Validation of American Thyroid Association Ultrasound Risk Assessment of Thyroid Nodules Selected for Ultrasound Fine-Needle Aspiration

Thyroid ◽  
2017 ◽  
Vol 27 (8) ◽  
pp. 1077-1082 ◽  
Author(s):  
Alice L. Tang ◽  
Mercedes Falciglia ◽  
Huaitao Yang ◽  
Jonathan R. Mark ◽  
David L. Steward
Keyword(s):  
Risk Assessment ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
American Thyroid Association ◽  
Fine Needle

scholarly journals Managing Thyroid Nodules in Qatar During the COVID19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A841-A842
Author(s):  
Zaina Alamer ◽  
Gowri Karuppasamy ◽  
Arwa Alsaud ◽  
Tania Jaber ◽  
Hanan Farghaly ◽  
...  
Keyword(s):  
High Risk ◽  
Early Detection ◽  
Fine Needle Aspiration ◽  
Medical Staff ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Morbidity And Mortality ◽  
American Thyroid Association ◽  
Fine Needle ◽  
Thyroid Fine Needle Aspiration

Abstract Background: The Coronavirus disease 2019 (COVID-19) pandemic impacted health care systems in all countries, including Qatar. Hamad Medical Corporation (HMC); In compliance with recommendations, suspended all non-urgent procedures, including thyroid fine needle aspiration biopsies (FNAB). Thyroid nodules are second most common cause of referral to HMC endocrine clinic. FNABs are gold standard to differentiate benign from malignant nodules.1- 2 Methods: Our approach includes a teleconsultation to obtain patient’s history and risk factors. Reviewing neck ultrasound (US), obtaining a calcitonin level if indicated, considering comorbidities associated with a high risk of COVID-19 morbidity and mortality.3 Results: We developed a pathway triaging thyroid (FNAB) to:1-Urgent: patients at higher risk of aggressive thyroid malignancy. Benefits of early detection and treatment outweigh the risk of COVID-19 exposure.4 FNAB should not be delayed.2-Semi-urgent: patients at low risk for COVID-19 and high suspicion thyroid nodules, but no evidence that early detection improves survival2, FNAB may be delayed up to 12 months.3-Non-urgent: patients with asymptomatic nodules that have low or intermediate suspicion US pattern.2 Also, includes nodules with ATA high suspicion US pattern in pregnant women and patients at high risk for COVID-19. The risks outweigh the benefits. FNAB should be delayed until outbreak is controlled.4 When urgent FNAB is indicated, safety of patients and medical staff needs to be addressed.5 We recommend testing patient for COVID-19 before FNAB, utilizing US guidance with rapid on-site adequacy evaluation in all cases. Cervical lymph node FNAB with TG washout should be done if indicated. The patient should wear a mask. All medical staff involved should wear personal protective equipment (PPE). The operator should wear N95 mask and face shield. The patient should be informed about cytopathology results via telemedicine. Conclusion: Triaging thyroid (FNAB) during the COVID-19 pandemic should be based on nodule characteristics and risk of COVID-19 morbidity and mortality. Our group recommends deferring FNAB for asymptomatic patients.4FNAB should not be delayed in selected patients who benefit from early detection and intervention. Table1: Triage of Thyroid fine needle aspiration biopsies (FNAB). ATA: American thyroid association. US: ultrasound.

scholarly journals The Role of Molecular Testing for the Indeterminate Thyroid FNA

Genes ◽  
2019 ◽  
Vol 10 (10) ◽  
pp. 736 ◽  
Author(s):  
Esther Diana Rossi ◽  
Liron Pantanowitz ◽  
William C. Faquin
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Adult Population ◽  
Needle Aspiration ◽  
Molecular Testing ◽  
American Thyroid Association ◽  
Cytological Diagnosis ◽  
Fine Needle ◽  
Thyroid Fna

Thyroid nodules are common in the adult population where a majority are benign and only 4.0% to 6.5% are malignant. Fine needle aspiration (FNA) is a key method used in the early stages to evaluate and triage patients with thyroid nodules. While a definitive cytological diagnosis is provided in more than 70–75% of all thyroid FNA cases, the group of indeterminate lesions offers a challenge in terms of interpretation and clinical management. Molecular testing platforms have been developed, are recognized as an option by the 2015 American Thyroid Association Guidelines, and are frequently used in conjunction with FNA as an integral part of the cytologic evaluation. In this review, the utility of molecular testing options for nodules assigned to the group of indeterminate thyroid FNAs is described.

