographic features. Material and Methods The percentage of AUS/FLUS cases, second fine needle aspiration cytology (FNAC) results, cyto-histopathological correlations and risk of malignancy were analyzed. Results 113 out of 1461 thyroid FNAC samples (7.7%) were diagnosed as AUS/FLUS and included in the study. Seventy three out of 113 cases (64.6 %) underwent repeat biopsies or surgery. From 45 cases repeat biopsies were taken and 28 had thyroidectomy or lobectomy. There was a significant relation between nodule size and underwent surgery or repeat FNAC (p=0.036). Malignancy rate was 24.6% for cases which had any managements. The malignancy rates were higher in AUS/FLUS cases with cytological atypia (28.8%). After surgery the most common malignancy was papillary thyroid carcinoma, followed by follicular carcinoma. Conclusion The risk of malignancy of AUS/FLUS cases is quite high because of the heterogeneity of the group. The sub-classification of this category according to cytological or/and architecture atypia may be more useful in predicting malignancy risk. Further larger studies with ancillary techniques including molecular analysis may be more useful in determining the malignancy risk and appropriate management of this heterogeneous category.
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Affiliation(s)
- S Erdogan-Durmus
- Istanbul University - Cerrahpasa, Faculty of Medicine - Cytopathology, Istanbul
| | - H Balta
- Firat University, School of Medicine - Pathology, Elazig
| | - R Demirtas
- Erzurum Training and Research Hospital - Pathology, Erzurum, Turkey
| | - A Kurt
- Erzurum Training and Research Hospital - Pathology, Erzurum, Turkey
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11
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Sakthisankari S, Vidhyalakshmi S, Shanthakumari S, Devanand B, Nagul U. The combination of ACR-Thyroid Imaging Reporting and Data system and The Bethesda System for Reporting Thyroid Cytopathology in the evaluation of thyroid nodules-An institutional experience. Cytopathology 2021; 32:472-481. [PMID: 33606346 DOI: 10.1111/cyt.12967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/31/2021] [Accepted: 02/12/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is widely utilised by cytopathologists. The American College of Radiology (ACR) has also proposed a thyroid imaging reporting and data system (TIRADS) to classify thyroid nodules and guide their selection for fine needle aspiration (FNA). The current study aimed to analyse the usefulness of TBSRTC in thyroid cytology reporting, to examine its histological correlation with TIRADS, and to compare the management of lesions in each cytological category in our institute to the TBSRTC recommendations. MATERIALS AND METHODS A retrospective study was performed on all thyroid FNAs from a 2-year period at a tertiary care centre. Histological correlations of TBSRTC and ACR TIRADS were examined for cases with surgical follow-up, and the risk of malignancy in each TBSRTC category, and sensitivity and specificity of FNA and TIRADS, were calculated. RESULTS A total of 337 thyroid FNAs were examined, with histological follow-up in 99 cases. Risk of malignancy in categories I-VI was 9.5%, 2.3%, 0.0, 8%, 87.5% and 100.0%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of FNA were 60.0%, 99.0%, 85.7%, and 97.5%, respectively, while those values for thyroid ultrasound were 90.3%, 72.2%, 92.9% and 65%, respectively. CONCLUSION The study substantiates the usefulness of TBSRTC in arriving at a more precise diagnosis. Hurthle cell lesions with atypia were the common cause of misdiagnosis. The combination of TIRADS and TBSRTC aids in better stratification of thyroid nodules and in decision making for management of lesions.
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Affiliation(s)
| | | | | | - Balalakshmoji Devanand
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, India
| | - Udayasankar Nagul
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, India
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12
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Al-Salam S, Sharma C, Abu Sa’a MT, Afandi B, Aldahmani KM, Al Dhaheri A, Yahya H, Al Naqbi D, Al Zuraiqi E, Mohamed BK, Almansoori SA, Al Zaabi M, Al Derei A, Al Shamsi A, Kaabi JA. Ultrasound-guided fine needle aspiration cytology and ultrasound examination of thyroid nodules in the UAE: A comparison. PLoS One 2021; 16:e0247807. [PMID: 33826647 PMCID: PMC8026079 DOI: 10.1371/journal.pone.0247807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/12/2021] [Indexed: 01/12/2023] Open
Abstract
Background Thyroid nodules are a common clinical finding and most are benign, however, 5–15% can be malignant. There is limited regional data describing the accuracy of ultrasound-guided fine needle aspiration (FNA) cytological examination compared to ultrasound examination of thyroid in patients who have undergone thyroid surgery. Methods A retrospective analysis of ultrasonographic (US) reports, FNA cytology reports and histopathology reports of 161 thyroid nodules presented at the endocrine center at Tawam hospital in Al Ain city, the United Arab Emirates during the period 2011–2019 was performed. US reports and images with FNA cytopathology reports and slides were reviewed by an independent radiologist and pathologist. Results In total, 40 nodules were reported as benign by US examination, while very low suspicious, low suspicious, intermediate suspicious and highly suspicious categories were reported in 21, 41, 14 and 45 nodules respectively. In addition, 68 nodules were reported as benign (Bethesda category II), while atypical follicular cells of unknown significance (Bethesda category III), follicular neoplasm (Bethesda category IV), suspicious for malignancy (Bethesda category V), and malignant (Bethesda category VI) categories were reported in 33, 9, 24 and 27 nodules respectively. The risk of malignancy for US benign nodules was 5%, while the risks of malignancy in very low suspicious, low suspicious, intermediate suspicious and highly suspicious nodules were 52%, 36%, 100% and 87%, respectively. The risk of malignancy for Bethesda category II was 3%, while the risks of malignancy in category III, IV, V and VI were 58%, 67%, 96% and 100%, respectively. Conclusion Thyroid FNA cytological examination and ultrasonography are key tools in predicting malignancy in thyroid nodules. Thyroid nodules with the diagnosis of Bethesda category III & IV run a high risk of malignancy thus more vigilance is required.
