Interpretive Errors in Fine-Needle Aspiration of Thyroid: A 13-Year Institutional Experience in Lebanon

2021 ◽  
pp. 1-13
Author(s):  
Chirine S. Khaled ◽  
Ibrahim M. Khalifeh ◽  
Nina S. Shabb
Keyword(s):  
Fine Needle Aspiration ◽  
Medical Center ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Sampling Errors ◽  
Follicular Cells ◽  
Fine Needle ◽  
Nuclear Atypia ◽  
Thyroid Fna ◽  
Cyst Lining

<b><i>Introduction:</i></b> Fine-needle aspiration (FNA) is a worldwide established diagnostic tool for the assessment of patients with thyroid nodules. All thyroid FNA interpretive errors (IEs) were reviewed at the American University of Beirut Medical Center over a 13-year period, in order to identify and analyze them. <b><i>Materials and Methods:</i></b> All FNAs and their corresponding pathology results are correlated yearly for quality assurance. Discrepant cases are segregated into sampling errors and IEs. All thyroid FNAs with IEs were collected from 2005 to 2017. FNA and pathology slides were reviewed by trained, board-certified cytopathologists, adhering to the latest Bethesda criteria. Reasons for erroneous diagnoses were studied. <b><i>Results:</i></b> There was a total of 11 IEs out of 340 thyroid FNAs followed by surgical resection. Five benign follicular nodules (BFNs) were misinterpreted as suspicious for carcinoma. Focal nuclear atypia in cyst-lining or follicular cells and a monotonous population of macrophages misinterpreted as Hurthle cells (HCs) were the causes of IEs in this category. Four Hashimoto’s thyroiditis (HT) cases were misinterpreted as suspicious for malignancy. Innate atypia of HCs and sampling misinterpretation were the causes of IEs in HT. One medullary and 1 follicular carcinoma were misinterpreted as suspicious for follicular neoplasm and BFN, respectively. Nine cases were better classified after review. <b><i>Conclusion:</i></b> Thyroid FNA IEs can be mitigated by meticulous screening and identification of all elements on FNA smears. Awareness of focal nuclear atypia in reactive cyst-lining and follicular cells in BFN, as well as HCs in HT, is highlighted. Adherence to The Bethesda System for Reporting Thyroid Cytopathology and consulting experienced cytopathologists significantly decrease IEs.

Application of the Bethesda Classification for Thyroid Fine-Needle Aspiration: Institutional Experience and Meta-analysis

2016 ◽  
Vol 140 (10) ◽  
pp. 1121-1131 ◽  
Author(s):  
Elliot A. Krauss ◽  
Megan Mahon ◽  
Jean M. Fede ◽  
Lanjing Zhang
Keyword(s):  
Fine Needle Aspiration ◽  
Meta Analysis ◽  
Needle Aspiration ◽  
Data Sources ◽  
Follicular Neoplasm ◽  
Fine Needle ◽  
Diagnostic Categories ◽  
Risk Of Malignancy ◽  
Thyroid Fna ◽  
Undetermined Significance

Context.—Fine-needle aspiration (FNA) biopsies have been an important component in the preoperative evaluation of thyroid nodules. Until the introduction of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in 2008, individual institutions had developed their own diagnostic categories. The BSRTC proposed 6 categories in an attempt to standardize reporting of thyroid FNA. Objective.—To present a 15-year experience of thyroid FNA at one institution, including data before and after introduction of the BSRTC. The risk of malignancy is compared with the meta-analysis of high-quality published data. Data Sources.—Data sources were PubMed, a manual search of references, and institutional data. Conclusions.—The diagnostic categories developed at our institution were similar to those proposed by the BSRTC, with best fit into the 6 categories easily accomplished and reported in the final 2 years of the study. Significant differences were noted in the frequencies of cases in diagnostic categories Benign (II; P = .003), Suspicious for follicular neoplasm/Follicular neoplasm (IV; P &lt; .001), and Malignant (VI; P = .003) after the introduction of the BSRTC. Eighteen published articles met the criteria for inclusion in the meta-analysis. The risk of malignancy in each category in our institution was similar to that determined in the meta-analysis, except for Insufficient for diagnosis (I; 20% versus 9%–14%). Meta-analysis showed an overlapping 95% CI of risk of malignancy between Atypia of undetermined significance/Follicular lesion of undetermined significance (III; 11%–23%) and Suspicious for follicular neoplasm/Follicular neoplasm (IV; 20%–29%), suggesting similar risks of malignancy. The use of newer molecular tests for these indeterminate cases may further refine risk assessment.

