Does the fine-needle aspiration diagnosis of ?H�rthle-cell neoplasm/follicular neoplasm with oncocytic features? denote increased risk of malignancy?

Introduction: Approximately 10% of fine needle aspiration biopsy (FNAB) of thyroid nodules may be verified as “suspicious for follicular neoplasm”; this category involves follicular adenoma, follicular carcinoma, follicular variants of papillary carcinoma and subclass “suspicious for Hurthle cell neoplasm”. At present, there is no diagnostic tool to discriminate between follicular adenoma and cancer. Most patients are required surgery to exclude malignant process. The aim: To define factors correlating with risk of malignancy in patients with FNAB of thyroid focal lesions and nodules verified as Bethesda tier IV. Materials and Methods: In this study 110 consecutive patients were included. All patients were operated because of FNAB result “suspicious for follicular neoplasm” of thyroid gland at a single institution from January 2016 until March 2020. From this set, six specific categories were defined and the clinical records for patients were collected: sex, age, presence of oxyphilic cells, diameter of the tumour, presence of Hashimoto disease, aggregate amount of clinical and ultrasonographic features of malignancy according to ATA. Results: In 18 patients (16,3%) thyroid cancer occurred. Most frequent subtype turned out to be papillary cancer (66,6%). In group of benign lesion (92 patients) predominance of follicular adenoma was disclosed – (49%). Age, gender, tumour diameter, aggregate amount of clinical and ultrasonografic factors, presence of Hashimoto disease and fine needle aspiration biopsy result suspicious for Hurthle cell neoplasm did not correspond to increased risk of malignancy. Conclusions: In patients with FNAB results classified as Bethesda tier IV there are no reliable clinical features associated with low risk of malignancy and surgery should be consider in every case as most appropriate manner to exclude thyroid cancer

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Hürthle Cells on Fine-Needle Aspiration Cytology Are Important for Risk Assessment of Focally PET/CT FDG Avid Thyroid Nodules

Cancers ◽

10.3390/cancers12123544 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3544

Author(s):

David N. Poller ◽

Hakim Megadmi ◽

Matthew J. A. Ward ◽

Pierpaolo Trimboli

Keyword(s):

Fine Needle Aspiration ◽

Fdg Pet ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Follicular Neoplasm ◽

Fine Needle ◽

Hürthle Cell ◽

Pet Ct ◽

Risk Of Malignancy ◽

Fdg Pet Ct

This study assesses the role of [18F] FDG PET/CT, fine needle aspiration (FNA) cytology and ultrasound in the 1–2% of patients with focally positive thyroid nodules on FDG PET/CT. All FDG PET/CT scans with focally increased thyroid FDG PET/CT uptake performed over 37 months in one institution were matched to patients undergoing thyroid FNA. Diffuse FDG PET/CT uptake patients were excluded. A total of 47 patients showed focally increased thyroid uptake. Consistent with previous studies, 18 (38.2%) patients had malignancy—12 primary thyroid carcinoma, 1 parathyroid carcinoma, 3 metastatic carcinoma to the thyroid and 2 lymphoma. A total of 15 (31.9%) lesions categorized as non-malignant contained Hürthle cells/oncocytes. A total of 14 lesions (29.8%) had focally increased FDG PET/CT uptake with no specific cytological or histopathological cause identified. No focally PET avid Hürthle cell/oncocytic lesions were found to be malignant. Exclusion of oncocytic lesions increased the calculated risk of malignancy (ROM) of focally PET avid nodules from 38% to 68%. It may be useful to exclude focally FDG PET/CT avid Hürthle cell/oncocytic lesions, typically reported as follicular neoplasm or suspicious for a follicular neoplasm, Hürthle cell type (Oncocytic) type, RCPath Thy 3F: Bethesda IV or sometimes Thy 3a: Bethesda III FNAs) from ROM calculations. Oncocytic focally PET/CT FDG avid lesions appear of comparatively lower risk of malignancy and require investigation or operation but these lesions should be readily identified by FNA cytology on diagnostic work up of focally PET avid thyroid nodules.