Fine-needle aspiration biopsies of thyroid nodules

2018 ◽  
Vol 57 (06) ◽  
pp. 211-215 ◽  
Author(s):  
Christian Schmidkonz ◽  
Karen Horstrup ◽  
Matthias Weppler ◽  
Torsten Kuwert ◽  
Michael Cordes
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Predisposing Factors ◽  
American Thyroid Association ◽  
Self Assessment ◽  
Needle Size ◽  
Fine Needle ◽  
Number Of Patients ◽  
Nodule Volume

Summary Objective: The purpose of the study was the characterization of adverse events (AEs) after fine-needle aspiration biopsies (FNABs) of thyroid nodules, as well as possible predisposing factors. Methods: A total of 205 patients, each of whom had undergone an FNAB of a thyroid nodule, were included in the study (15 of whom were taking anticoagulant medication). The thyroid nodules were classified according to the ultrasound criteria of the American Thyroid Association (ATA). The FNABs were carried out by four trained nuclear medicine specialists from two institutions. To detect AEs, all patients were asked to fill out a standardized self-assessment questionnaire. Results: Out of 205 patients, 189 (92 %) reported no AEs. Fourteen patients (6.8 %) had mild or moderate AEs, such as short-term pain at the puncture site. In two patients (1 %), the AEs were classified as significant, and required medical followup, which revealed an intrathyroid hematoma in one patient and dysphonia in the other. All AEs were reversible. None of the patients taking anticoagulants experienced any AEs. The parameters of age, sex, nodule volume, ATA nodule type, needle size, and physician performing the biopsy were not predisposing factors for side effects (p = 0.54, p = 0.73, p = 0.75, p = 0.94, p = 0.35, and p = 0.24, respectively). Conclusions: The vast majority of patients tolerated the FNAB very well. AEs were seldom observed. A small number of patients experienced AEs that required no intervention or could be self-managed by the patient. Considering the almost negligible risk of the procedure, FNAB should be increasingly used for the classification of thyroid nodules.

Risk Stratification of Thyroid Nodules With Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS) Cytology Using Ultrasonography Patterns Defined by the 2015 ATA Guidelines

2017 ◽  
Vol 126 (9) ◽  
pp. 625-633 ◽  
Author(s):  
Ji Hye Lee ◽  
Kyunghwa Han ◽  
Eun-Kyung Kim ◽  
Hee Jung Moon ◽  
Jung Hyun Yoon ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Fine Needle Aspiration ◽  
Clinical Characteristics ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
American Thyroid Association ◽  
Fine Needle ◽  
Malignancy Rate ◽  
Undetermined Significance

Purpose: The purpose of this study was to evaluate the predictive value of ultrasonography (US) patterns based on the 2015 American Thyroid Association (ATA) guidelines for malignancy in atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) nodules. Methods: From January 2014 to August 2015, 133 thyroid nodules that were initially diagnosed as AUS/FLUS on fine needle aspiration (FNA) were included in this study. Each nodule was assigned a category with US patterns defined by the ATA guidelines. Clinical characteristics and US patterns were compared between the benign and malignant nodules, and malignancy rates were calculated according to the ATA guidelines. Results: The malignancy rate in the very low suspicion group was 0.0% in AUS/FLUS nodules. When applying the ATA guidelines, significant differences existed for US patterns between the benign and malignant nodules in the AUS group ( P = .032) but not the FLUS group ( P = .168). Conclusions: Ultrasonography patterns by the 2015 ATA guidelines can provide risk stratification for nodules with AUS cytology but not for ones with FLUS cytology. For nodules with AUS/FLUS cytology with the very low suspicion pattern of the ATA guidelines, follow-up US might be recommended instead of repeat FNA.