scholarly journals Fine needle aspiration cytology comparison of diagnosed thyroid nodules diagnosis with postoperative histopathology

2018 ◽  
Vol 5 (12) ◽  
pp. 3898
Author(s):  
Gülay Turan ◽  
Servet Kocaöz
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
High Ratio ◽  
Follicular Neoplasm ◽  
City Hospital ◽  
Correct Treatment ◽  
Predictive Values ◽  
Fine Needle ◽  
Thyroid Fna

Background: Around 2.5% of male cancer in Turkey, 12% of female cancers include cancers of the thyroid. Early diagnosis and correct treatment of thyroid cancers is therefore important. However, in addition to preventing the complications, patients not to be subjected to unnecessary thyroid procedure depend on the pre-detection of that whether the nodules are benign or malign. The objectives of the study were to investigate whether fine needle aspiration (FNA) cytology of thyroid nodules is sufficient for diagnosis. Thyroid FNA result is based on the standardized Bethesda System for Reporting Thyroid Cytopathology (TBSRTC).Methods: FNA cytology reports of 1808 patients for the period between January 2011 and December 2017 in Atatürk City Hospital, which is located in Balıkesir province, in the western part of Turkey, were retrospectively analyzed. Cytology results were reported as follows: non-diagnostic, benign, atypia (AUS) or follicular lesion (FLUS) of undetermined significance, follicular neoplasm or suspected follicular neoplasm (FN), suspected malignity and malign. They were compared with postoperative histopathology result.Results: According to the thyroid FNA cytology, 409 patients were operated on, and the obtained specimens were histopathologically analyzed. The histopathological malignity rates of patients were detected to be as follows: 0.0%, 2.0%, 3.0%, 12.1%, 31.3% and 51.5%. It was detected that malign thyroid cancer was detected to be seen more in women and the age group of 31-60. The sensitivity value of the research was detected to be 92%, which was a significantly high ratio. Positive and negative predictive values were detected to be 97% and 92%, respectively.Conclusions: Where FNA cytology result is insufficient, FNA procedure should be repeated. FNA must be repeated with USG for cases with suspected AUS, FLUS and follicular neoplasm.

scholarly journals Fine Needle Aspiration of Thyroid Nodules Using the Bethesda System for Reporting Thyroid Cytopathology: An Institutional Experience in a Rural Setting

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Aili Guo ◽  
Yuuki Kaminoh ◽  
Terra Forward ◽  
Frank L. Schwartz ◽  
Scott Jenkinson
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Rural Setting ◽  
Follicular Neoplasm ◽  
Fine Needle ◽  
Bethesda System ◽  
Thyroid Fna ◽  
Thyroid Cytopathology ◽  
The Bethesda System

