Assessment of the total cost of FNAC as a diagnostic tool in patients with thyroid nodules

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6628-6628
Author(s):  
I. Borget ◽  
P. Vielh ◽  
M. Allyn ◽  
M. Schlumberger ◽  
G. De Pouvourville
Keyword(s):  
False Positive ◽  
Thyroid Nodules ◽  
Unit Cost ◽  
False Negative ◽  
Final Diagnosis ◽  
Sensitivity Analyses ◽  
Markov Modelling ◽  
Total Cost ◽  
Number Of Patients

6628 Background: The prevalence of thyroid nodules in the general population ranges from 4 to 7% and fine-needle aspiration cytology (FNAC) is a widely used diagnostic procedure. As the final diagnosis is based on post-surgical pathology of the lesion, a number of patients with nodules classified as benign or indeterminate by cytology may have a postponed final diagnosis, impacting the procedure cost. This study aims to determine the total cost of FNAC, by taking into account of diagnostic mistakes (false-positive and false-negative), failures of FNAC (indeterminate results) and the follow-up of non operated patients. Methods: A Markov model was built to describe the management of patients through time, from the first FNA-t. We derived estimates for diagnostic accuracy values and follow-up from a retrospective study, including all patients who had their first FNAC from 2003 to 2005 at Institut Gustave Roussy. Costs were computed from the viewpoint of the hospital. A microcosting study was performed to determine the unit cost of FNAC. Sensitivity analyses were performed. Results: Out of the 624 patients who had FNAC, 15 were cytologically classified as malignant, 57 as suspicious and 171 as indeterminate. Surgical excision was carried on in 155 cases. The unit cost of FNAC was 121 €. Markov modelling showed that the mean total cost of a true diagnosis including unnecessary surgeries, repeat FNAC and follow-up was 1,145 Euros. The number of false negative and false positive cases had little impact on total cost, whereas it was significantly affected by the percentage (27%) of unsatisfactory specimens. The absence of such specimens would reduce the total cost to 738 Euros (35%). Conclusions: The cost of FNAC exceeds its unit production cost. It depends on the performance of the cytologist and on the rate of indeterminate results that might be reduced by routine ultrasound-guidance. No significant financial relationships to disclose.

scholarly journals Unfavorable Outcomes in Solid and Spongiform Thyroid Nodules Treated with Laser Ablation. A 5-Year Follow-up Retrospective Study

2019 ◽  
Vol 19 (7) ◽  
pp. 1041-1045 ◽  
Author(s):  
Roberto Negro ◽  
Gabriele Greco
Keyword(s):  
Retrospective Study ◽  
Laser Ablation ◽  
Thyroid Nodules ◽  
False Negative ◽  
Thyroid Function Test ◽  
Final Diagnosis ◽  
Therapeutic Modality ◽  
Nodule Volume

Objective: Laser Ablation (LA) is a therapeutic modality for reducing the volume of large benign thyroid nodules. This retrospective study was aimed at assessing the outcome of LA in patients with benign nonfunctioning thyroid nodules in a 5-years follow-up. Methods: Sixty-two patients (47 females; mean age 54.7±12 yr) with benign cold thyroid nodules underwent LA from July 2009 to March 2012. Nodule volume, thyroid function test, and ultrasound were monitored at baseline, and at 3, 6 and 12 months after the procedure, then annually. After dividing nodules in solid and spongiform, we evaluated unfavourable outcomes: 1) nodule’s volume reduction <50%; 2) need for surgery; 3) need for additive LA session (due to nodule re-growth with persistence of cosmetic concern or compressive symptoms). Results: Baseline volume did not differ between solid and spongiform nodules as well as energy delivered and the number of needles used. Unfavourable outcomes occurred in 24 patients (38.7%). Nineteen/ 24 (79.2%) patients who experienced unfavourable outcomes belonged to the solid nodules group (P<0.01). When considering only those who benefited from LA, the 5-years reduction was 59.7% for solid and 78.6% for spongiform nodules (P<0.05). One/6 patients who underwent surgery (solid nodules group) had a final diagnosis of Follicular Variant of Papillary Thyroid Cancer (FVPTC). Conclusion: Large solid nodules, unlike spongiform, submitted to LA are characterized by a long-term unfavourable outcome and entail a potential risk of false negative cytologic results.

