scholarly journals Assessment of Nondiagnostic Ultrasound-Guided Fine Needle Aspirations of Thyroid Nodules

2002 ◽  
Vol 87 (11) ◽  
pp. 4924-4927 ◽  
Author(s):  
Erik K. Alexander ◽  
Jenny P. Heering ◽  
Carol B. Benson ◽  
Mary C. Frates ◽  
Peter M. Doubilet ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Significant Risk ◽  
Needle Aspiration ◽  
Multivariable Model ◽  
Ultrasound Guided ◽  
Significant Independent Predictor ◽  
Fine Needle ◽  
Risk Of Malignancy

Abstract Thyroid nodules are common. Evaluation of patients with thyroid nodules typically includes fine needle aspiration biopsy (FNA), an approach that has proven to be accurate for the detection of thyroid cancer. Although the majority of biopsies are adequate for a cytological diagnosis, up to 20% will be insufficient or nondiagnostic. Current opinion suggests that such aspirates should be repeated, although no systematic study has investigated the usefulness of this approach, especially when ultrasound guidance is used to direct the initial FNA. We sought to define the predictors and optimal follow-up strategy for initial nondiagnostic ultrasound-guided FNAs of thyroid nodules. Data were collected for all patients at the Brigham and Women’s Hospital Thyroid Nodule Clinic between 1995–2000 who underwent ultrasound-guided FNA of a thyroid nodule. All patients with nondiagnostic cytology were advised to return for a repeat ultrasound-guided FNA. Patient age, gender, nodule size, cystic content, solitary vs. multinodular thyroid, and nodule location were documented and evaluated as possible predictors of a nondiagnostic biopsy in a multivariable model. The rate of diagnostic cytology obtained on repeat ultrasound-guided FNA was calculated. A total of 1128 patients with 1458 nodules were biopsied over a 6-yr period. A total of 1269 aspirations (950 patients) were diagnostic, and 189 (178 patients) were nondiagnostic. The cystic content of each nodule was the only significant independent predictor of nondiagnostic cytology (P < 0.001). The fraction of specimens with initial nondiagnostic cytology increased with greater cystic content (P < 0.001 for trend). A diagnostic ultrasound-guided FNA was obtained on the first repeat biopsy in 63% of nodules and was inversely related to increasing cystic content of each nodule (P = 0.03). One hundred and nineteen patients with 127 nodules returned for follow-up as advised, and malignancy was documented in 5%. Despite ultrasound-guided FNA, there remains a significant risk of initial nondiagnostic cytology, largely predicted by the cystic content of each nodule. Repeat aspiration is often successful and should be the standard approach to such nodules, given their risk of malignancy.

scholarly journals Nušalimų gydymas Vilniuje 2000–2005 metais

2007 ◽  
Vol 5 (4) ◽  
pp. 0-0
Author(s):  
Tomas Butėnas ◽  
Audrius Gradauskas ◽  
Arvydas Skorupskas
Keyword(s):  
Blood Flow ◽  
Thyroid Cancer ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Doppler Sonography ◽  
Color Doppler ◽  
Needle Aspiration ◽  
Color Doppler Sonography ◽  
Ultrasound Guided ◽  
Fine Needle

