Guideline Compliance in Surgery for Thyroid Nodules – A Retrospective Study

2017 ◽  
Vol 125 (05) ◽  
pp. 327-334 ◽  
Author(s):  
A. Reinisch ◽  
P. Malkomes ◽  
N. Habbe ◽  
J. Bojunga ◽  
F. Grünwald ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Diagnostic Algorithm ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Thyroid Stimulating Hormone ◽  
University Hospital ◽  
Malignancy Rate ◽  
Preoperative Diagnostic ◽  
Needle Aspiration Cytology ◽  
Recommended Algorithm

Abstract Diagnostic guidelines for thyroid nodules focus on malignancy risk assessment to avoid unnecessary diagnostic operations. These guidelines recommend a combination of tests in form of a diagnostic algorithm. The present study analyzed the recommended algorithm and its implementation by different medical professionals. Preoperative diagnostic procedures, laboratory tests and histopathological findings of patients who underwent thyroid surgery between 2006 and 2013 were analyzed. The results were stratified by the assignation by specialized endocrinologists (ENP), general practitioners (GP) or Goethe-University Hospital Frankfurt (UKF). 677 patients were enrolled, of these 62% were assigned by UKF, 18.5% by an ENP and 19.5% by a GP. Ultrasonography rate was significantly higher in UKF (97.6%) compared to patients assigned by GP (90.9%, p<0.0001). Rates for fine-needle aspiration cytology ranged between 47.6% in UKF and 23.2% in ENP (p<0.0001). In over 93% of the patients an analysis of thyroid-stimulating hormone and triiodothyronine/thyroxin was realized. The overall malignancy rate was 11.82%. The malignancy rate was significantly higher if a FNA biopsy was performed (16.35 vs. 8.94%; p=0.0048). A higher malignancy rate could only be seen if the preoperative diagnostic workup included FNA. Besides this, the grade of algorithm adherence showed no effect on the malignancy rate.

scholarly journals Diagnostic Algorithm for Metastatic Lymph Nodes of Differentiated Thyroid Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1338
Author(s):  
Sae Rom Chung ◽  
Jung Hwan Baek ◽  
Young Jun Choi ◽  
Tae-Yon Sung ◽  
Dong Eun Song ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Diagnostic Algorithm ◽  
Needle Aspiration ◽  
Differentiated Thyroid Carcinoma ◽  
Ultrasound Guided ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Malignancy Rate ◽  
Needle Aspiration Cytology ◽  
Ultrasound Features

We aimed to evaluate appropriate strategies for interpreting fine-needle aspiration cytology (FNAC) and thyroglobulin concentrations obtained through aspiration (FNA-Tg) results based on the sonographic features of lymph nodes (LNs). Consecutive patients who underwent ultrasound-guided FNAC and FNA-Tg for metastatic LNs from differentiated thyroid carcinomas (DTCs) from January 2014 to December 2018 were reviewed retrospectively. LNs were categorized sonographically as suspicious, indeterminate, or benign. The optimal FNA-Tg cutoff for metastatic LNs was evaluated preoperatively, after lobectomy, and after total thyroidectomy. The diagnostic performances of FNA-Tg, FNAC, and their combination were analyzed based on the sonographic features of LNs. The malignancy rates of LNs were analyzed based on the sonographic features, FNAC, and FNA-Tg results. Of the 1543 LNs analyzed, 528 were benign, whereas 1015 were malignant. FNA-Tg increased the sensitivity and accuracy of FNAC for LNs. The malignancy rate of LNs found to be malignant by FNAC or elevated FNA-Tg ranged from 82% to 100%, regardless of the sonographic features. The malignancy rate of LNs with indeterminate or benign FNAC findings and low FNA-Tg were stratified according to their sonographic features. We propose a diagnostic algorithm, based on combined FNAC, FNA-Tg, and ultrasound features of LNs, for diagnosing metastatic LNs of DTCs.

scholarly journals Exploring the Diagnostic Efficacy of Fine-Needle Aspiration Cytology in Thyroid Nodules ≥ 4 cm: Results from a Tertiary Health Care Center in Jharkhand

2018 ◽  
Vol 4 (02) ◽  
pp. 054-056
Author(s):  
Rajeev Bhardwaj ◽  
Rishabh Kumar Rana
Keyword(s):  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Thyroid Nodules ◽  
False Negative ◽  
Needle Aspiration ◽  
Histopathologic Examination ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Malignancy Rate ◽  
Needle Aspiration Cytology

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.