Accuracy of Fine-Needle Aspiration of Thyroid

2001 ◽  
Vol 125 (4) ◽  
pp. 484-488 ◽  
Author(s):  
Mojghan Amrikachi ◽  
Ibrahim Ramzy ◽  
Sheldon Rubenfeld ◽  
Thomas M. Wheeler
Keyword(s):  
Fine Needle Aspiration ◽  
False Positive ◽  
Thyroid Nodules ◽  
False Negative ◽  
Cost Effective ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Follicular Variant ◽  
Fine Needle

Abstract Context.—Fine-needle aspiration has become an accepted and cost-effective procedure for rapid diagnosis of thyroid lesions. The routine use of fine-needle aspiration has reduced the rate of unnecessary surgery for thyroid nodules. Objectives.—To determine the accuracy of fine-needle aspiration biopsy diagnosis and to discuss the possible pitfalls. Design, Setting, and Participants.—Reports of 6226 fine-needle aspiration biopsies of the thyroid performed during a period of 16 years (1982–1998) were reviewed. Computerized reports of the fine-needle aspiration biopsies were sent to the physicians who performed the procedures, and clinical follow-up information regarding the patients was requested. Twenty-four clinicians participated in the study. Histologic diagnoses were available for 354 cases. The cytopathologic diagnoses were correlated with the histologic findings or clinical outcomes. Results.—The cytologic diagnoses were as follows: 210 (3.4%) malignant, 450 (7.2%) suspicious, 3731 (60%) benign, and 1845 (29.5%) unsatisfactory. Most of the cases with negative or unsatisfactory aspirates were followed clinically or by repeat fine-needle aspiration. We identified 11 false-negative and 7 false-positive diagnoses. For aspirates considered sufficient for diagnosis, the sensitivity and specificity levels were 93% and 96%, respectively. Conclusions.—Fine-needle aspiration of the thyroid gland is highly accurate and has a low rate of false-negative and false-positive diagnoses. The major diagnostic problems are caused by diagnosis using a marginally adequate specimen, diagnosis of malignancy based on just 1 or 2 atypical cytologic features, or overlapping cytologic features of follicular neoplasm with those of follicular variant of papillary carcinoma.

FDG-PET for Staging and Follow-up of HIV-Infected Patients with Non Hodgkin Lymphoma and Hodgkin Lymphoma: A Single Center Experience.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 5014-5014
Author(s):  
Silvia Cantoni ◽  
Erika Ravelli ◽  
Maria Cristina Moioli ◽  
Chiara Rusconi ◽  
Vittorio Ruggero Zilioli ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Ct Scan ◽  
Hodgkin Lymphoma ◽  
False Positive ◽  
Fdg Pet ◽  
False Negative ◽  
Hiv Positive ◽  
Number Of Patients ◽  
Positive Results

Abstract Abstract 5014 Introduction Risk of developing non Hodgkin lymphomas (NHL) is known to be increased among patients (pts) infected by HIV-1 and sporadic non-HIV related cases of Hodgking lymphomas (HL) are also described. HIV-positive pts also feature a virus-related systemic lymphoadenopathy which makes nodal involvement by lymphoma difficult to evaluate using conventional imaging. The role of positron-emission tomography using 18F-fluorodeoxyglucose (FDG-PET) in the staging and evaluation of response to treatment of pts with NHL and HL is well established in immunocompetent pts, while only limited information is available on lymphomas arising in the setting of HIV infection. We report on a retrospective analysis of FDG-PET results in a group of HIV pts with lymphoma, both NHL and HL, followed-up at our hospital. Patients and methods Twelve HIV-positive male pts with a diagnosis of lymphoma (7 high grade and 1 follicular NHL, 4 HL) underwent a total of 22 PET scans. PET results were compared with those obtained by computed tomography (CT). Nine PET were performed at staging, 7 at restaging following chemotherapy, and 6 at follow-up. At diagnosis of lymphoma: median CD4 count was 200 cells/mcL (range 98-451); HIV genome was undetectable in 5/9 pts, in the remaining 4 pts for whom the data was available viral loads ranged from 103 to 1,452,720 copies/mL; 10/12 pts were already receiving HAART, while the remaining 2 pts started treatment upon diagnosis of lymphoma. Results In the majority of cases (17/22 = 77%) results of PET, CT scan and clinical status were concordant, being diagnostic of either lymphoma presence (11/17) or absence (6/17). No false positive results were recorded at follow-up. In 5/22 cases (23%) PET and CT scan were discordant. In 4 cases PET yielded a false negative result; in 2 cases at diagnosis (2 pts with HL) and in 2 cases at follow-up (both in the pt with follicular lymphoma). In the remaining case, a PET-negative CT-positive adenopathy was demonstrated which proved to be reactive in nature at biopsy. Discussion Our results suggest that FDG-PET is useful in the evaluation of lymphoma in the setting of HIV infection, similarly to what has been observed among immunocompetent pts. Although the number of patients is limited, in our experience PET proved to be able to discriminate between reactive and lymphomatous involvement of lymphoid tissue as demonstrated by absence of false positive results in pts evaluated at follow-up. These results need to be confirmed by larger clinical trials. Disclosures No relevant conflicts of interest to declare.

