Risk of malignancy in thyroid nodules: predictive value of puncture feeling of grittiness in the process of fine-needle aspiration

AimsAnalysis of molecular markers in addition to cytological analysis of fine-needle aspiration (FNA) samples is a promising way to improve the preoperative diagnosis of thyroid nodules. Previously, we have developed an algorithm for the differential diagnosis of thyroid nodules by means of a small set of molecular markers. Here, we aimed to validate this approach using FNA cytology samples of Bethesda categories III and IV, in which preoperative detection of malignancy by cytological analysis is impossible.MethodsA total of 122 FNA smears from patients with indeterminate cytology (Bethesda III: 13 patients, Bethesda IV: 109 patients) were analysed by real-time PCR regarding the preselected set of molecular markers (the BRAF V600E mutation, normalised concentrations of HMGA2 mRNA, 3 microRNAs, and the mitochondrial/nuclear DNA ratio). The decision tree–based classifier was used to discriminate between benign and malignant tumours.ResultsThe molecular testing detected malignancy in FNA smears of indeterminate cytology with 89.2% sensitivity, 84.6% positive predictive value, 92.9% specificity and 95.2% negative predictive value; these characteristics are comparable with those of more complicated commercial tests. Residual risk of malignancy for the thyroid nodules that were shown to be benign by this molecular method did not exceed the reported risk of malignancy for Bethesda II histological diagnosis. Analytical-accuracy assessment revealed required nucleic-acid input of ≥5 ng.ConclusionsThe study shows feasibility of preoperative differential diagnosis of thyroid nodules of indeterminate cytology using a small panel of molecular markers of different types by a simple PCR-based method using stained FNA smears.

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Risk of malignancy and neoplasia predicted by three molecular testing platforms in indeterminate thyroid nodules on fine-needle aspiration

Diagnostic Cytopathology ◽

10.1002/dc.24250 ◽

2019 ◽

Vol 47 (9) ◽

pp. 853-862 ◽

Cited By ~ 2

Author(s):

Kristen L. Partyka ◽

Karen Trevino ◽

Melissa L. Randolph ◽

Harvey Cramer ◽

Howard H. Wu

Keyword(s):

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Molecular Testing ◽

Fine Needle ◽

Risk Of Malignancy

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Surgical Outcome of Thyroid Nodules with Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Fine Needle Aspiration Biopsy

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1220 ◽

2017 ◽

Vol 9 (3) ◽

pp. 100-103

Author(s):

Saad Alqahtani ◽

Saif Alsobhi ◽

Riyadh I Alsalloum ◽

Saleh N Najjar ◽

Hindi N Al-Hindi

Keyword(s):

Fine Needle Aspiration ◽

Surgical Outcome ◽

Thyroid Nodules ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Aspiration Biopsy ◽

Fine Needle ◽

Risk Of Malignancy ◽

Needle Aspiration Biopsy ◽

Undetermined Significance

ABSTRACT Aim To correlate selected clinical and ultrasonographic (US) characteristics with the final histopathological diagnosis in patients with atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS), and whether this information can be used in planning the surgical approach. Materials and methods It is a retrospective study including the operated cases of AUS/FLUS from 2011 to 2014 treated at one center. Results This cohort included 87 women and 28 men. To test for independence between categorical variables, the chi-square test was used. There was no significant correlation between age or US variables and final pathological diagnosis. However, final diagnosis of malignancy was higher in men compared with women (64.3 and 41.4% respectively; p = 0.035). Furthermore, a significant association between the diagnosis of repeated fine needle aspiration biopsy (FNAB) and the final pathological diagnosis was noted (benign vs malignant, p = 0.005). Conclusion The FNAB has a significant role in the assessment of thyroid nodules. Our results showed no correlation between age, US variables, and the risk of malignancy. Male gender is associated with higher risk of malignancy. Clinical significance Determining the risk of malignancy and prediction of surgical outcome may help triaging cases for repeat FNA or proceeding to surgery. How to cite this article Alqahtani S, Alsobhi S, Alsalloum RI, Najjar SN, Al-Hindi HN. Surgical Outcome of Thyroid Nodules with Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Fine Needle Aspiration Biopsy. World J Endoc Surg 2017;9(3):100-103.