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Application of the Bethesda Classification for Thyroid Fine-Needle Aspiration: Institutional Experience and Meta-analysis

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2015-0154-sa ◽

2016 ◽

Vol 140 (10) ◽

pp. 1121-1131 ◽

Cited By ~ 33

Author(s):

Elliot A. Krauss ◽

Megan Mahon ◽

Jean M. Fede ◽

Lanjing Zhang

Keyword(s):

Fine Needle Aspiration ◽

Meta Analysis ◽

Needle Aspiration ◽

Data Sources ◽

Follicular Neoplasm ◽

Fine Needle ◽

Diagnostic Categories ◽

Risk Of Malignancy ◽

Thyroid Fna ◽

Undetermined Significance

Context.—Fine-needle aspiration (FNA) biopsies have been an important component in the preoperative evaluation of thyroid nodules. Until the introduction of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in 2008, individual institutions had developed their own diagnostic categories. The BSRTC proposed 6 categories in an attempt to standardize reporting of thyroid FNA. Objective.—To present a 15-year experience of thyroid FNA at one institution, including data before and after introduction of the BSRTC. The risk of malignancy is compared with the meta-analysis of high-quality published data. Data Sources.—Data sources were PubMed, a manual search of references, and institutional data. Conclusions.—The diagnostic categories developed at our institution were similar to those proposed by the BSRTC, with best fit into the 6 categories easily accomplished and reported in the final 2 years of the study. Significant differences were noted in the frequencies of cases in diagnostic categories Benign (II; P = .003), Suspicious for follicular neoplasm/Follicular neoplasm (IV; P < .001), and Malignant (VI; P = .003) after the introduction of the BSRTC. Eighteen published articles met the criteria for inclusion in the meta-analysis. The risk of malignancy in each category in our institution was similar to that determined in the meta-analysis, except for Insufficient for diagnosis (I; 20% versus 9%–14%). Meta-analysis showed an overlapping 95% CI of risk of malignancy between Atypia of undetermined significance/Follicular lesion of undetermined significance (III; 11%–23%) and Suspicious for follicular neoplasm/Follicular neoplasm (IV; 20%–29%), suggesting similar risks of malignancy. The use of newer molecular tests for these indeterminate cases may further refine risk assessment.

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Malignancy Risk and Related Factors of Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance in Thyroid Fine Needle Aspiration

International Journal of Endocrinology ◽

10.1155/2018/4521984 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

So-hyeon Hong ◽

Hyejin Lee ◽

Min-Sun Cho ◽

Jee Eun Lee ◽

Yeon-Ah Sung ◽

...

Keyword(s):

Clinical Features ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

Follicular Neoplasm ◽

Related Factors ◽

Fine Needle ◽

Malignancy Risk ◽

Thyroid Fine Needle Aspiration ◽

Risk Of Malignancy ◽

Undetermined Significance

Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in thyroid fine needle aspiration (FNA) is a challenging category. The malignancy risk is different by multiple factors and subsequent management strategy is inconclusive. Therefore, we analyzed the malignancy risk of AUS/FLUS according to radiological and clinical features. A total of 687 nodules that had been initially diagnosed as AUS/FLUS were retrospectively reviewed from 6365 thyroid FNAs between 2011 and 2014. The ultrasonographic (US) features were categorized using the Korean Thyroid Imaging Reporting and Data System. Radiological and clinical features were compared according to the second FNA results or histologically confirmed results from surgery. Repeat FNA was performed on 248 (36%) nodules, and 49 (7%) nodules underwent immediate surgery. Among the 248 nodules subjected to repeated FNA, 49 (20%) nodules were diagnosed again as AUS/FLUS, 123 (50%) were found to be benign, and 47 (19%) were diagnosed as follicular neoplasm, suspicious for malignancy or malignant. Among histologically confirmed nodules, the US features were more unfavorable in malignant nodules, and hypo- or anechogenicity was associated with a higher risk of malignancy after adjusting for age, size, and other US features (P<0.01). In conclusion, we observed that malignant nodules tended to show unfavorable US features, especially hypo- or anechogenicity. Age, sex, and thyroid function were not significantly associated with malignancy risk. We also found out that malignancy risk was not different between the group which underwent immediate operation following the AUS/FLUS diagnosis and the group which underwent repeated FNA after the initial diagnosis.

