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.

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.

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 Cytomorphological Study of Various Thyroid Nodules as per Bethesda Criteria

2021 ◽  
Vol 8 (12) ◽  
pp. 722-725
Author(s):  
Sharath Chandra Keshapaga ◽  
Tiwari Sundari Devi ◽  
Byrapuram Vijaya Nirmala ◽  
Durga Hari Prasanna Kumar Kalla
Keyword(s):  
Diagnostic Criteria ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Cost Effective ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Fine Needle ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
Thyroid Lesions

BACKGROUND Thyroid nodules are common and occur in 4 % - 7 % of the general population. Diseases of the thyroid are of great importance because they are most amenable to medical or surgical management. The benefit of thyroid fine needle aspiration (FNA) derives in large part from the ability to make a reliably benign interpretation that avoids unnecessary surgery. A uniform reporting system for thyroid FNA will facilitate effective communication among cytopathologist and the referring physician and allow easy and reliable sharing of data from different laboratories for national and international collaborative studies. For uniformity of reporting cytological smears “The Bethesda System for Reporting Thyroid Cytopathology” was recommended and the smears were divided into 6 diagnostic categories. We wanted to know the age and sex distribution and prevalence of various thyroid lesions as per Bethesda diagnostic criteria. We wanted to study the cytological and morphological features of thyroid lesions by fine needle aspiration cytology (FNAC). METHODS The present study is a prospective type of descriptive study, carried out from January 2016 to December 2017 at Andhra Medical College, Visakhapatnam. A total of 1291 cases were evaluated and classified according to Bethesda system of cytopathology. FNAC was done and the smears were immediately fixed in isopropyl alcohol and stained with haematoxylin and eosin. RESULTS In the present study a total of 1291 cases was analysed out of which 1193 were benign, 13 were AFLUS, 32 were follicular neoplasms, 10 were suspicious of malignancies and 36 malignant. All the lesions were classified as per Bethesda diagnostic criteria. CONCLUSIONS FNAC is a simple and cost-effective procedure which guides the clinical practitioner to choose the right form of treatment for the patient subsequently avoiding unnecessary surgery and ensuing morbidity. KEYWORDS Thyroid, Cytopathology, FNAC, Bethesda, Follicular Neoplasm, Benign, Malignant

scholarly journals Value of rapid on-site evaluation for ultrasound-guided thyroid fine needle aspiration

2018 ◽  
Vol 47 (2) ◽  
pp. 626-634 ◽  
Author(s):  
Danni Jiang ◽  
Yichen Zang ◽  
Dandan Jiang ◽  
Xiaojuan Zhang ◽  
Cheng Zhao
Keyword(s):  
Fine Needle Aspiration ◽  
Complication Rate ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Significant Difference ◽  
Thyroid Fine Needle Aspiration ◽  
Site Evaluation ◽  
Thyroid Fna

Objective Application of rapid on-site evaluation (ROSE) for thyroid fine needle aspiration (FNA) is controversial. Therefore, ROSE has not been universally applied. This study aimed to evaluate the value of ROSE for ultrasound-guided thyroid FNA. Methods A total of 997 patients with 1103 suspicious thyroid nodules had ultrasound-guided FNA performed from January 2016 to February 2018. There were 513 nodules with ROSE and 590 nodules without ROSE. The cytological nondiagnostic rate, needle passes, and procedural times of thyroid FNA with or without ROSE were compared. The nondiagnostic rates of subsets of suspicious thyroid nodules were further compared. Results There was no significant effect of ROSE on the nondiagnostic rate of FNA. However, FNA with ROSE significantly reduced the numbers of sub-centimeter, mixed solid-cystic, macrocalcified, and hypervascular nodules. There was a significantly smaller number of needle passes and less procedural times with ROSE than without ROSE. There was no significant difference in the complication rate of FNA with and without ROSE. Conclusion ROSE for thyroid FNA reduces the number of needle passes and procedural times. ROSE has a higher clinical application value in subsets of thyroid nodules, which tend to be difficult to diagnose with FNA.

scholarly journals Pajzsmirigygöbök vékonytű-aspirációs citológiai vizsgálata. A Bethesda-rendszer (2008) minőségbiztosítása

2015 ◽  
Vol 156 (41) ◽  
pp. 1661-1666 ◽  
Author(s):  
Mihály Bak ◽  
Ilona Péter ◽  
Tibor Nyári ◽  
Péter Simon ◽  
Mátyás Újlaky ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Needle Aspiration Cytology ◽  
Thyroid Cytopathology ◽  
The Bethesda System

Introduction: The methods available for the diagnosis of thyroid nodules include physical examination, imaging, laboratory and fine-needle aspiration cytology tests. Aim: The aim of this study was to determine the quality assurance of fine-needle aspiration cytology of thyroid nodules. Method: Cytology results were rated to 6 categories according to the Bethesda System for Reporting Thyroid Cytopathology (2008) (I. nondiagnostic; II. benign; III. atypia of undetermined significance; IV. follicular neoplasia; V. suspicious for malignancy; VI. malignant). All cytology reports were compared with the final histology diagnosis. Results: A total of 1384 patient with thyroid nodule underwent fine-needle aspiration biopsy cytology. Smears were classified I. inadequate in 214 (15.9%); II. benign 986; III. atypical 56; IV. follicular neoplasm 41; V. suspicious for malignancy 18; VI. malignant 33 cases. Two hundred and twenty seven (16.8%) of the cases were operated and histologically verified. The positive predictive value in the benign category was 98.25% and in the malignant 88.46%. The sensitivity of the follicular neoplasm was 66.67%. Conclusion: The results suggest that fine-needle aspiration cytology of thyroid nodules using the Bethesda System for Reporting Thyroid Cytopathology has a high diagnostic accuracy. The auditing values of the results meet the proposed threshold values. Orv. Hetil., 2015, 156(41), 1661–1666.

