Abstract #806353: Thyroid Nodule with Indeterminate Cytology: A Single Institutional Experience with Molecular Testing

Abstract Purpose To assess Strain Ratio (SRE) and Shear Wave Elastography (SWE) accuracy alone and with TIRADS classification, for the risk stratification of indeterminate thyroid nodules. Materials and methods 128 Patients with 128 indeterminate nodules candidates for thyroidectomy underwent preoperative staging neck ultrasound and were classified according to K-TIRADS score. After TIRADS evaluation, semi-quantitative (SRE) and quantitative (SWE expressed in kPa) elastosonography were performed and relative diagnostic performances, alone and in combination, were compared through ROC curves analysis. In order to maximize the SRE and SWE sensitivity and specificity, their cut-off values were calculated using the Liu test. Bonferroni test was used to evaluate statistically significant differences with a p value < 0.05. Results Sensitivity, specificity, PPV and NPV were, respectively, 71.4%, 82.4%, 62.5%, 87.5% for K-TIRADS baseline US, 85.7%, 94.1%, 85.7%, 94.1% for SRE and 57.1%, 79.4%, 53.3%, 81.8% for SWE (kPa expressed). SRE evaluation showed the best diagnostic accuracy compared to the SWE (kPa expressed) (p < 0.05) and to the K-TIRADS (p > 0.05). The association of SRE with conventional ultrasound with K-TIRADS score increased sensitivity (92.9% vs 71.4%) but decreased the specificity than conventional US alone (76.5% vs 82.4%). Conclusion Strain Elastosonography can be associated with K-TIRADS US examination in the thyroid nodule characterization with indeterminate cytology; in fact, adding the SRE to K-TIRADS assessment significantly increases its sensitivity and negative predictive value. However, further multicenter studies on larger population are warranted.

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Contemporary Management of Thyroid Nodules

Annual Review of Medicine ◽

10.1146/annurev-med-042220-015032 ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Kristen Kobaly ◽

Caroline S. Kim ◽

Susan J. Mandel

Keyword(s):

Thyroid Nodules ◽

Cervical Lymphadenopathy ◽

Standard Technique ◽

Clinical History ◽

Needle Aspiration ◽

Annual Review ◽

Publication Date ◽

Molecular Testing ◽

Risk Of Malignancy ◽

Indeterminate Cytology

Thyroid nodules are common in the general population, with higher prevalence in women and with advancing age. Approximately 5% of thyroid nodules are malignant; the majority of this subset represents papillary thyroid cancer. Ultrasonography is the standard technique to assess the underlying thyroid parenchyma, characterize the features of thyroid nodules, and evaluate for abnormal cervical lymphadenopathy. Various risk stratification systems exist to categorize the risk of malignancy based on the ultrasound appearance of a thyroid nodule. Nodules are selected for fine-needle aspiration biopsy on the basis of ultrasound features, size, and high-risk clinical history. Cytology results are classified by the Bethesda system into six categories ranging from benign to malignant. When cytology is indeterminate, molecular testing can further risk-stratify patients for observation or surgery. Surveillance is indicated for nodules with benign cytology, indeterminate cytology with reassuring molecular testing, or non-biopsied nodules without a benign sonographic appearance. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

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ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology

BMC Endocrine Disorders ◽

10.1186/s12902-019-0429-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 11

Author(s):

Thayse Lozovoy Madsen Barbosa ◽

Cleo Otaviano Mesa Junior ◽

Hans Graf ◽

Teresa Cavalvanti ◽

Marcus Adriano Trippia ◽

...

Keyword(s):

Thyroid Nodules ◽

Clinical Decision Making ◽

Clinical Decision ◽

Needle Aspiration ◽

Molecular Testing ◽

American Thyroid Association ◽

Institutional Review ◽

The Us ◽

Risk Of Malignancy ◽

Indeterminate Cytology

Abstract Background Cytologically indeterminate thyroid nodules currently present a challenge for clinical decision-making. The main aim of our study was to determine whether the classifications, American College of Radiology (ACR) TI-RADS and 2015 American Thyroid Association (ATA) guidelines, in association with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), could be used to stratify the malignancy risk of indeterminate thyroid nodules and guide their clinical management. Methods The institutional review board approved this retrospective study of a cohort of 140 thyroid nodules in 139 patients who were referred to ultrasound-guided fine-needle aspiration cytology (FNAC) from January 2012 to June 2016 with indeterminate cytological results (44 Bethesda III, 52 Bethesda IV and 44 Bethesda V) and in whom pre-FNAC thyroid US images and histological results after surgery were available. Each included nodule was classified by one radiologist blinded to the cytological and histological diagnoses according to the ACR TIRADS scores and the US patterns as recommended in the 2015 ATA guidelines. The risk of malignancy was estimated for Bethesda, TI-RADS scores, ATA US patterns and their combination. Results Of the 140 indeterminate thyroid nodules examined, 74 (52.9%) were histologically benign. A different rate of malignancy (p < 0.001) among Bethesda III, IV and V was observed. The rate of malignancy increased according to the US suspicion categories (p < 0.001) in both US classifications (TI-RADS and ATA). Thyroid nodules classified as Bethesda III and the lowest risk US categories (very low, low and intermediate suspicion by ATA and 2, 3 and 4a by TI-RADS) displayed a sensitivity of 95.3% for both classifications and a negative predictive value of 94.3 and 94.1%, respectively. The highest risk US categories (high suspicion by ATA and 4b,4c and 5 by TI-RADS) were significantly associated with cancer (odds ratios [ORs] 14.7 and 9.8, respectively). Conclusions Ultrasound classifications, ACR TI-RADS and ATA guidelines, may help guide the management of indeterminate thyroid nodules, suggesting a conservative approach to nodules with low-risk US suspicion and Bethesda III, while molecular testing and surgery should be considered for nodules with high-risk US suspicion and Bethesda IV or V.