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Ultrasound-guided fine needle aspiration cytology and ultrasound examination of thyroid nodules in the UAE: A comparison

PLoS ONE ◽

10.1371/journal.pone.0247807 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0247807

Author(s):

Suhail Al-Salam ◽

Charu Sharma ◽

Maysam T. Abu Sa’a ◽

Bachar Afandi ◽

Khaled M. Aldahmani ◽

...

Keyword(s):

United Arab Emirates ◽

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Ultrasound Examination ◽

Needle Aspiration ◽

Follicular Neoplasm ◽

Ultrasound Guided ◽

Cytological Examination ◽

Fine Needle ◽

Risk Of Malignancy

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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Hürthle Cell Neoplasms Diagnosed by Fine Needle Aspiration Are Not Associated with an Increased Risk of Malignancy

Acta Cytologica ◽

10.1159/000361073 ◽

2014 ◽

Vol 58 (3) ◽

pp. 235-238 ◽

Cited By ~ 5

Author(s):

Susan McKee ◽

Howard Wu ◽

Xiaoyan Wang ◽

Harvey Cramer ◽

Jingmei Lin ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Needle Aspiration ◽

Fine Needle ◽

Hürthle Cell ◽

Increased Risk ◽

Risk Of Malignancy

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Cytologic Categorization with Risk Stratification of Endoscopic Ultrasound-Guided Fine Needle Aspiration from Pancreatic Lesions Based on Guidelines of the Papanicolaou Society of Cytopathology: 12-Year Tertiary Care Experience

Discoveries ◽

10.15190/d.2021.13 ◽

2021 ◽

Vol 9 (3) ◽

pp. e134

Author(s):

Nilay Nishith ◽

◽

Ram Nawal Rao ◽

Praveer Rai ◽

◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Tertiary Care ◽

Diagnostic Category ◽

Needle Aspiration ◽

Ultrasound Guided ◽

Fine Needle ◽

Care Experience ◽

Increased Risk ◽

Risk Of Malignancy

Background and Aims: Pancreatic malignancy is an important cause of cancer mortality worldwide. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) plays a crucial role in the pre-operative diagnosis of pancreatic lesions. In this study, we have analyzed the cytological spectrum of pancreatic lesions in the Indian population over 12 years, categorized them according to the Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology (PSCPC), and assessed the risk of malignancy (ROM) for each of the categories. Methods: A computerized data search from January 2008 to December 2019 revealed 581 pancreatic EUS-FNA samples, among which surgical follow-up was available for 73 cases. All cytological specimens were reviewed and prospectively classified into one of the six diagnostic categories proposed by the PSCPC. Subsequently, a cyto-histological correlation was performed and the ROM was calculated for each category. Results: The cytologic diagnoses included 50 non-diagnostic (category I), 175 negative for malignancy (category II), 19 atypical (category III), 27 neoplastic:benign (category IVA), 30 neoplastic:other (category IVB), 26 suspicious (category V), and 254 malignant (category VI) cases. ROM for non-diagnostic aspirates, non-neoplastic benign specimens, atypical cases, neoplastic:benign, neoplastic:other, suspicious for malignancy, and the malignant category was 16.7%, 7.1%, 33.3%, 0.0%, 20.0%, 100%, and 78.6%, respectively. Conclusion: We document an increased risk of malignancy from category I to category VI of the PSCPC. The malignancy risk for category VI (malignant) was statistically significant in our study but was lower in comparison to the values reported by other authors. Nonetheless, such an approach would establish transparent communication between the pathologist and the clinician, as well as aid the clinician in decision making, particularly in intermediate categories.