Background. Fine needle aspiration (FNA) remains the first-line diagnostic in management of thyroid nodules and reduces unnecessary surgeries. However, it is still challenging since cytological results are not always straightforward. This study aimed to examine the results of thyroid FNA using the Bethesda system for reporting thyroid cytopathology (TBSRTC) to establish the level of accuracy of FNA procedures in a rural practice setting. Method. A retrospective chart review was conducted on existing thyroid FNA performed in a referral endocrine center between December 2011 and November 2015. Results. A total of 159 patients (18–88 years old) and 236 nodule aspirations were performed and submitted for evaluation. 79% were benign, 3% atypia/follicular lesion of unknown significance (AUS/FLUS), 5% follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 4% suspicious for malignancy (one case was indeed an atypical parathyroid neoplasm by surgical pathology), 2% malignant, and 7% nondiagnostic. Two cases also had advanced molecular analysis on FNA specimens before thyroidectomy. Conclusion. The diagnostic yield of FNA cytology from our practice in a rural setting suggests that accuracy and specificity are comparable to results from larger centers.

Comparison of Diagnostic Rates and Concordance with Subsequent Surgical Resections between Conventional Smear and ThinPrep Preparations versus ThinPrep Only in Thyroid Fine Needle Aspiration (T-FNA) Specimens

2021 ◽  
pp. 1-10
Author(s):  
Miguel Rufail ◽  
Xin Jing ◽  
Brian Smola ◽  
Amer Heider ◽  
Richard Cantley ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Diagnostic Category ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Fine Needle ◽  
Advantages And Disadvantages ◽  
Thyroid Fine Needle Aspiration ◽  
Thyroid Fna ◽  
Thyroid Cytopathology

<b><i>Background:</i></b> Thyroid fine needle aspiration (T-FNA) is a mainstay in management of thyroid nodules. However, the preparation of T-FNA specimens varies across institutions. Prior studies have compared diagnostic rates between different specimen preparations of T-FNA specimens and their associated advantages and disadvantages. However, few have compared the rates of all diagnostic categories of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) between liquid-based preparations (LBPs) and a combination of LBP and conventional smear (CS) preparations. Our study compares TBSRTC diagnostic rates between these 2 cohorts and correlates cytologic diagnoses with subsequent thyroid resections to evaluate rates of neoplasia (RON) and malignancy (ROM). <b><i>Methods:</i></b> 584 consecutive thyroid FNA specimens were collected and stratified by preparation type (ThinPrep [TP] vs. CS &amp; TP). Diagnostic rates for each TBSRTC diagnostic category were calculated. The institution’s electronic medical records database was searched for histologic diagnoses of previously sampled thyroid nodules to evaluate the RON and ROM. <b><i>Results:</i></b> Of 584 thyroid FNA specimens, 73 (12.5%) and 511 (87.5%) were evaluated by TP only and CS &amp; TP, respectively, reflecting the predominance of rapid on-site evaluation (ROSE) with CS for T-FNAs at our institution. Of the TP only and CS &amp; TP cohorts, 29 (39.7%) and 98 (19.2%) had subsequent resections, respectively. The frequency of non-diagnostic cases was lower in the CS &amp; TP cohort (12.7% vs. 26%). While the diagnostic rate of follicular lesion of undetermined significance was similar for both cohorts, SFN categorization was only utilized in the CS &amp; TP cohort (1.5% vs. 0%). Although RON and ROM were similar between cohorts in many of the TBSRTC categories, there was a higher RON associated with non-diagnostic specimens in the TP only cohort when the denominator included all non-diagnostic cases. <b><i>Conclusion:</i></b> The combination of CS and LBP may potentially decrease the non-diagnostic rate of T-FNA specimens as well as the number of passes required for diagnosis, particularly with ROSE. Evaluation of morphologic features highlighted in conventional smears may facilitate diagnostic categorization in the “suspicious for follicular neoplasm” category.

