Diagnostic Accuracy of Fine Needle Aspiration in Thyroid Nodules Arising in Patients with Graves Disease

2017 ◽  
Vol 61 (2) ◽  
pp. 117-124 ◽  
Author(s):  
Jen-Fan Hang ◽  
Mohammed T. Lilo ◽  
Justin A. Bishop ◽  
Syed Z. Ali
Keyword(s):  
Predictive Value ◽  
Thyroid Nodules ◽  
Follicular Adenoma ◽  
Clinical Information ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Graves Disease ◽  
Fine Needle ◽  
Cellular Atypia ◽  
Sensitivity Specificity

Objective: Cytopathologic interpretation in Graves disease (GD) is considered challenging due to significant cellular atypia. Study Design: We retrospectively identified 55 fine needle aspirations (FNAs) from 43 patients with GD that subsequently underwent thyroidectomy from 1995 to 2016. Results: There were 5 patients with papillary thyroid carcinoma (PTC) and 4 with follicular adenoma (FA). Of the 5 patients with PTC, FNA was interpreted as PTC in 3, atypia of undetermined significance (AUS) in 1, and adenomatoid nodule (AN) in 1 (with a 0.5-cm incidental microcarcinoma). Of the 4 patients with FA, FNA was interpreted as follicular neoplasm (FN) in 2, AUS in 1, and AN in 1. Of the 46 nonneoplastic nodules, FNA was interpreted as nondiagnostic in 2, benign in 26, AUS in 15, FN in 1, and suspicious for PTC in 2. None was diagnosed as malignant. The sensitivity, specificity, positive predictive value, and negative predictive value of PTC diagnosis in FNA were 60, 100, 100, and 96.2%, respectively. Conclusion: FNA is a useful tool for identifying neoplastic nodules arising in GD. However, cytologic atypia often leads to indeterminate diagnoses (18/46, 39.1%). Awareness of clinical information regarding prior treatment for GD may be helpful to avoid overinterpretation.

Impact of the Afirma Gene Expression Classifier Result on the Surgical Management of Thyroid Nodules with Category III/IV Cytology and Its Correlation with Surgical Outcome

2016 ◽  
Vol 60 (3) ◽  
pp. 205-210 ◽  
Author(s):  
Shweta Chaudhary ◽  
Yanjun Hou ◽  
Rulong Shen ◽  
Shveta Hooda ◽  
Zaibo Li
Keyword(s):  
Gene Expression ◽  
Predictive Value ◽  
Surgical Outcome ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Molecular Test ◽  
Gene Expression Classifier ◽  
Sensitivity Specificity ◽  
Undetermined Significance

Objective: The Afirma gene expression classifier (GEC) is a molecular test to further classify indeterminate fine-needle aspiration (FNA) as benign or suspicious for malignancy. Study Design: A total of 158 FNAs with Bethesda category III/IV cytology were sent for an Afirma GEC test. We correlated the Afirma GEC results with surgical outcome and also compared the data after Afirma's implementation with the data before. Results: Among the 158 FNAs, the Afirma result was benign in 63 (40%), suspicious in 85 (54%) and unsatisfactory in 10 (6%). In total, 73 (86%) suspicious Afirma cases had surgery and 28 (38%) showed carcinoma. In contrast, only 8 (13%) benign Afirma cases had surgery and all of them were benign. The sensitivity, specificity, negative predictive value and positive predictive value (PPV) of Afirma were 100, 15, 100 and 38%, respectively. The PPV was 20% in cases with follicular lesion of undetermined significance, but was 50% in cases suspicious for follicular neoplasm (SFN). The surgical excisional rate was significantly decreased in SFN cases after the Afirma test. Conclusions: The Afirma GEC is useful for further risk stratifying SFN cases.

The Role of Ultrasound-Guided Fine-Needle Aspiration of Thyroid Bed Lesions and Clinical Predictors of Recurrent Papillary Thyroid Carcinoma

2020 ◽  
Author(s):  
Lisi Yuan ◽  
Judith Jebastin Thangaiah ◽  
Deborah J Chute
Keyword(s):  
Thyroid Carcinoma ◽  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Papillary Thyroid ◽  
Fine Needle ◽  
Recurrent Malignancy ◽  
Sensitivity Specificity

