Can a gene-expression classifier with high negative predictive value solve the indeterminate thyroid fine-needle aspiration dilemma?

Context: Ultrasound (US) elastography (USE) was recently been reported as a sensitive, noninvasive tool for identifying thyroid cancer. However, the accuracy of this technique is hampered by the intra- and interoperator variability, some US features of the nodule, and the coexistence of autoimmune thyroid disease (ATD). Objectives: The purpose of this article was to assess the accuracy of USE findings in the differential diagnosis of thyroid nodules compared with other US features to evaluate its feasibility in the presence of ATDs and identify the strain index (SI) cutoff with the highest diagnostic performance. Design: We evaluated 528 consecutive patients for a total of 661 thyroid nodules. All nodules underwent fine-needle aspiration cytology (FNAC) and USE evaluation. The SI was calculated as a ratio of the nodule strain divided by the strain of the softest part of the surrounding normal tissue. Results: The median SI value was significantly higher in THY4 and THY5 than in THY2 nodules in ATD-positive, ATD-negative, and ATD-unknown patients. The cutoff of SI for malignancy was estimated to be 2.905 by receiver operating characteristic curve analysis in a screening set (379 FNAC results), and then tested in a replication set (252 FNAC results). In all cases, a SI value of ≥2.905 conferred to the nodule a significantly greater probability of being malignant. This SI cutoff had the greatest area under the curve, sensitivity, and negative predictive value, compared with the conventional US features of malignancy. Conclusion: The elastographic SI has a high sensitivity, specificity, and negative predictive value for the diagnosis of thyroid malignancy both in the presence and in the absence of ATD. If our data on USE are also confirmed in THY3 nodules, FNAC could be avoided in a number of thyroid nodules with certain features.

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The Impact of Benign Gene Expression Classifier Test Results on the Endocrinologist–Patient Decision to Operate on Patients with Thyroid Nodules with Indeterminate Fine-Needle Aspiration Cytopathology

Thyroid ◽

10.1089/thy.2012.0180 ◽

2012 ◽

Vol 22 (10) ◽

pp. 996-1001 ◽

Cited By ~ 100

Author(s):

Daniel S. Duick ◽

Joshua P. Klopper ◽

James C. Diggans ◽

Lyssa Friedman ◽

Giulia C. Kennedy ◽

...

Keyword(s):

Gene Expression ◽

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Test Results ◽

Fine Needle ◽

Patient Decision ◽

Gene Expression Classifier ◽

The Impact

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Accuracy of Fine Needle Aspiration Biopsy in Diagnosing Parotid Gland Malignancy

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v31i2.229 ◽

2016 ◽

Vol 31 (2) ◽

pp. 24-26

Author(s):

Kathleen Joy B. Santiago ◽

Rodante A. Roldan ◽

Samantha S. Castañeda

Keyword(s):

Positive Predictive Value ◽

Parotid Gland ◽

Negative Predictive Value ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Aspiration Biopsy ◽

Fine Needle ◽

Sensitivity Specificity

Objective: To determine the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of FNAB in detecting parotid malignancies in our institution. Methods: Design: Retrospective Chart Review Setting: Tertiary Government Hospital Participants: Postoperative records of seventy six (76) patients with tumors of the parotid gland preoperatively diagnosed by FNAB. Results: The sensitivity of FNAB was 46%. The specificity and positive predictive value were both 100% and negative predictive value was 90%. Overall accuracy in diagnosing malignant parotid tumor was 91%. Conclusion: FNAB in this institution is a poor predictor of malignancy, having a sensitivity rate of only 46%. While this may serve as a basis for not recommending pre-operative FNAB for patients with parotid tumors in the interim, other factors should also be considered, including concerns with the actual performance and interpretion of FNAB in our institution. Keywords: Parotid neoplasm, Cancer of the parotid, fine needle aspiration biopsy, sensitivity, specificity, accuracy

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Ultrasound and guided fine needle aspiration cytology in the submandibular triangle

South African Journal of Radiology ◽

10.4102/sajr.v2i3.1637 ◽

1997 ◽

Vol 2 (3) ◽

pp. 8-13

Author(s):