scholarly journals Validation of TIRADS ACR Risk Assessment of Thyroid Nodules in Comparison to the ATA Guidelines

2021 ◽  
Vol 11 ◽  
pp. 37
Author(s):  
Goni Merhav ◽  
Sagit Zolotov ◽  
Ahmad Mahagneh ◽  
Leonid Malchin ◽  
Michal Mekel ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Risk Stratification ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
American Thyroid Association ◽  
Fine Needle ◽  
Clinically Significant ◽  
Benign Nodules

Objectives: The prevalence of thyroid nodules in adults, detected by ultrasound (US), is reported as high as 68%. US-guided fine-needle aspiration biopsy (FNAB) is the test of choice used to determine the nature of the nodules. However, not more than 15% are found to be malignant. Reducing the number of unnecessary FNAB while identifying clinically significant malignant nodules is imperative. There are several guidelines suggested for risk stratification of thyroid nodules by US. The aim of our study was to validate and compare Thyroid Imaging Reporting and Data System (TIRADS) American College of Radiology (ACR) and American Thyroid Association (ATA) risk stratification, specifically pertaining to reduction of unnecessary biopsies. Material and Methods: The study included 281 nodules in 245 patients who underwent FNAB between May 2018 and June 2019. Statistical analysis was performed only on 235 nodules that according to the TIRADS ACR and/ or ATA guidelines were eligible for FNAB. Data collected included nodule characteristics with corresponding TIRADS and ATA grading and cytological results using Bethesda scoring. Results: An agreement was found between the two criteria methods in 58.2% (137/235) of the cases. In 35.3% (83/235), ATA recommended FNAB while TIRADS did not. The specificity for ATA criteria was 7% (15/221) and for TIRADS was 37% (81/221). The sensitivity was 100% (14/14) for ATA and 86% (12/14) for TIRADS. Conclusion: Application of ACR TIRADS criteria can reduce the number of US-guided FNAB performed on benign nodules compared to ATA criteria, by 35%, with a cost of only two missed carcinomas that remained on further follow-up.

GUIDELINE IMPLEMENTATION ON FINE-NEEDLE ASPIRATION FOR THYROID NODULES: FOCUSING ON MICRONODULES

2020 ◽  
Vol 26 (9) ◽  
pp. 1017-1025
Author(s):  
Si Eun Lee ◽  
Eun-Kyung Kim ◽  
Hee Jung Moon ◽  
Jung Hyun Yoon ◽  
Vivian Youngjean Park ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Thyroid Surgery ◽  
Thyroid Nodules ◽  
Guideline Implementation ◽  
Needle Aspiration ◽  
Data System ◽  
American Thyroid Association ◽  
Fine Needle ◽  
Thyroid Imaging