Abstract Objectives Fine-needle aspiration (FNA) of thyroid bed lesions after thyroidectomy is challenging to evaluate. We determined the sensitivity, specificity, and positive and negative predicative value of thyroid bed FNA (TB-FNA) for detecting local recurrence of thyroid carcinoma. Methods A retrospective search was conducted for TB-FNAs from patients with a prior thyroid resection and subsequent ipsilateral FNA from the thyroid bed. Clinical and pathologic data were retrieved from the medical record. Patients were ultimately classified as “malignant” or “benign” based on the worst pathology identified and follow-up available. Results Forty-two cases were included, and the prior thyroidectomy pathology included 36 papillary thyroid carcinomas, two follicular carcinomas, one medullary carcinoma, and three benign cases. TB-FNA was adequate in 38 (90.5%) cases and interpreted as positive for malignancy (n = 22; 52.4%), suspicious for follicular neoplasm (n = 3; 7.1%), atypia of unknown significance (n = 2; 4.8%), and benign (n = 10; 23.8%). Twenty-seven patients had histologic follow-up, and 24 (87.5%) showed recurrent malignancy. The cytology sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 96%, 100%, 100%, 92.3%, and 97.4%, respectively, for identification of recurrent malignancy. Conclusions Most TB-FNA cases ultimately were diagnosed with malignancy on follow-up, although there may be sampling bias, as not all clinically benign cases had surgical follow-up.

Diagnostic value of 2017 ACR Thyroid Imaging Reporting and Data System (TI-RADS) combined with fine needle aspiration biopsy in thyroid nodules

2021 ◽  
pp. 1-10
Author(s):  
Chao Zhang ◽  
Yu-Qin Huang ◽  
Zhi-Long Liu
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Diagnostic Value ◽  
Needle Aspiration ◽  
Data System ◽  
Fine Needle ◽  
Thyroid Imaging ◽  
Accuracy Increase ◽  
Sensitivity Specificity

OBJECTIVE: To evaluate diagnostic value of Thyroid Imaging Reporting and Data System published by American College of Radiology (ACR TI-RADS) in 2017, ultrasound-guided fine-needle aspiration (US-FNA), and the combination of both methods in differentiation between benign and malignant thyroid nodules. METHODS: The data of US-FNA and ACR TI-RADS are collected from 159 patients underwent thyroid surgery in our hospital, which include a total of 178 thyroid nodules. A Bethesda System for Reporting Thyroid Cytopathology category of ≥IV and an ACR TI-RADS category ≥4 are regarded as diagnosis standards for malignancy in US-FNA and ACR TI-RADS, respectively. The pathological results after surgery are considered as the gold standard. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the ACR TI-RADS, US-FNA and the combination of both methods for the differential diagnosis of thyroid nodules are calculated, respectively. RESULTS: The sensitivity, specificity and accuracy of ACR TI-RADS are 85.4%, 37.5%and 72.5%, respectively. The sensitivity, specificity and accuracy of US-FNA are 70.0%, 100%and 78.1%, respectively. After combining these two methods, the sensitivity, specificity and accuracy increase to 99.23%, 37.50%and 82.58%, respectively. The sensitivity of ACR TI-RADS is higher than that of US-FAN, and the sensitivity of combining these two methods is also higher than that of using ACR TI-RADS and US-FNA alone. CONCLUSION: The established ACR TI-RADS can help in selecting the target during nodule puncture, while the combination of ACR TI-RADS and US-FAN can further improve diagnostic ability for detecting malignant thyroid nodules.

scholarly journals Thyroid Cytopathology Reporting by the Bethesda System: A Two-Year Prospective Study in an Academic Institution

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Payal Mehra ◽  
Anand Kumar Verma
Keyword(s):  
Prospective Study ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Fine Needle ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
The Bethesda System ◽  
Undetermined Significance

Background. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has attempted to standardize reporting and cytological criteria in aspiration smears. Aims. The objective of this study was to analyze the thyroid cytology smears by TBSRTC, to determine the distribution of diagnostic categories and subcategories, to analyze cytological features, and to correlate the cytopathology with histopathology, wherever surgery was done. Materials and Methods. This was a prospective study of 225 fine needle aspirations (FNA) of thyroid nodules. All fine needle aspiration cytology (FNAC) diagnoses were classified according to the features given in the monograph of TBSRTC into nondiagnostic/unsatisfactory (ND/UNS), benign, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm/suspicious of a follicular neoplasm (FN/SFN), suspicious for malignancy (SFM), and malignant. Cytohistological correlation was done, when surgical material was available. Results. The distribution of various categories from 225 evaluated thyroid nodules was as follows: 7.2% ND/UNS, 80.0% benign, 4.9% AUS/FLUS, 2.2% FN, 3.5% SFM, and 2.2% malignant. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Conclusions. TBSRTC is an excellent reporting system for thyroid FNA. It also provides clear management guidelines to clinicians to go for follow-up FNA or surgery and also the extent of surgery.