Afirma Testing in Thyroid Nodules with Indeterminate Cytology: A single Medical Institute Experience

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S94-S95
Author(s):  
Z Yang ◽  
T Zhang ◽  
L Layfield ◽  
M Esebua
Keyword(s):  
Predictive Value ◽  
Thyroid Nodules ◽  
False Negative ◽  
Follicular Adenoma ◽  
Follicular Carcinoma ◽  
Medical Institute ◽  
Cell Adenoma ◽  
Indeterminate Cytology ◽  
Thyroid Fna

Abstract Introduction/Objective About 10 to 30% of thyroid fine needle aspiration (FNA) nodules have indeterminate cytology, including Bethesda III, IV, and V. Afirma Gene Expression Classifier (GEC) measuring the expression of 167 mRNA was designed to classify the indeterminate thyroid nodules into benign and suspicious categories. This study aimed to evaluate the clinical performance of the Afirma GEC testing in these indeterminate thyroid lesions. Methods Medical records of patients with indeterminate thyroid FNA results and corresponding Afirma GEC results from November 2012 to December 2019 were retrieved. Subsequent surgical follow-up results were obtained. GEC results were compared to the histologic diagnoses. Results 1. There were 77 cases with indeterminate thyroid FNA results. Cytology diagnosis included 67 Bethesda III and 10 Bethesda IV. Afirma GEC results were benign for 41 cases (53%), suspicious for 32 cases (42%), and non- diagnostic for 4 cases (5%). Twenty seven of 32 cases (84%) with suspicious GEC results had surgical follow-up which revealed 12 malignant and 15 benign histologic diagnoses. Only 11 of 41 cases (27%) with benign GEC results had surgery which showed 8 benign and 3 malignant diagnoses. Based on the data, the sensitivity of this test is 80% and specificity is 65%. Positive predictive value (PPV) is 44% and negative predictive value (NPV) is 73%. The false positive cases include 5 Hurthle cell adenoma, 4 nodular hyperplasia, 3 follicular adenoma, 2 Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFPT), and 1 lymphocytic thyroiditis. The false negative cases include 2 minimally invasive follicular carcinoma (from same patient) and 1 papillary thyroid carcinoma. Conclusion 1. We demonstrated in this study that a little more than half of the cases with indeterminate thyroid cytology had negative Afirma GEC results. 2.Afirma test has relatively low specificity (65%) and PPV (44%). The sensitivity (80%) and NPV (73%) is relatively higher but is lower than the values in most literature. This could be due to the fact that majority of the Afirma GEC negative cases in this study did not have surgical follow-up and the sample size is small. 3.Afirma GEC test is a relatively good “rule-out” molecular test for indeterminate thyroid nodules but is not a reliable “rule-in” test due to the low specificity and PPV.

scholarly journals False Covid-19 Test Results – Could We Do Things Better? A Personal Opinion

2020 ◽  
Vol 8 (5) ◽  
Author(s):  
Suzanne Lisbeth Ekelund
Keyword(s):  
False Positive ◽  
False Negative ◽  
Test Results ◽  
Negative Results ◽  
False Negative Results ◽  
Personal Opinion ◽  
Potential Problems