Objective: We investigated patients who were referred to our institution after fine-needle aspiration (FNA) was performed at outside clinics to evaluate how many nodules satisfied the FNA indications of the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and compare that to the number of thyroid nodules that satisfy the FNA indications of the American College of Radiology (ACR)-TIRADS and American Thyroid Association (ATA) guidelines. Methods: Between January 2018 and December 2018, 2,628 patients were included in our study. The included patients were those referred for thyroid surgery after having a suspicious thyroid nodule. We retrospectively applied the three guidelines to each thyroid nodule and determined whether each nodule satisfied the FNA indications. We compared the proportion of nodules satisfying the FNA indications of each guideline using a generalized linear model and generalized estimating equation. Results: The median size of the 2,628 thyroid nodules was 0.9 cm (range, 0.2 to 9.5 cm). We found that FNA was not indicated for 54.1%, 47.7%, and 19.1% of nodules and 87.3%, 99.0%, and 97.8% among them were micronodules (<1 cm) according to the ACR-TIRADS, ATA guideline, and K-TIRADS, respectively. The proportion of micronodules which satisfied the FNA indications was significantly higher for the K-TIRADS (65.1%) compared to the ACR TIRADS (12.1%) and ATA guideline (12.1%) ( P<.001). Conclusion: Among patients referred for thyroid surgery to our institutions, about 35% of the micronodules underwent FNA despite not being appropriate for indications by the K-TIRADS. Systematic training for physicians as well as modifications to increase the sensitivity of the guideline may be needed to reduce the overdiagnosis of thyroid cancers, especially for micronodules. Abbreviations: ACR = American College of Radiology; ATA = American Thyroid Association; FNA = fine-needle aspiration; K-TIRADS = Korean Thyroid Imaging Reporting and Data System; LN = lymph node; TIRADS = Thyroid Imaging Reporting and Data System; US = ultrasound

scholarly journals Malignancy Analyses of Thyroid Nodules in Patients Subjected to Surgery with Cytological- and Ultrasound-Based Risk Stratification Systems

Endocrines ◽  
2020 ◽  
Vol 1 (2) ◽  
pp. 102-118
Author(s):  
Stefania Giuliano ◽  
Maria Mirabelli ◽  
Eusebio Chiefari ◽  
Margherita Vergine ◽  
Rita Gervasi ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Clinical Features ◽  
Fine Needle Aspiration ◽  
Thyroid Surgery ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
American Thyroid Association ◽  
Fine Needle ◽  
Indeterminate Cytology

The fine needle aspiration (FNA) cytology is the gold standard for the preoperative diagnosis of thyroid cancer. However, up to 30% of FNA examinations yield nondiagnostic or indeterminate results and this complicates patient management. Clinical features and ultrasound (US) patterns, including US risk stratification systems, could be useful in the preoperative diagnostic workup and prediction of malignancy, but the evidences are not univocal. Methods: 400 consecutive patients subjected to thyroid surgery were retrospectively enrolled at our institution in Calabria, Southern Italy. Preoperative US and FNA cytological descriptions, formulated according to the “Italian consensus for reporting thyroid fine-needle aspiration cytology” (ICCRTC) classification and three US risk stratification systems (those developed by the American Association of Clinical Endocrinologists, American College of Endocrinology and Associazione Medici Endocrinologi (AACE/ACE/AME), American Thyroid Association (ATA), and American College of Radiology (ACR-TIRADS)), were collected, along with histological results. Results: 147 thyroid cancer cases, in large majority papillary carcinomas, were detected on final histological examination. Almost two-thirds of patients subjected to thyroid surgery for either benign or malignant lesions were female. Patient’s age ≤20 years and between 21–30 years were clinical features associated with increased risk of thyroid cancer in logistic regression analyses. US features associated with thyroid cancer included irregular margins, solid composition, microcalcifications, and marked hypoechogenicity. The AACE/ACE/AME, ATA, and ACR-TIRADS risk categories, corresponding to specific US patterns, were strong predictors of malignancy in both genders, but not in nodules with indeterminate cytology. A measured difference between the longitudinal (L) and the anteroposterior (AP) diameter >5 mm, a proxy for a parallel-oriented oval shape of a nodule, emerged as a robust protective factor against thyroid cancer (OR 0.288 (95%CI 0.817–0.443); p < 0.001), regardless of cytological risk. Conclusions: Some, but not all, well-established predictors of TC have been confirmed in this study. Controversy surrounds the diagnostic performance of US risk stratification systems for the detection of thyroid cancer in the subgroup of nodules with indeterminate cytology, suggesting their use only to set the thresholds for FNA. A measured difference between L and AP diameters >5 mm may represent an additional and practical tool for ruling out malignancy in thyroid nodules, with the potential to reduce unnecessary surgical procedures.

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