Tomas Butėnas,  Audrius Gradauskas,  Arvydas SkorupskasVilniaus universiteto Reabilitacijos, sporto medicinos ir slaugos institutas,Vilniaus miesto universitetinė ligoninė, Antakalnio g. 57, LT-10207 VilniusEl paštas: [email protected] Tikslas Retrospektyviai išanalizuoti ligonių, gydytų nuo nušalimų Vilniaus miesto universitetinėje ligoninėje (VMUL) 2000–2005 metais, gydymo būdus ir rezultatus, juos palyginti su literatūros duomenimis. Metodai Darbo pobūdis – retrospektyvus. Analizuotos 129 pacientų, gydytų nuo nušalimų VMUL 2000–2005 m., ligos istorijos, darbui naudota kompiuterinė duomenų bazė, statistinė analizė buvo atlikta SPSS 8v. kompiuterine programa. Vertinta ligonių amžius, lytis, TLK-10 diagnozė, socialinė padėtis, girtumas nušalimo metu, laikas nuo nušalimo iki kreipimosi į gydymo įstaigą, laikas nuo hospitalizacijos iki operacijos, atliktos operacijos tipas, hospitalizacijos laikas nuo operacijos iki gydymo pabaigos, žaizdos (-ų) komplikacijos, bendras hospitalizacijos laikas, baigtis, nušalimų dažnis per metus. Rezultatai Gydyta 129 pacientai, iš jų 109 (84,5%) vyrai, 20 (15,5%) moterų. Vidutinis pacientų amžius 46,16 metų. Nustatytos galutinės diagnozės: čiurnos ir pėdos nušalimas ir audinių nekrozė (n = 97), paviršinis čiurnos ir pėdos nušalimas (n = 12), riešo ir plaštakos nušalimas ir audinių nekrozė (n = 9), paviršinis riešo ir plaštakos nušalimas (n = 11). Pasiskirstymas pagal socialinę padėtį: neturintys nuolatinės gyvenamosios vietos 53 (41,08%), nedirbantys 33 (25,58%), dirbantys 12 (9,30%), invalidai 10 (7,75%), pensininkai 19 (14,73%), moksleiviai ir studentai 2 (1,55%). Nušalimo metu 67 (51,94%) buvo girti, 14 (10,85%) blaivūs, 48 (37,21%) kreipėsi vėlai ir neatsimena, ar buvo girti, arba neprisipažino. Vidutinis laikas nuo nušalimo iki kreipimosi į gydymo įstaigą 9,7 dienos (0–58). Laikas nuo hospitalizacijos iki operacijos 6,03 (0–27) dienos. Didžiųjų amputacijų atlikta 23 (25,55%), mažųjų – 67 (74,44%), iš viso operuota 90 (69,77%) pacientų. Suteikta pirmoji pagalba, gydyti konservatyviai, atliktos tik paviršinės nekrektomijos arba mirė 39 (30,23%) ligoniai. Vidutinis hospitalizacijos laikas nuo operacijos iki gydymo pabaigos 27,73 (1–96) dienos. Žaizdų komplikacijos: sugijimas antriniu būdu n = 89 (98,89%), pėdos flegmona n = 1 (1,11%). Bendras hospitalizacijos laikas 28,61 (1–117) dienos. Gydymo metu mirė 16 ligonių (ištikus ūminiam širdies ir plaučių nepakankamumui dėl bendro kūno sušalimo). Hospitalizacijos metu invalidumas suteiktas 14 ligonių, išrašyti ambulatoriniam gydymui 106, savavališkai pasišalino iš gydymo įstaigos 2 ligoniai, perkelti į reabilitacijos ligonines 7 ligoniai. Išvados Iš rezultatų matome, jog dažniausiai gydyti vidutinio amžiaus, neturintys nuolatinės gyvenamosios vietos, nušalimo metu vartoję alkoholį vyrai. 37,21% ligonių po nušalimo į gydymo įstaigą kreipėsi vėlai. Dažniausiai nušąlamos pėdos ir čiurnos sritis. Vidutinis bendras hospitalizacijos laikas yra ilgas. Dėl daugumos pacientų asocialios gyvensenos, žalingų įpročių sudėtinga juos gydyti ambulatoriškai ir suteikti invalidumą. Pagrindiniai žodžiai: nušalimas, chirurginis gydymas Frostbite injury treatment in Vilnius in 2000–2005 Tomas Butėnas,  Audrius Gradauskas,  Arvydas SkorupskasInsitute of Oncology, Vilnius University, Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: [email protected] Background / objective Several gray scale sonographic characteristics have been found to be highly suggestive of thyroid cancer, but the role of color Doppler sonography in the evaluation of a thyroid nodule for malignancy has not been defined. The purpose of this study was to determine whether gray scale and color Doppler sonography can be used to diagnose or exclude malignancy in a thyroid nodule. Patients and methods 184 patients with nonpalpable thyroid nodules (diameter less than 1.5 cm) were studied by means of ultrasound-guided fine-needle aspiration biopsy. Patients were included in the study on the basis of sonographical features implicating a possible malignant nature of nodules. We obtained color Doppler images of nonpalpable thyroid nodules undergoing ultrasound-guided fine-needle aspiration. The color Doppler appearance of nonpalpable thyroid nodule was graded from I for no visible flow through IV for extensive internal flow. Of the studied patients, 85 underwent subsequent surgery with histological examination of obtained specimens. Results Characteristic Doppler-sonographical features of nonpalpable thyroid nodules were analysed taking into consideration their histological form. There were 184 nonpalpable thyroid nodules sampled, of which 48 were malignant (all confirmed at surgery), and 37 were benign. Benign nonpalpable nodules frequently had extranodular blood flow, whereas malignant thyroid nodules frequently had intra- and perinodular blood flow (p = 0.026 of the chi-square test). Conclusions Small nonpalpable malignant thyroid nodules more frequently are visualized as hypoechoic and solid in comparison with non-malignant small thyroid nodules. A characteristic Doppler-sonographical feature of small malignant thyroid nodules is intra- and perinodular blood flow. Key words: thyroid nodules, thyroid cancer, ultrasound, color Doppler sonography, ultrasound-guided fine-neddle aspiration biopsy