This paper describes the problems with false covid-19 test results, both false positive and false negative results. The problems are related to the quality of tests, test sampling and the currently limited follow-up procedures. A test and follow-up strategy that could decrease the potential problems is suggested.

scholarly journals Will Real Time Visualization of Needle in Target Thyroid Nodules Minimize False Negative FNA Results?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A904-A905
Author(s):  
Vijaykumar Sekar ◽  
Panadeekarn Panjawatanan ◽  
Sofia Junaid Syed
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
False Negative ◽  
Thyroid Ultrasound ◽  
Papillary Thyroid ◽  
Ultrasound Guided ◽  
Real Time Visualization ◽  
The Right

Abstract Introduction: Prevalence of thyroid nodules in the adult population based on detection by ultrasonography is about 20-76% of which only 5% account for thyroid cancer. All patients with a suspected thyroid nodule either on physical examination or noted incidentally on other imaging should be evaluated with thyroid ultrasound. Any thyroid nodule &gt;= 1 cm on ultrasound should be investigated with FNAC. Ultrasound guided FNAC techniques are used to reduce false negative results. We present a patient with suspicious finding on initial thyroid ultrasound and subsequent negative FNAC presenting a few years later with papillary thyroid cancer. Case Presentation: A 32 y.o. female with history of thyroid nodule and thyroiditis presented to the endocrine clinic for follow-up of her thyroid nodule. 5 years ago, she was diagnosed with thyroid nodule, which was found on an ultrasound scan for workup of her dysphagia. The thyroid ultrasound then showed diffusely heterogeneous thyroid gland with an ill-defined area of decreased echogenicity in the right lobe and left superior lobe and possible nodule in the lower pole left thyroid. Blood work showed TSH of 1.71 (n 0.34-3.00 uIU/ml) and thyroid peroxidase antibody levels was 27.8 (n &lt; 9.0 IU/ml). A CT scan of neck with contrast was done and no concerning mass was seen. The patient had a follow-up ultrasound after 8 months which showed small bilateral thyroid lesions, somewhat ill-defined. The patient had an FNA biopsy of the right thyroid nodule: the results were consistent with a benign follicular nodule. A follow-up thyroid ultrasound was done in a year, and the findings were unchanged. The patient came back 3 years later for follow-up with complaints of a new palpable nodule in the neck. Ultrasound showed unchanged right thyroid nodule and some new cervical adenopathy. The ultrasound showed a 2.2 cm heterogeneous lymph node with punctate echogenic foci along the right lateral margin of the right internal jugular vein at the level of the thyroid gland, Subsequently FNA biopsy of the right cervical node and right thyroid node were done. The cells from lymph nodes were positive for malignancy and cells from the right thyroid nodule were atypical. Overall the appearance was consistent with papillary thyroid carcinoma. Subsequently the patient underwent total thyroidectomy and right modified lymph node dissection and the pathology results came back as multifocal papillary thyroid cancer right side 1.2 cm and left side 0.4 cm, with metastasis to 2 lymph nodes. Conclusion: The reported false negative rate of ultrasound-guided FNAC is variable. Success of US-FNA depends on experience of operator and cyto-pathologist and the intrinsic nature of the nodule. Malignancy rates of only 1-2% are reported with repeat FNA in prior benign nodules. Good FNA techniques and real-time visualization of needle in target nodules can further decrease false negatives.

scholarly journals Does the clinical assessment help in predicting malignancy in thyroid swell

2017 ◽  
Vol 5 (1) ◽  
pp. 12-13
Author(s):  
Ishwor Raj Devkota ◽  
S. Bhandary ◽  
S. Karki
Keyword(s):  
Positive Predictive Value ◽  
Clinical Assessment ◽  
Thyroid Surgery ◽  
Predictive Value ◽  
False Positive ◽  
Thyroid Nodules ◽  
False Negative ◽  
Male Ratio ◽  
The Mean ◽  
One Year