Incidence of malignancy in solitary thyroid nodules

2015 ◽  
Vol 129 (7) ◽  
pp. 677-681 ◽  
Author(s):  
S M Keh ◽  
S K El-Shunnar ◽  
T Palmer ◽  
S F Ahsan
Keyword(s):  
Thyroid Surgery ◽  
High Probability ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Malignancy Rate ◽  
The Mean ◽  
Needle Aspiration Cytology ◽  
High Index Of Suspicion

AbstractObjectives:This study aimed to investigate the prevalence and clinical significance of solitary thyroid nodules in patients who underwent thyroid surgery.Methods:A retrospective review was performed of the case notes of all adult patients who underwent thyroid surgery from January 2003 to December 2009. All patients with solitary thyroid nodules identified by ultrasonography were included.Results:In total, 225 patients underwent thyroid surgery. The prevalence of solitary thyroid nodules was 27.1 per cent (61 out of 225 patients). Seventy-two per cent of patients were women and the mean age at presentation was 52 ± 16 years. In all, 75.4 per cent of solitary nodules had neoplastic pathology and the malignancy rate was 34.4 per cent. The sensitivity and specificity of fine needle aspiration cytology for neoplasm detection were 73.9 per cent and 80.0 per cent, respectively. There was no association between the various ultrasonography parameters and malignancy risk (p > 0.05).Conclusion:Solitary thyroid nodules should be investigated thoroughly with a high index of suspicion because there is a high probability (34.0 per cent) of malignancy.

Clinical Utility of Sonographic Features in Indeterminate Pediatric Thyroid Nodules

2021 ◽  
Author(s):  
Danielle M. Richman ◽  
Christine E. Cherella ◽  
Jessica R. Smith ◽  
Biren P. Modi ◽  
Benjamin Zendejas ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Risk Level ◽  
Aspiration Cytology ◽  
Malignancy Rate ◽  
Risk Levels ◽  
Malignancy Risk ◽  
Indeterminate Nodules ◽  
Needle Aspiration Cytology ◽  
Indeterminate Cytology

Objective. Surgical resection is recommended for cytologically indeterminate pediatric thyroid nodules due to their intermediate malignancy risk. We evaluated the utility of ultrasound characteristics for refining malignancy risk to inform the management of these nodules. Design. Retrospective cohort study (2004-2019) Methods. We analyzed consecutive thyroid nodules with indeterminate fine-needle aspiration cytology (Bethesda category III, IV, or V) in pediatric patients (<19 years). We assessed the association of demographic and sonographic characteristics with malignancy risk among all indeterminate nodules and within each Bethesda category. Results. Eighty-seven cytologically indeterminate nodules were identified in 78 patients. Bethesda category was III in 56 nodules (64%), IV in 12 (14%), and V in 19 (22%). The malignancy rate was 46/87 (53%) overall, and 23/56 (41%), 8/12 (75%), and 15/19 (79%) in Bethesda III, IV, and V nodules, respectively. Malignancy rate was higher in solitary nodules (67% vs. 37%, p=0.004) and nodules with irregular margins (100% vs. 44%, p<0.001) or calcifications (82% vs. 43%, p=0.002). American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS) risk level TR5 was associated with a higher rate of malignancy than lower TI-RADS risk levels (80% vs. 42%, p=0.002). Within individual Bethesda categories, TI-RADS risk level was not associated with malignancy. No sonographic feature had a negative predictive value for malignancy greater than 80%. Conclusions. In pediatric thyroid nodules with indeterminate cytology, some sonographic features—including higher ACR TI-RADS risk level—are associated with malignancy, but these associations are unlikely to alter clinical management in most cases.