scholarly journals Comparison of surgeon-performed ultrasound-guided fine needle aspiration cytology with histopathological diagnosis of thyroid nodules

2019 ◽  
Vol 35 (4) ◽  
Author(s):  
Muhammad Ayoob Jat
Keyword(s):  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Histopathological Diagnosis ◽  
Ultrasound Guided ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Solitary Thyroid Nodule ◽  
Needle Aspiration Cytology

Objective: To assess the Solitary thyroid nodules by surgeon-performed ultrasound-guided FNAC and evaluate with the histopathological findings. Methods: This study includes 100 Consecutive patients of a solitary thyroid nodule which were presented to the Outpatients Department of Surgery during the period of two years from September 2016 to August 2018. Exclusion criteria were patients with extra-thyroid swelling, diffuse goiter and multinodular goiter. All patients with a solitary thyroid nodule underwent Surgeon –performed ultrasound-guided FNAC in the department of Radiology. After thyroid surgery, thyroid specimens were sent for histopathology and evaluate with FNAC findings. Results: The study included hundred patients with solitary thyroid nodule, 75(75%) female and 25 (25%) male with a ratio of F 3:1M. The age of the patients ranged from 15-75 years with a mean age of 35 years. The result of 100 cases of Surgeon –performed Ultrasound –guide FNAC of a solitary thyroid nodule were inconclusive in 10 cases (10%), Non-neoplastic in 60 cases (60%) and Neoplastic lesions in 30 cases (30%). After evaluation of findings from FNAC and histopathology, four cases with benign FNAC (adenomatous/colloid Goiter) turnout as neoplastic (papillary carcinoma) on histopathology and six cases with neoplastic FNAC (papillary carcinoma), just two cases turnout as benign (nodular colloid goiter with cystic degeneration) on histopathology. In present study Surgeon – performed Us FNAC has found to be 87.5% sensitive, 95.3% specific and 92.0% diagnostic accuracy. Conclusion: Surgeon – performed Ultrasound-guided FNAC is a safe, simple and accurate technique in the diagnosis of solitary thyroid nodule. doi: https://doi.org/10.12669/pjms.35.4.537 How to cite this:Jat MA. Comparison of surgeon-performed ultrasound-guided fine needle aspiration cytology with histopathological diagnosis of thyroid nodules. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.537 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Ultrasound-guided fine needle aspiration cytology and ultrasound examination of thyroid nodules in the UAE: A comparison