Objectives: To predict malignant nodules in solitary thyroid nodules on clinical assessment.Materials and methods: A total of 48 cases with thyroid nodule were clinically assessed in detail and underwent the standard thyroid surgery at BPKIHS, Dharan during the period of one year (April 2012 to march 2013).Results: The mean age was 41.42 years with female to male ratio of 15:1. Most of the patients were euthyroid (73%). Majority of the thyroid nodules were malignant (85.4%) and only 14.6% were benign on clinical assessment. The sensitivity of clinical evaluation was 84.6%, specificity 13.6%, positive predictive value 53.6%, negative predictive value 42.8%. Percentage of the false negative, false positive and overall accuracy was 57.1%, 46.3% and 52% respectively.Conclusion: Even though the sensitivity is high, clinical assessment has low specificity. So we cannot rely on clinical assessment in predicting malignancy in the thyroid nodules.  

Outcomes of Indeterminate Thyroid Nodules Managed Nonoperatively after Molecular Testing

2020 ◽  
Author(s):  
Catherine Y Zhu ◽  
Ines Donangelo ◽  
Deepashree Gupta ◽  
Dalena T Nguyen ◽  
Joana E Ochoa ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
False Negative ◽  
False Negative Rate ◽  
Molecular Testing ◽  
Test Results ◽  
Molecular Test ◽  
Negative Rate ◽  
Indeterminate Nodules

Abstract Context Molecular testing to refine the diagnosis of cytologically indeterminate thyroid nodules has become increasingly popular, but data on long-term durability of test results and the rate of delayed operation are limited. Objective Determine the delayed rate of surgical resection in indeterminate nodules with benign/negative molecular testing and the risk of false-negative molecular test results. Design Prospective follow-up of the Gene Expression Classifier vs Targeted Next-Generation Sequencing in the Management of Indeterminate Thyroid Nodules randomized controlled trial comparing the diagnostic test performance of Afirma Gene Expression Classifier and ThyroSeq v2. Setting University of California, Los Angeles. Participants Patients who underwent thyroid biopsy with indeterminate (Bethesda III/IV) cytology (April 2016 to July 2017). Intervention Ultrasound surveillance. Main Outcome Measure False-negative rate of molecular testing. Results Of 95 indeterminate nodules with negative/benign molecular test results, 12 nodules underwent immediate resection (11 benign nodules, 1 noninvasive follicular thyroid neoplasm nodule with papillary-like nuclear features). Nonoperative management was pursued for 83 (87.4%) nodules. The median surveillance was 26.7 months. Ten nodules were resected during surveillance and malignancy was identified in 4 nodules (overall false-negative rate of 5.8%). In the 4 malignant nodules that underwent delayed operation, surgery was prompted by sonographic changes during surveillance. Conclusions The majority of indeterminate nodules with negative molecular testing have a stable clinical course over 3 years of follow-up, but our finding of a 6% false-negative rate highlights the importance of continuing sonographic surveillance. Long-term studies are needed to determine the optimal length of follow-up.

scholarly journals The Confirmation Rate of Primary Hits: A Predictive Model

2002 ◽  
Vol 7 (3) ◽  
pp. 175-190 ◽  
Author(s):  
Paul Fogel ◽  
Pascal Collette ◽  
Alain Dupront ◽  
Tina Garyantes ◽  
Denis Guédini
Keyword(s):  
Predictive Model ◽  
False Positive ◽  
False Negative ◽  
Individual Compound ◽  
Additional Advantage ◽  
Primary Screening ◽  
Alternative Approach ◽  
Compound Screening ◽  
Calculated Probability

HTS data from primary screening are usually analyzed by setting a cutoff for activity, in order to minimize both false-negative and false-positive rates. An alternative approach, based on a calculated probability of being active, is presented here. Given the predicted confirmation rate derived from this probability, the number of primary positives selected for follow-up can be optimized to maximize the number of true positives without picking too many false positives. Typical cutoff-determining methods are more serendipitous in their nature and not easily optimized in an effort to optimize screening efforts. An additional advantage of calculating a probability of being active for each compound screened is that orthogonal mixtures can be deconvoluted without presetting a deconvolution threshold. An important consequence of using the probability of being active with orthogonal mixtures is that individual compound screening results can be recorded irrespective of whether the assays were performed on single compounds or on cocktails.

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