scholarly journals Should we perform fine needle aspiration cytology of subcentimetre thyroid nodules? A retrospective review of local practice

Ultrasound ◽  
2019 ◽  
Vol 27 (1) ◽  
pp. 64-68 ◽  
Author(s):  
Jasmine ME Chua ◽  
Jonathan YM Tang ◽  
Desmond SW Lim ◽  
Nanda Venkatanarasimha ◽  
Sivanathan Chandramohan ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Thyroid Nodules ◽  
Surgical Excision ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Malignancy Rate ◽  
Needle Aspiration Cytology

In light of the rising rate of incidentally detected subcentimetre thyroid nodules due to improved surveillance and diagnostic imaging, the decision of whether to perform fine needle aspiration cytology is increasingly pertinent. We aim to assess (1) the sampling adequacy of fine needle aspiration cytology, (2) malignancy rate, (3) thyroidectomy rate and (4) diagnostic accuracy of fine needle aspiration cytology. A total of 245 subcentimetre nodules in 220 patients underwent fine needle aspiration cytology between 2011 and 2014. Medical records were reviewed for cytology results, subsequent management and histopathological results in the event the patient underwent thyroidectomy. Sampling adequacy was calculated as the percentage of diagnostic results (Bethesda II–VI). Malignancy rate was defined as the percentage of Bethesda IV–VI diagnoses. Amongst patients with Bethesda IV–VI diagnoses who underwent thyroidectomy, their cytology reports were correlated with post-operative histopathological findings. The sampling adequacy of fine needle aspiration cytology was 77.1%. Malignancy rate (Bethesda IV–VI) was 9.7%. The respective malignancy rates in the < 5 mm nodule group and ≥ 5 mm nodule group were 6.67 and 10.0%. In total, 79.2% (19/24) of the malignant nodules underwent surgical excision. The rest declined surgery and/or were lost to follow-up. Amongst the malignant nodules which were surgically resected, 84.2% (16/19) had definitive malignant histology. Five of these demonstrated multifocal carcinoma and/or extrathyroidal extension of carcinoma on histology. Initial fine needle aspiration cytology and subsequent histopathological diagnoses matched in all cases except for three that had false-positive fine needle aspiration cytology results. Majority of our patients with suspicious cytology results subsequently underwent thyroidectomy, notwithstanding the relatively lower diagnostic accuracy of fine needle aspiration cytology in subcentimetre thyroid nodules.

Role of fine needle aspiration cytology in the preoperative diagnosis of malignancy in parotid and submandibular gland neoplasm

2014 ◽  
Vol 19 (2) ◽  
pp. 110-118
Author(s):  
Mohammad Amzad Hossain ◽  
Md Zahedul Alam ◽  
Md Rojibul Haque ◽  
Md Nazmul Haque ◽  
KM Nurul Alam ◽  
...  
Keyword(s):  
Submandibular Gland ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
False Negative ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Medical College ◽  
Preoperative Diagnostic ◽  
Needle Aspiration Cytology

Objective: To evaluate the role of Fine Needle Aspiration Cytology in the preoperative diagnosis of malignancy in parotid and submandibular gland neoplasm. Methods: This cross sectional study on 50 cases was conducted in the Department of Otolaryngology and Head-Neck Surgery of Sir Salimullah Medical College Mitford Hospital and Dhaka Medical College Hospital from January’2009 to June 2010. Results: Fine needle aspiration cytology findings of our all 50 cases were compared with postoperative histopathological reports. Out of the 50 cases, in 36(72%) cases of benign neoplasm and 7(14%) cases of malignant neoplasm, pre-operative FNAC findings and post operative histopathological findings were same. In 7 cases, FNAC and post operative histopathological findings did not matched. These were 2 (4%) false positive and 5 (10%) false negative result.In our study sensitivity of FNAC for reporting malignancy was 58.33%, specificity to rule out malignancy was 94.73% and overall accuracy in detecting malignant tumour was 86%. Positive predictive value and negative value were 77.77% and 87.80% respectively. It can be concluded that fine needle aspiration cytology is a safe, cheap and useful preoperative diagnostic tool in the diagnosis of malignancy in parotid and submandibular gland, but as fine needle aspiration cytology partly depends on operator skill, it may give false negative and false positive result. Conclusion: FNAC is a useful preoperative diagnostic tool for malignant parotid and submandibular glands with high specificity and sensitivity. DOI: http://dx.doi.org/10.3329/bjo.v19i2.17634 Bangladesh J Otorhinolaryngol 2013; 19(2): 110-118