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Preoperative evaluation and predictive value of fine-needle aspiration and frozen section of thyroid nodules

Journal of the American College of Surgeons ◽

10.1016/s1072-7515(98)00221-x ◽

1998 ◽

Vol 187 (5) ◽

pp. 494-502 ◽

Cited By ~ 69

Author(s):

Loretta A Boyd ◽

Richard C Earnhardt ◽

John T Dunn ◽

Henry F Frierson ◽

John B Hanks

Keyword(s):

Fine Needle Aspiration ◽

Predictive Value ◽

Thyroid Nodules ◽

Frozen Section ◽

Preoperative Evaluation ◽

Needle Aspiration ◽

Fine Needle

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THE RISK OF THYROID CANCER IN PATIENTS WITH THYROID NODULE 3 CM OR LARGER

Endocrine Practice ◽

10.4158/ep-2020-0136 ◽

2020 ◽

Vol 26 (11) ◽

pp. 1286-1290

Author(s):

Edy Kornelius ◽

Shih-Chang Lo ◽

Chien-Ning Huang ◽

Yi-Sun Yang

Keyword(s):

Thyroid Cancer ◽

Positive Predictive Value ◽

Thyroid Carcinoma ◽

Thyroid Nodule ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Thyroid Nodules ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Fine Needle

Objective: There are conflicting data on the risk of thyroid cancer in thyroid nodules 3 cm or larger, and few such studies on this issue have been conducted in Asia. This study aimed to examine the risk of thyroid cancer in patients with thyroid nodules 3 cm or larger. Methods: This was a 7-year retrospective study conducted in a tertiary referral hospital in Taiwan. All patients with a thyroid nodule measuring ≥3 cm who underwent thyroid operation with or without fine-needle aspiration biopsy (FNAB) were included. The prevalence rate of thyroid cancer, as well as the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and false-negative rate of FNAB for thyroid nodule ≥3 cm were also examined. Results: A total of 132 patients were included in this study. Thyroid cancer was detected in 19 of 132 (14.4%) thyroid nodules measuring ≥3 cm. The performance of FNAB for detecting cancer in nodules 3 cm or larger without considering other ultrasonography parameters was relatively poor with a sensitivity of 50%, but the specificity (100%), PPV (100 %), and NPV (93.4 %) were excellent. Conclusion: The risk of thyroid cancer for thyroid nodules ≥3 cm in this study was low. The PPV and NPV of FNAB were high for the detection of cancer in large nodules. The decision to perform thyroidectomy should not be solely based on nodule size and should include other factors, such as ultrasound characteristics and surgical risk. Abbreviations: ATA = American Thyroid Association; FNAB = fine-needle aspiration biopsy; mPTC = micropapillary thyroid carcinoma; NPV = negative predictive value; PPV = positive predictive value; PTC = papillary thyroid carcinoma

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Moving Toward a Systematic Approach for Reporting Salivary Gland Cytopathology: An Institutional Experience and Literature Review

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2017-0283-ra ◽

2018 ◽

Vol 143 (6) ◽

pp. 664-669 ◽

Cited By ~ 2

Author(s):

Xunda Luo ◽

Nirag Jhala ◽

Jasvir S. Khurana ◽

Christopher Fundakowski ◽

Darshana N. Jhala ◽

...

Keyword(s):

Salivary Gland ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Reporting System ◽