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Thyroid Nodules in Thammasat University Hospital

2021 ◽  
Vol 104 (10) ◽  
pp. 1667-1670
Keyword(s):  
Diagnostic Accuracy ◽  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
The Other ◽  
Follicular Neoplasm ◽  
Fine Needle ◽  
Malignancy Rate

Background: Fine needle aspiration (FNA) cytology is a key investigation of thyroid nodules. There are several reports of FNA accuracy, which ranges from 75.0% to 94.8%, while false negative rates are 5.8% to 21.5%. In Thailand, there is no available data of FNA accuracy according to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The present study reported single-institute data of FNA accuracy, that could be used in thyroid nodule management. Objective: To determine the diagnostic accuracy of FNA cytology results of thyroid nodules collected in Thammasat University (TU) Hospital. Materials and Methods: The present study was a retrospective study collected cytologic results of all thyroid nodules that subsequently had definitive histopathologic diagnoses. The data were gathered from clinics at TU Hospital that performed thyroid nodule FNA between May 2011 and November 2014. The FNA cytology results were classified according to TBSRTC. Each cytopathologic result was compared with its postoperative tissue histopathology. The malignancy rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: The present study included 197 thyroid nodule FNA cytology results. The sensitivity and specificity were 77.8% and 65.4%, respectively. The calculated PPV was found to be 47.7%, and the NPV was 87.9%. The accuracy of these results was 69.0%. The malignancy rate of the unsatisfactory group was 6.25%, benign group 8.05%, atypia of undetermined significance or follicular lesion of unknown significance 22.22%, follicular neoplasm/suspicious for follicular neoplasm 14.20%, suspicious for malignancy 73.68%, and malignant 100%. Conclusion: The FNA cytology in TU Hospital has comparable sensitivity to the other studies. Interestingly, the malignancy rate in the follicular neoplasm category is lower than that of the other institutes because of a high false positive rate in this category. This causes lower specificity and accuracy, which may cause a higher rate of unnecessary operations. Keywords: FNA; Thyroid nodule; Diagnostic accuracy

scholarly journals RISK FACTORS OF MALIGNANCY IN PATIENTS WITH FINE NEEDLE ASPIRATION BIOPSY RESULTS INTERPRETED AS “SUSPICIOUS FOR FOLLICULAR NEOPLASM”

2020 ◽  
Vol 73 (7) ◽  
pp. 1323-1329
Author(s):  
Jarosław Świrta ◽  
Michał Romaniszyn ◽  
Marcin Barczyński
Keyword(s):  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Biopsy ◽  
Follicular Adenoma ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Follicular Neoplasm ◽  
Fine Needle ◽  
Risk Of Malignancy ◽  
Needle Aspiration Biopsy ◽  
Aggregate Amount

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

scholarly journals Diagnostic Value of Rapid On-Site Evaluation for CT-Guided Percutaneous Fine Needle Aspiration in the Diagnosis of Pulmonary Occupying Lesions

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Tian-Feng Peng ◽  
Tao Ren ◽  
Han-Sheng Wang ◽  
Zhe-Xiang Feng ◽  
Mei-Fang Wang
Keyword(s):  
Lung Cancer ◽  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Rate Sensitivity ◽  
Needle Aspiration ◽  
Ct Guided ◽  
Fine Needle ◽  
Site Evaluation ◽  
Sensitivity Specificity ◽  
The Rose

Objective. Rapid on-site evaluation (ROSE) is an effective and efficient auxiliary examination, but its value for CT-guided percutaneous fine-needle aspiration (FNA) in the diagnosis of pulmonary occupying lesions is unclear. This study is aimed at evaluating the clinical utility of ROSE for CT-guided percutaneous FNA. Methods. We reviewed 234 patients from September 2018 to April 2019. The result using ROSE was compared with the final pathological diagnosis of CT-guided percutaneous FNA, and we also compared the complications between the ROSE group and the NO-ROSE group. The final pathological diagnosis results served as the gold standard. We also analyzed the diagnostic rate of FNA and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of malignancy. The correlation between diverse pathological types of lung cancer was also taken into consideration. Results. In total, 132 patients underwent CT-guided percutaneous FNA with ROSE (ROSE group), and 102 did not (NO-ROSE group). The diagnostic rate, sensitivity, specificity, PPV, and NPV of the ROSE group were 91.6%, 89.1%, 94.1%, 93.4%, and 90.1%, respectively. The complication rates of the ROSE group and the NO-ROSE group were 8.33% and 16.67%, respectively. This difference was not statistically significant ( P > 0.05 ). In subsets of adenocarcinoma (AC) and small cell lung cancer (SCLC) patients, the ROSE result was highly consistent with the final pathological result. Conclusion. CT-guided percutaneous FNA combined with ROSE has a high diagnostic rate, sensitivity, and specificity for pulmonary occupying lesions and an acceptable rate of complications. This method is worthy of wide use given its high efficiency and safety.

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

1998 ◽  
Vol 187 (5) ◽  
pp. 494-502 ◽  
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

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

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

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

2013 ◽  
Vol 98 (12) ◽  
pp. 4790-4797 ◽  
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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