scholarly journals Cost Effectiveness of Transbronchial Needle Aspiration

1999 ◽  
Vol 6 (4) ◽  
pp. 332-335 ◽  
Author(s):  
Jennifer A Crocket ◽  
Eric YL Wong ◽  
Dale C Lien ◽  
Khanh Gia Nguyen ◽  
Michelle R Chaput ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Benign Disease ◽  
University Hospital ◽  
High Yield ◽  
Transbronchial Needle Aspiration ◽  
Computed Tomographic ◽  
The Cost

OBJECTIVE: To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy.DESIGN: Retrospective study.SETTING: A university hospital.POPULATION STUDIED: Ninety-six patients referred for bronchoscopy with computed tomographic evidence of significant mediastinal or hilar adenopathy.RESULTS: Ninety-nine patient records were reviewed. Three patients had two separate bronchoscopy procedures. TBNA was positive in 42 patients (44%) and negative in 54 patients. Of the 42 patients with a positive aspirate, 40 had malignant cytology and two had cells consistent with benign disease. The positive TBNA result altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures. The cost of these subsequent procedures was estimated at $27,335. No complications related to TBNA were documented.CONCLUSIONS: TBNA is a high-yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer.

scholarly journals Choosing the best algorithm among five thyroid nodule ultrasound scores: from performance to cytology sparing—a single-center retrospective study in a large cohort

2021 ◽  
Author(s):  
Clotilde Sparano ◽  
Valentina Verdiani ◽  
Cinzia Pupilli ◽  
Giuliano Perigli ◽  
Benedetta Badii ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Real Life ◽  
Scoring Systems ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Common Disease ◽  
Single Center ◽  
Thyroid Microcarcinoma ◽  
Thyroid Malignancies

Abstract Objective Incidental diagnosis of thyroid nodules, and therefore of thyroid cancer, has definitely increased in recent years, but the mortality rate for thyroid malignancies remains very low. Within this landscape of overdiagnosis, several nodule ultrasound scores (NUS) have been proposed to reduce unnecessary diagnostic procedures. Our aim was to verify the suitability of five main NUS. Methods This single-center, retrospective, observational study analyzed a total number of 6474 valid cytologies. A full clinical and US description of the thyroid gland and nodules was performed. We retrospectively applied five available NUS: KTIRADS, ATA, AACE/ACE-AME, EUTIRADS, and ACRTIRADS. Thereafter, we calculated the sensitivity, specificity, PPV, and NPV, along with the number of possible fine-needle aspiration (FNA) sparing, according to each NUS algorithm and to clustering risk classes within three macro-groups (low, intermediate, and high risk). Results In a real-life setting of thyroid nodule management, available NUS scoring systems show good accuracy at ROC analysis (AUC up to 0.647) and higher NPV (up to 96%). The ability in FNA sparing ranges from 10 to 38% and reaches 44.2% of potential FNA economization in the low-risk macro-group. Considering our cohort, ACRTIRADS and AACE/ACE-AME scores provide the best compromise in terms of accuracy and spared cytology. Conclusions Despite several limitations, available NUS do appear to assist physicians in clinical practice. In the context of a common disease, such as thyroid nodules, higher accuracy and NPV are desirable NUS features. Further improvements in NUS sensitivity and specificity are attainable future goals to optimize nodule management. Key Points • Thyroid nodule ultrasound scores do assist clinicians in real practice. • Ultrasound scores reduce unnecessary diagnostic procedures, containing indolent thyroid microcarcinoma overdiagnosis. • The variable malignancy risk of the “indeterminate” category negatively influences score’s performance in real-life management of thyroid lesions.

Sign in / Sign up

Export Citation Format

Share Document