Collaborative Work ◽

Benign Neoplasm ◽

Needle Aspiration ◽

Fine Needle ◽

Tier System ◽

Risk Of Malignancy

Context.— Despite the clinical utility of fine-needle aspiration for the diagnosis of salivary pathologies, salivary lesions remain one of the most challenging areas in cytopathology. This is partially because there is no consensus on how to report salivary gland cytopathology, which has resulted in inconsistent terminology among institutions and individual cytopathologists and in confusion in communication among cytopathologists and ordering providers. Objective.— To summarize our experience with an institutional salivary gland cytopathology reporting system, as an initiative to promote collaborative work toward a consensus on a reporting system. Design.— We developed an empirical 6-tier classification reporting system. Slides of 107 salivary gland fine-needle aspirations with subsequent histology slides were reviewed and reclassified using the 6-tier system. The performance of the cytology reporting system was evaluated with the histology diagnoses serving as the gold standard. Results.— Fine-needle aspiration diagnoses made based on the institutional 6-tier classification system were generally consistent with histology diagnoses for the disease spectrum reported in this study. The sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing malignancies with the system were 86% (12 of 14), 93% (40 of 43), 80% (12 of 15), and 95% (40 of 42), respectively. The risk of malignancy increased from 0% (0 of 13) for negative for neoplasm to 7% (2 of 29) for benign neoplasm, 67% (2 of 3) for suspicious for malignancy, and 83% (10 of 12) for positive for malignancy. Conclusions.— The institutional 6-tier system provides a succinct, risk-of-malignancy–based system to report salivary gland cytology. Our experience with this system helps to pave the way for the adoption of the Milan System for Reporting Salivary Gland Cytopathology.

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Comparison of Elastographic Strain Index and Thyroid Fine-Needle Aspiration Cytology in 631 Thyroid Nodules

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2013-2672 ◽

2013 ◽

Vol 98 (12) ◽

pp. 4790-4797 ◽

Cited By ~ 24

Author(s):

Flavia Magri ◽

Spyridon Chytiris ◽

Valentina Capelli ◽

Margherita Gaiti ◽

Francesca Zerbini ◽

...

Keyword(s):

Negative Predictive Value ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Fine Needle Aspiration Cytology ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Aspiration Cytology ◽

Strain Index ◽

Fine Needle ◽

Needle Aspiration Cytology

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 predictive value of elastography in thyroid nodules and its comparison with fine-needle aspiration biopsy results

Turkish Journal of Surgery ◽

10.5152/ucd.2014.2519 ◽

2014 ◽

Vol 30 (3) ◽

pp. 147-152

Author(s):

Mehmet Celal Kizilkaya ◽

Fazilet Erozgen ◽

Muzaffer Akinci ◽

Rafet Kaplan ◽

Sefa Tuzun ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Predictive Value ◽

Thyroid Nodules ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Aspiration Biopsy ◽

Fine Needle ◽

Needle Aspiration Biopsy

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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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Comparison of power Doppler and thermography for the selection of thyroid nodules in which fine-needle aspiration biopsy is indicated

Radiologia Brasileira ◽

10.1590/0100-3984.2014.0111 ◽

2016 ◽

Vol 49 (5) ◽

pp. 311-315 ◽

Cited By ~ 11

Author(s):

Maria Lucia D'Arbo Alves ◽

Manoel Henrique Cintra Gabarra

Keyword(s):

Fine Needle Aspiration ◽

Predictive Value ◽

Thyroid Nodules ◽

Fine Needle Aspiration Biopsy ◽

Power Doppler ◽

Needle Aspiration ◽

Aspiration Biopsy ◽

Fine Needle ◽

Needle Aspiration Biopsy ◽

Selection Of

Abstract Objective: To compare two methods-power Doppler and thermography-for the analysis of nodule vascularization and subsequent selection of nodules to be biopsied. Materials and Methods: A total of 510 subjects with thyroid nodules were analyzed by power Doppler and submitted to fine-needle aspiration biopsy (FNAB). Thirty-seven patients were submitted to nodule excision (29 due to carcinoma or suspected carcinoma and 8 by patient choice). Among those patients, power Doppler had raised the suspicion of malignancy in 39 lesions, compared with 48 for FNAB. Another group, comprising 110 patients, underwent thermography, which raised the suspicion of malignancy in 124 thyroid nodules, as did FNAB. Malignant nodules were excised in all 110 of those patients (95 underwent nodulectomy and 15 underwent thyroidectomy), malignancy being confirmed by intraoperative examination of frozen biopsy samples. Results: In relation to the FNAB findings, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of power Doppler were 95.16%, 23.52%, 96.22%, 16.70%, and 89.51%, respectively, compared with 100%, 58.06%, 87.73%, 100%, and 89.51%, respectively, for thermography. Conclusion: Thermography was more precise than was power Doppler for the selection of thyroid nodules to be biopsied.

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