scholarly journals DIAGNOSIS OF ENDOCRINE DISEASE: High-yield thyroid fine-needle aspiration cytology: an update focused on ancillary techniques improving its accuracy

2016 ◽  
Vol 174 (2) ◽  
pp. R53-R63 ◽  
Author(s):  
M Bongiovanni ◽  
P Trimboli ◽  
E D Rossi ◽  
G Fadda ◽  
A Nobile ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
Fine Needle Aspiration ◽  
Diagnostic Category ◽  
Needle Aspiration ◽  
Fine Tuning ◽  
High Yield ◽  
Fine Needle ◽  
Care Community ◽  
Thyroid Fine Needle Aspiration ◽  
Thyroid Fna

Thyroid fine-needle aspiration (FNA) cytology is a fast growing field. One of the most developing areas is represented by molecular tests applied to cytological material. Patients that could benefit the most from these tests are those that have been diagnosed as ‘indeterminate’ on FNA. They could be better stratified in terms of malignancy risk and thus oriented with more confidence to the appropriate management. Taking in to consideration the need to improve and keep high the yield of thyroid FNA, professionals from various fields (i.e. molecular biologists, endocrinologists, nuclear medicine physicians and radiologists) are refining and fine-tuning their diagnostic instruments. In particular, all these developments aim at increasing the negative predictive value of FNA to improve the selection of patients for diagnostic surgery. These advances involve terminology, the application of next-generation sequencing to thyroid FNA, the use of immunocyto- and histo-chemistry, the development of new sampling techniques and the increasing use of nuclear medicine as well as molecular imaging in the management of patients with a thyroid nodule. Herein, we review the recent advances in thyroid FNA cytology that could be of interest to the ‘thyroid-care’ community, with particular focus on the indeterminate diagnostic category.

Factors Influencing the Reliability of Thyroid Fine-Needle Aspiration: Analysis of Thyroid Nodule Size, Guidance Mode for Aspiration and Preparation Method

2015 ◽  
Vol 59 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Hui-qin Guo ◽  
Zhi-hui Zhang ◽  
Huan Zhao ◽  
Li-juan Niu ◽  
Qing Chang ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Rate Sensitivity ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Nodule Size ◽  
Study Results ◽  
Thyroid Fine Needle Aspiration ◽  
Thyroid Fna ◽  
Thinprep Technique

Objective: We aimed to clarify the influence of ThinPrep preparation, nodule size and guidance mode on the accuracy of thyroid fine-needle aspiration (FNA). Methods: A total of 1,240 thyroid FNAs were reviewed and 489 cases with histological correlations were enrolled in this study. Results: Of the 489 total cases examined, 101 were processed with both ThinPrep and conventional preparation and 388 entirely with ThinPrep. The overall nondiagnostic rate, sensitivity and accuracy of FNA were 2.0, 91.0 and 89.4%, respectively. The cases with a preoperative ultrasound (n = 469) were grouped according to nodule size. The nondiagnostic rate, sensitivity and accuracy of FNA did not differ significantly with nodule size (p1 = 0.339, p2 = 0.179, p3 = 0.119). A total of 101 resections were performed with palpation-guided FNA and 388 were performed with ultrasound-guided FNA. The nondiagnostic rates, sensitivity and accuracy of FNA were similar in these two groups. Conclusions: The ThinPrep technique is a valid method for thyroid FNA and is effective for thyroid nodules ≥0.5 cm. The reliability of FNA results is not reduced with larger nodules. The use of palpation-guided FNA for palpable solid nodules is also effective.

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 Rapid On-site Evaluation (ROSE) for Fine Needle Aspiration of Thyroid: Is It Helpful?

2021 ◽  
Vol 3 (1) ◽  
pp. 1-7
Author(s):  
Ahmed K. Aly ◽  
Mahmoud A. Ali ◽  
Apoorva Sharma ◽  
Michael A. Gubbels ◽  
Xing Zhao ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Significant Difference ◽  
Site Evaluation ◽  
Bethesda System ◽  
The Difference ◽  
Thyroid Cytopathology ◽  
The Bethesda System

Introduction: Thyroid nodules are very common. Many are detected incidentally due to increased head and neck imaging. The majority are benign; however, malignancy can’t be excluded in many cases and tissue sampling is needed. Ultrasound guided fine needle aspiration is an easy and effective way to sample g thyroid nodules. Inadequate sampling was reported in 10-40% of the cases. Rapid On-site Evaluation (ROSE) was proposed to assess obtained sample for adequacy. The aim of this study is to identify the benefit of applying ROSE with US-FNA of thyroid nodules within our institution. Materials and methods: Patients who underwent FNA for thyroid nodules with ROSE availability documented in their procedure note between January 2017 to December 2018 were retrospectively included. All procedures were done by experienced radiologists. Aspirated material was Diff Quik stained for immediate evaluation. The final cytological diagnosis and specimen adequacy was based on The Bethesda system for reporting thyroid cytopathology. Specimen adequacy was compared between ROSE and non-ROSE groups. Results: 442 thyroid nodules were biopsied. ROSE was available for 65 nodules. Non-diagnostic rate with ROSE was 10.8% compared to 13.8% without ROSE with the difference being statistically insignificant. ROSE availability improved sample adequacy of nodules less than 3 cm with statistically significant difference of 100.0% with ROSE vs. 87% without ROSE. Conclusion: The current study does not justify the routine use of ROSE. However, ROSE availability is beneficial with smaller sized thyroid nodules and less experienced radiologists performing the procedure. Doi: 10.28991/SciMedJ-2021-0301-1 Full Text: PDF

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