A. T. Ahuja ◽

W. T. Yang ◽

W. King ◽

C. Metreweli

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Fine Needle Aspiration Cytology ◽

Relevant Information ◽

Needle Aspiration ◽

Aspiration Cytology ◽

Fine Needle ◽

Needle Aspiration Cytology

Objective: The aim of this study was to evaluate whether High Resolution Ultrasound (US) along with Fine Needle Aspiration Cytology (FNAC) can provide the surgeon with adequate preoperative information for masses in the submandibular triangle.Subjects and methods: Eighty-two consecutive patients with suspected masses of the submandibular triangle had US with guided FNAC (49 patients) and final histological correlation (47 patients).Results: Compared to final histology, US had a sensitivity of 97%, specificity 83%, positive predictive value 91% and a negative predictive value of 95% while FNAC had sensitivity of 100%, specificity 90%, positive predictive value 94% and negative predictive value of 100%.Conclusion: US combined with a FNAC is an ideal initial investigation for evaluating masses in submandibular area. It is quick, inexpensive, easily available, and provides the surgeon with relevant information preoperatively obviating the need for further expensive imaging.

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Endoscopic ultrasound-guided fine needle aspiration cytology in the mediastinum

Orvosi Hetilap ◽

10.1556/oh.2013.29556 ◽

2013 ◽

Vol 154 (9) ◽

pp. 338-344 ◽

Cited By ~ 1

Author(s):

Zsolt Dubravcsik ◽

Péter Serényi ◽

László Madácsy ◽

Attila Szepes

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Needle Aspiration ◽

Safe Procedure ◽

Benign Lesions ◽

Ultrasound Guided ◽

Fine Needle

Introduction: Endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration in the posterior mediastinum is technically a relatively simple and safe procedure, and it can provide important information for the further management of patients. Aim: To analyze and compare the results of mediastinal endoscopic ultrasound-guided fine needle aspiration with the data available in the literatue. Patients and methods: The authors retrospectively analyzed their prospective database on mediastinal endoscopic ultrasound-guided fine needle aspiration of 49 patients referred to their endoscopy centre between 1 November 2009 and 1 November 2012. For the fine needle aspiration 22 and 25 G needles were used. Two to six needle passes were performed in each patient. All slides were prepared at the endoscopy unit and analyzed at the cytology laboratory. Results: The authors performed mediastinal endoscopic ultrasound-guided fine needle aspiration for enlarged lymph nodes or suspected mediastinal malignancy in all but 4 patients (2 suspected oesophageal cancers, 1 suspected benign oesophageal stenosis with wall thickening and 1 cardia tumour, all with non-diagnostic endoscopic biopsies). Five patients were excluded from the analysis since fine needle aspiration was not performed in them. Benign lesions were suspected based on the endoscopic ultrasound morphology in 7, and malignant disease in 37 patients. In 3 cases samples obtained by biopsy were not informative for cytological analysis. Cytology confirmed all benign lesions and showed malignancy in 28 cases. Cytology failed to reveal malignancy in 6 patients, although it was suspected based upon endoscopic ultrasound finding. Furthermore, endoscopic ultrasound-guided fine needle aspiration provided the diagnosis in 15 of the 17 patients when bronchoscopy was non-diagnostic. The diagnostic accuracy of the EUS-FNA was the following: sensitivity 82%, specificity 100%, positive predictive value 1.0, negative predictive value 0.54. Only one infectious complication was encountered after fine needle aspiration despite antibiotic prophylaxis. Discussion: Endoscopic ultrasound-guided fine needle aspiration of mediastinal pathology is an accurate, safe and technically relatively easy procedure, however it requires practice and skills in mediastinal anatomy. It has an excellent positive predictive value, a very good sensitivity, but slightly poor negative predictive value. The results of this study are concordant with the literature data. The authors suggest that at least 4 needle passes in the absence of on-site pathologist should be performed in order to minimize the number of false-negative results. Orv. Hetil., 2013, 154, 338–344.

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