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Serum Thyrotropin Concentration as a Novel Predictor of Malignancy in Thyroid Nodules Investigated by Fine-Needle Aspiration

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2006-0527 ◽

2006 ◽

Vol 91 (11) ◽

pp. 4295-4301 ◽

Cited By ~ 298

Author(s):

K. Boelaert ◽

J. Horacek ◽

R. L. Holder ◽

J. C. Watkinson ◽

M. C. Sheppard ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Tertiary Care ◽

Needle Aspiration ◽

Thyroid Malignancy ◽

Care Clinic ◽

Fine Needle ◽

Increased Risk ◽

Risk Of Malignancy ◽

Serum Tsh

Abstract Context: Thyroid nodules and goiter are common, and fine-needle aspiration biopsy (FNAB) is the first investigation of choice in distinguishing benign from malignant disease. Objective: The objective of the study was to assess whether simple clinical and biochemical parameters can predict the likelihood of thyroid malignancy in subjects undergoing FNAB. Design: The design was a prospective cohort. Setting: The study was conducted at a single secondary/tertiary care clinic. Participants: One thousand five hundred consecutive patients without overt thyroid dysfunction (1304 females and 196 males, mean age 47.8 yr) presenting with palpable thyroid enlargement between 1984 and 2002 were evaluated by FNAB of the thyroid. Intervention(s): There were no interventions. Main Outcome Measures: Goiter type was assessed clinically and classified as diffuse in 183, multinodular in 456, or solitary nodule in 861 cases. Serum TSH concentration at presentation was measured in a sensitive assay in patients presenting after 1988 (n = 1183). The final cytological or histological diagnosis was determined after surgery (n = 553) or a minimum 2-yr clinical follow-up period (mean 9.5 yr, range 2–18 yr). Results: The overall sensitivity and specificity of FNAB in predicting malignancy were 88 and 84%, respectively. The risk of diagnosis of malignancy rose in parallel with the serum TSH at presentation, with significant increases evident in patients with serum TSH greater than 0.9 mU/liter, compared with those with lower TSH. Binary logistic regression analysis revealed significantly increased adjusted odds ratios (AORs) for the diagnosis of malignancy in subjects with serum TSH 1.0–1.7 mU/liter, compared with TSH less than 0.4 mU/liter [AOR 2.72, 95% confidence interval (CI) 1.02–7.27, P = 0.046], with further increases evident in those with TSH 1.8–5.5mU/liter (AOR 3.88, 95% CI 1.48–10.19, P = 0.006, compared with TSH < 0.4 mU/liter) and greater than 5.5 mU/liter (AOR 11.18, 95% CI 3.23–8.63, P < 0.001, compared with TSH < 0.4 mU/liter). Males (AOR 1.8, 95% CI 1.04–3.1, P = 0.04), younger patients (AOR 1.1, 95% CI 1.01–1.15, P = 0.025), and those with clinically solitary nodules (AOR 2.53, 95% CI 1.5–4.28, P = 0.001) were also at increased risk. Based on these findings, a formula to predict the risk of the diagnosis of thyroid malignancy in individual patients, taking into account their gender, age, goiter type determined clinically, and serum TSH, was calculated. Conclusions: The risk of malignancy in a thyroid nodule increases with serum TSH concentrations within the normal range. In addition to patient’s gender, age, and goiter type, the serum TSH concentration at presentation is an independent predictor of the presence of thyroid malignancy. We propose that these simple clinical and biochemical factors can serve as an adjunct to FNAB in predicting risk of malignancy.

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