Atypical Hidradenoma Mimicking Primary Mammary Carcinoma on Breast Fine-Needle Aspiration: A Case Report with Long-Term Follow-Up

2016 ◽  
Vol 60 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Lisa M. Rooper ◽  
Jeffrey S. Iding ◽  
Jonathan D. Cuda ◽  
Syed Z. Ali
Keyword(s):  
Differential Diagnosis ◽  
Fine Needle Aspiration ◽  
Mammary Carcinoma ◽  
Needle Aspiration ◽  
Partial Mastectomy ◽  
Low Grade ◽  
Fine Needle ◽  
Nuclear Atypia ◽  
Long Term Follow Up ◽  
Palpable Breast

Background: Fine-needle aspiration (FNA) is well-established as an accurate technique for the diagnosis of palpable breast masses. While the differential diagnosis of such lesions usually focuses on benign or malignant mammary proliferations, a subset of breast neoplasms arises from skin and soft tissue. Skin adnexal neoplasms such as hidradenoma can pose a particular pitfall on breast FNA cytology (FNAC) as epithelial proliferations that are not of ductal or lobular origin. Case: A 59-year-old female presented with a superficial breast mass. FNAC revealed a hypercellular lesion with marked nuclear atypia that was highly suspicious for carcinoma. However, at partial mastectomy, the histological features of the tumor were consistent with atypical hidradenoma. Negativity for estrogen receptor (ER) and progesterone receptor (PR) confirmed the diagnosis. Eighteen years later, the patient remains free of recurrence or metastasis. Conclusions: This report offers the first description of findings of atypical hidradenoma on FNAC. In the breast, its high cellularity and nuclear atypia can mimic a primary mammary carcinoma on FNAC. Although breast and skin adnexal tumors show a immunohistochemical overlap, negative ER and PR stains in a low-grade tumor can suggest a nonmammary lesion. Skin adnexal neoplasms should be considered in the differential diagnosis of superficial breast tumors.

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 Comparison on the Use of Spinal (Stylet) Needle and Simple Needle in Ultrasound Guided Thyroid Nodule FNA; Does the Needle Affect Thyroid FNA Result?

2020 ◽  
Vol 17 (2) ◽  
Author(s):  
Alireza Aziz Ahari ◽  
Mohammad Ali Mohammadi Vajari ◽  
Navid Khatibi Moghadam ◽  
Hassan Hashemi ◽  
Mahmoud Parvin ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Significant Relationship ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Needle Type ◽  
Expert Radiologist ◽  
Diagnostic Samples ◽  
Thyroid Fna

Background: Thyroid fine needle aspiration (FNA) is currently the most acceptable method for evaluating thyroid nodules. Non-satisfactory sample is the main limitation of FNA. It has been shown that spinal needles can reduce the number of non-diagnostic samples. Objectives: In this study, we decided to compare the results obtained using spinal (stylet) needle and simple needle in thyroid nodule FNA according to the agreement between them and with the pathology results as the gold standard. Patients and Methods: Sampling of thyroid nodules of 156 patients was performed by a simple non-stylet 23 gauge needle (A) and a spinal 22 gauge needle with stylet (B). The samples were provided to the pathologist for blind examination. All samples were obtained by an expert radiologist and the pathology examination was also performed by a pathologist expert in thyroid gland diseases. Blind analysis was done using SPSS Statistics for Windows, version 16 (SPSS Inc., Chicago, Ill., USA). Results: The results of FNA with needles A and B were reported unsatisfactory in 11.51 (18 subjects) and 3.84 (six subjects), respectively (P = 0.01). The result in 63.46% (99 subjects) of the participants, in whom FNA was obtained by needle B was introduced as a better sample by the pathologist in comparison with 36.44% (57 subjects) (P < 0.001). Cancer was diagnosed in 9.56 and 7.66 of the samples yielded by needles B and A, respectively, which was not statistically significant (P = 0.54). There was also a significant relationship between thyroid imaging reporting and data system (TI-RADS) score and FNA result. Conclusion: A significant relationship between the adequate sampling results, the qualitative examination result, TI-RADS score and the needle type indicates the importance of needle type on the results of thyroid FNA. Using spinal (stylet) needles may reduce the number of non-diagnostic samples in fine needle aspiration of thyroid nodules and therefore, can have a better effect on the results of this method.

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.

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