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Affiliation(s)
- Suhail Al-Salam
- Department of Pathology, College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Charu Sharma
- Department of Internal Medicine, College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Bachar Afandi
- Endocrine Division–Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Alia Al Dhaheri
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hayat Yahya
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Duha Al Naqbi
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Esraa Al Zuraiqi
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Baraa Kamal Mohamed
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Shamsa Ahmed Almansoori
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Meera Al Zaabi
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Aysha Al Derei
- College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Amal Al Shamsi
- Department of Internal Medicine, College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Juma Al Kaabi
- Department of Internal Medicine, College of Medicine& Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- * E-mail:
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13
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Zahid A, Shafiq W, Nasir KS, Loya A, Abbas Raza S, Sohail S, Azmat U. Malignancy rates in thyroid nodules classified as Bethesda categories III and IV; a subcontinent perspective. J Clin Transl Endocrinol 2021; 23:100250. [PMID: 33643850 PMCID: PMC7887641 DOI: 10.1016/j.jcte.2021.100250] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Adnan Zahid
- Internal Medicine Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre
| | - Waqas Shafiq
- Internal Medicine Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre
| | - Khawaja Shehryar Nasir
- Internal Medicine Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre
| | - Asif Loya
- Pathology Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre
| | - Syed Abbas Raza
- Internal Medicine Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre
| | - Sara Sohail
- Internal Medicine Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre
| | - Umal Azmat
- Internal Medicine Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre
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14
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Diagnostic Role of Cell-free DNA Integrity in Thyroid Cancer Particularly for Bethesda IV Cytology. Endocr Pract 2021; 27:673-681. [PMID: 33601025 DOI: 10.1016/j.eprac.2021.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The cell-free DNA integrity index (cfDI) is promising for the differentiation between malignant and benign tumors, but little data has been reported on thyroid cancer (TC). We explored its diagnostic role in TC, mainly in cases of Bethesda category IV. METHODS cfDI was evaluated by quantitative real-time polymerase chain reaction using 2 primer sets to identify cell-free DNAs (cfDNAs) Alu83 and Alu244. Blood samples were collected from 85 patients with thyroid nodules (18 papillary [PTC], 21 follicular [FTC], 21 medullary, and 25 benign thyroid nodules [BTN]) before fine-needle aspiration cytology and surgical treatment and also from 25 patients with autoimmune thyroid disease (ATD) and 25 healthy subjects (HS). RESULTS cfDNA Alu244 concentration ≥6.95 ng/mL and cfDI ≥0.3 were excellent sensitive and specific tests to discriminate TC particularly cytologically indeterminate thyroid nodules (Bethesda IV) from the control groups (BTN, ATD, and HS). The levels of both cfDNA Alu83 and Alu244 were decreased while cfDI was increased significantly in medullary compared with FTC and PTC, with a nonsignificant difference between the latter subgroups. There was a significantly positive correlation between both cfDNA Alu83 and Alu244 with the T-classification of TNM staging and capsular invasion among PTC and FTC patients and between cfDI with Bethesda categories. Additionally, ATD had significantly higher cfDNA Alu83 and lower cfDI than HS. CONCLUSION cfDI is a useful noninvasive molecular biomarker in TC that correlates with the Bethesda classification and histopathology. Tumor size and capsular invasion were correlated with quantitative cfDNA among PTC and FTC.
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15
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Kumar N, Gupta R, Gupta S. Molecular testing in diagnosis of indeterminate thyroid cytology: Trends and drivers. Diagn Cytopathol 2020; 48:1144-1151. [PMID: 32501611 DOI: 10.1002/dc.24522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 12/11/2022]
Abstract
Fine needle aspiration (FNA), the cornerstone of diagnosis in thyroid swellings, fails to render a definitive diagnosis in about 20% to 30% of cases that are reported as indeterminate on cytology. Since the clinical management in thyroid rests on the risk of malignancy (ROM) in a given nodule, this distinction between "benign" and "possibly malignant" assumes paramount clinical importance. Over the last two decades, tremendous progress has been achieved in our understanding of the molecular basis of thyroid pathologies leading to identification of several genetic alterations that could potentially be exploited for diagnostic, prognostic and therapeutic purposes. An array of molecular tests has hit the markets aiming to predict the ROM in thyroid nodules. A deeper understanding of the strengths and limitations of these tests is imperative to be able to judiciously choose the right molecular test in a given case for maximum clinical benefit. This narrative review provides an overview of current status of molecular testing in the evaluation of thyroid nodules encompassing the current status and applications of these tests in diagnostic, prognostic and therapeutic areas along with a brief insight into the future developments in this field.
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Affiliation(s)
- Neeta Kumar
- Department of Pathology, Faculty of Dentistry, Jamia Millia Islamia (Central University), New Delhi, India
| | - Ruchika Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Sanjay Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
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