BRAF
            V600E
            mutation analysis in fine‐needle aspiration cytology specimens for diagnosis of thyroid nodules: The influence of false‐positive and false‐negative results

Abstract Background Any nodules of the thyroid, ≥ 4 cm, are generally associated with false-negative results for malignancy on fine-needle aspiration cytology (FNAC), which generally are confirmed cases of malignancy after histopathologic examinations. Methods A retrospective hospital-based study was done in which data of patients having thyroid lesions ≥ 4 cm were reviewed. We checked the FNAC and histopathologic examination done on these lesions. Ultrasonography (USG)–guided aspiration records were also assessed. Sensitivity and specificity of FNAC for the detection of neoplastic or malignant lesions was determined. Results A total of 192 patients (57 female) were included in study. Preoperative fine-needle aspiration (FNA) biopsies were categorized as negative for malignancy (n = 183, 63%), suspicious (n = 6, 4%), and malignant (n = 4, 2%). Final pathology of nodule was found to be benign in 157 (81.35%) patients, whereas in 36 (18.65%) patients, nodules were found to be malignant. Conclusion In this study, we found the malignancy rate of thyroid nodules ≥ 4 cm to be similar to the accepted malignancy rate of smaller thyroid nodules. We missed 32 cases of malignancy on FNAC. Because of high incidence of thyroid malignancy, all nodules ≥ 4 cm must undergo histopathologic examination.

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A Study to Evaluate the Size of Thyroid Nodules as an Indicator for Malignancy

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.1.4 ◽

2020 ◽

Vol 3 (1) ◽

pp. 16-20

Author(s):

Ajay Kumar Jha ◽

Ajit Kumar Sinha

Keyword(s):

Thyroid Nodules ◽

Current Practice ◽

False Negative ◽

False Negative Rate ◽

Needle Aspiration ◽

Indication For Surgery ◽

Aspiration Cytology ◽

Fine Needle ◽

Risk Of Malignancy ◽

Needle Aspiration Cytology

Background: Several authors have questioned the accuracy of fine- needle aspiration cytology (FNAC) in large thyroid nodules. It’s the current practice to provide thyroidectomy to patient with thyroid nodules 4 cm or larger regardless of the FNAC results. The aim of the study is to answer two questions: is the size of nodule associated with higher risk of malignancy and is the size indication for surgery. Subjects and Methods: This study included 20 patients who underwent thyroidectomy. We compared all thyroid nodules with benign FNAC and their final histopathology reports. Patients were divided into two groups based on the size of the nodule (< 4cm or >4cm) and indication of surgery. Results: 20 patients with thyroid nodule underwent thyroid surgery. 13 patients had nodule <4cm and 7 patients were 4 cm. For patients with nodules <4 cm, 3 patients had a malignancy, and for those with nodules 4 cm, 1 patients had a malignancy. For benign cases FNAC and histopathology reports are showing same results, (p<0.05). Conclusion: Thyroid nodules 4 cm are not risk factor of malignancy. Thyroid nodules 4 cm with benign FNAC should not undergo thyroidectomy as false negative rate is low. Therefore, the decision for surgery ought not to be taken based on the size of the nodule.

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Does Tumor Size Influence the Diagnostic Accuracy of Ultrasound-Guided Fine-Needle Aspiration Cytology for Thyroid Nodules?

International Journal of Endocrinology ◽

10.1155/2016/3803647 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 11

Author(s):

Do Hoon Koo ◽

KwangSeop Song ◽

Hyungju Kwon ◽

Dong Sik Bae ◽

Ji-hoon Kim ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Predictive Value ◽

Fine Needle Aspiration Cytology ◽

Thyroid Nodules ◽

False Negative ◽

Needle Aspiration ◽

Aspiration Cytology ◽

Fine Needle ◽

Needle Aspiration Cytology ◽

Accuracy Rates

Background. Fine-needle aspiration cytology (FNAC) is diagnostic standard for thyroid nodules. However, the influence of size on FNAC accuracy remains unclear especially in too small or too large thyroid nodules. The objective of this retrospective cohort study was to investigate the effect of nodule size on FNAC accuracy. Methods. All consecutive patients who underwent thyroidectomy for nodules in 2010 were enrolled. FNAC results (according to the Bethesda system) were compared to pathological diagnosis. The nodules were categorized into groups A–E on the basis of maximal diameter on ultrasound (≤0.5, >0.5–1, >1-2, >2–4, and >4 cm, resp.). Results. There were 502 cases with 690 nodules. Overall FNAC sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.4%, 98.2%, 99.4%, 86.4%, and 96.0%, respectively. False-negative rates (FNRs) of groups A–E were 3.2%, 5.1%, 1.3%, 13.3%, and 50%, respectively. Accuracy rates of groups A–E were 96.8%, 94.8%, 99%, 94.7%, and 87.5%, respectively. Conclusion. Although accuracy rates of FNAC in thyroid nodules smaller than 0.5 cm are comparable to the other group, thyroid nodules larger than 4 cm with benign cytology carry a higher risk of malignancy, which suggest that those should be considered for intensive follow-up or repeated biopsy.

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Benign fine-needle aspiration cytology of thyroid nodule: to repeat or not to repeat?

Acta Endocrinologica ◽

10.1530/eje-09-0514 ◽

2009 ◽

Vol 161 (6) ◽

pp. 933-937 ◽

Cited By ~ 20

Author(s):

Filip Gabalec ◽

Jan Čáp ◽

Aleš Ryška ◽

Tomáš Vašátko ◽

Věra Ceeová

Keyword(s):

Thyroid Nodule ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Cytology ◽

False Negative ◽

Needle Aspiration ◽

Aspiration Cytology ◽

Fine Needle ◽

Negative Results ◽

Needle Aspiration Cytology ◽

Benign Nodules

ContextFine-needle aspiration cytology (FNAC) is the gold standard for evaluating thyroid nodules. It has a sensitivity rate of about 95%, i.e. false negative results represent up to 5% of cases. The value of repeated FNAC during follow-up is still controversial.ObjectiveTo evaluate the usefulness of repeating the FNAC for initially benign nodules.Design and methodsAll 5017 patients who underwent FNAC of the thyroid nodule in years 1991–2008 were retrospectively evaluated.ResultsRepeated FNAC was performed in 574 nodules with initially benign results. The number of repetitions varied from one to six. Repeatedly benign results were found in 498 cases, and malignant/suspicious results with initially benign cytology were found in 76 nodules (13.2%). Carcinoma was present in 13 out of the 58 surgically treated malignant/suspicious results of initially benign cytology.ConclusionsA change from a benign FNAC result to a malignant/suspicious one was present in more than 13% of the patients with initially benign cytology; malignancy has been recognised on the basis of repeated FNAC in 2.3% patients. In the majority of cases, the repetition corrected wrong cytological interpretation of results other than colloidal goitre, especially Hashimoto's thyroiditis and regressive changes. We believe that repeating FNAC in patients with benign cytology in about a 1-year horizon can reduce the rate of undiagnosed tumours.

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