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Molecular Testing in Patients with Indeterminate Cytology of Thyroid Fine Needle Aspiration: A single Medical Institute Experience

Journal of the American Society of Cytopathology ◽

10.1016/j.jasc.2020.07.096 ◽

2020 ◽

Vol 9 (6) ◽

pp. S48

Author(s):

Zhongbo Yang ◽

Maryna Vazmitsel ◽

Magda Esebua

Keyword(s):

Fine Needle Aspiration ◽

Needle Aspiration ◽

Medical Institute ◽

Molecular Testing ◽

Fine Needle ◽

Thyroid Fine Needle Aspiration ◽

Indeterminate Cytology

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Contemporary Thyroid Nodule Evaluation and Management

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa322 ◽

2020 ◽

Vol 105 (9) ◽

pp. 2869-2883 ◽

Cited By ~ 4

Author(s):

Giorgio Grani ◽

Marialuisa Sponziello ◽

Valeria Pecce ◽

Valeria Ramundo ◽

Cosimo Durante

Keyword(s):

Thyroid Nodule ◽

Access To Health Care ◽

English Language ◽

Evidence Synthesis ◽

Low Frequency ◽

Initial Assessment ◽

Molecular Testing ◽

Data Systems ◽

Sonographic Examination ◽

Pubmed Search

Abstract Context Approximately 60% of adults harbor 1 or more thyroid nodules. The possibility of cancer is the overriding concern, but only about 5% prove to be malignant. The widespread use of diagnostic imaging and improved access to health care favor the discovery of small, subclinical nodules and small papillary cancers. Overdiagnosis and overtreatment is associated with potentially excessive costs and nonnegligible morbidity for patients. Evidence Acquisition We conducted a PubMed search for the recent English-language articles dealing with thyroid nodule management. Evidence Synthesis The initial assessment includes an evaluation of clinical risk factors and sonographic examination of the neck. Sonographic risk-stratification systems (e.g., Thyroid Imaging Reporting and Data Systems) can be used to estimate the risk of malignancy and the need for biopsy based on nodule features and size. When cytology findings are indeterminate, molecular analysis of the aspirate may obviate the need for diagnostic surgery. Many nodules will not require biopsy. These nodules and those that are cytologically benign can be managed with long-term follow-up alone. If malignancy is suspected, options include surgery (increasingly less extensive), active surveillance or, in selected cases, minimally invasive techniques. Conclusion Thyroid nodule evaluation is no longer a 1-size-fits-all proposition. For most nodules, the likelihood of malignancy can be confidently estimated without resorting to cytology or molecular testing, and low-frequency surveillance is sufficient for most patients. When there are multiple options for diagnosis and/or treatment, they should be discussed with patients as frankly as possible to identify an approach that best meets their needs.

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Thyroid Nodule Molecular Testing: Is It Ready for Prime Time?

Frontiers in Endocrinology ◽

10.3389/fendo.2020.590128 ◽

2020 ◽

Vol 11 ◽

Author(s):

Tahsin M. Khan ◽

Martha A. Zeiger

Keyword(s):

Thyroid Nodule ◽

Prime Time ◽

Molecular Testing

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Papillary Thyroid Carcinoma With Cystic Changes in a Patient With Prior History of Toxic Nodule

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709620942672 ◽

2020 ◽

Vol 8 ◽

pp. 232470962094267

Author(s):

Gliceida Maria Galarza Fortuna ◽

Paola Rios ◽

Ailyn Rivero ◽

Gabriela Zuniga ◽

Kathrin Dvir ◽

...

Keyword(s):

Thyroid Cancer ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Thyroid Nodule ◽

Thyroid Nodules ◽

Molecular Testing ◽

Papillary Thyroid ◽

Thyroid Lobectomy ◽

Cystic Changes ◽

History Of

Thyroid nodules are palpable on up to 7% of asymptomatic patients. Cancer is present in 8% to 16% of those patients with previously identified thyroid nodules. Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, accounting for approximately 85% of thyroid cancers. Although most appear as solid nodules on ultrasound imaging, a subset of 2.5% to 6% has cystic components. The presence of cystic changes within thyroid nodules decreases the accuracy of fine needle aspiration (FNA) in the diagnosis of thyroid cancer, given the difficulty of obtaining appropriate cellular content. This becomes a diagnostic and therapeutic challenge. We present a case of a 31-year-old female with a 1-month history of palpitations, fatigue, and night sweats, who underwent evaluation, and was diagnosed with subclinical hyperthyroidism. She presented 4 years later with compressive symptoms leading to repeat FNA, showing Bethesda III-atypia of undetermined significance and negative molecular testing. Thyroid lobectomy revealed PTC with cystic changes. This case is a reminder that patients with hyperfunctioning thyroid nodule should have closer follow-up. It poses the diagnostic dilemma of how much is good enough in the evaluation and management of a thyroid nodule. Early detection and action should be the standard of care.

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