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0247807
Author(s):  
Suhail Al-Salam ◽  
Charu Sharma ◽  
Maysam T. Abu Sa’a ◽  
Bachar Afandi ◽  
Khaled M. Aldahmani ◽  
...  
Keyword(s):  
United Arab Emirates ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Ultrasound Examination ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Ultrasound Guided ◽  
Cytological Examination ◽  
Fine Needle ◽  
Risk Of Malignancy

Background Thyroid nodules are a common clinical finding and most are benign, however, 5–15% can be malignant. There is limited regional data describing the accuracy of ultrasound-guided fine needle aspiration (FNA) cytological examination compared to ultrasound examination of thyroid in patients who have undergone thyroid surgery. Methods A retrospective analysis of ultrasonographic (US) reports, FNA cytology reports and histopathology reports of 161 thyroid nodules presented at the endocrine center at Tawam hospital in Al Ain city, the United Arab Emirates during the period 2011–2019 was performed. US reports and images with FNA cytopathology reports and slides were reviewed by an independent radiologist and pathologist. Results In total, 40 nodules were reported as benign by US examination, while very low suspicious, low suspicious, intermediate suspicious and highly suspicious categories were reported in 21, 41, 14 and 45 nodules respectively. In addition, 68 nodules were reported as benign (Bethesda category II), while atypical follicular cells of unknown significance (Bethesda category III), follicular neoplasm (Bethesda category IV), suspicious for malignancy (Bethesda category V), and malignant (Bethesda category VI) categories were reported in 33, 9, 24 and 27 nodules respectively. The risk of malignancy for US benign nodules was 5%, while the risks of malignancy in very low suspicious, low suspicious, intermediate suspicious and highly suspicious nodules were 52%, 36%, 100% and 87%, respectively. The risk of malignancy for Bethesda category II was 3%, while the risks of malignancy in category III, IV, V and VI were 58%, 67%, 96% and 100%, respectively. Conclusion Thyroid FNA cytological examination and ultrasonography are key tools in predicting malignancy in thyroid nodules. Thyroid nodules with the diagnosis of Bethesda category III & IV run a high risk of malignancy thus more vigilance is required.

scholarly journals The Value of Ultrasound-Guided Fine-Needle Aspiration Cytology Combined with Puncture Feeling in the Diagnosis of Thyroid Nodules

2021 ◽  
pp. 1-9
Author(s):  
Li Li ◽  
Xiao Chen ◽  
Peipei Li ◽  
Yibo Liu ◽  
Xiaoli Ma ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Diagnostic Value ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Nodule Size ◽  
Needle Aspiration Cytology

<b><i>Introduction:</i></b> There are few studies on the role of puncture feeling in thyroid nodules during ultrasound-guided fine-needle aspiration cytology (US-FNAC), although it is expected to become a new predictive technique. We aimed to analyze the importance of puncture feeling in combination with US-FNAC and investigate whether it can be used as an indicator to predict the nature of thyroid nodules. <b><i>Materials and Methods:</i></b> From January 1, 2018, to October 31, 2020, a total of 623 thyroid nodules were included. Puncture feeling was classified as “soft,” “hard,” or “hard with grittiness.” The correlation between puncture feeling and postoperative pathology and the diagnostic value of FNAC combined with puncture feeling were analyzed, and the influence of thyroid nodule size on puncture feeling, FNAC, and FNAC combined with puncture feeling was studied. We further explored the correlation between puncture feeling and histopathology in Bethesda III and IV thyroid nodules. <b><i>Results:</i></b> There was a significant correlation between puncture feeling and postoperative pathology (<i>p</i> &#x3c; 0.001). The sensitivity, negative predictive value, and total coincidence rate of US-FNAC combined with puncture feeling for the diagnosis of thyroid nodules were higher than those of US-FNAC alone (96.1, 83.6, and 94.7% vs. 89.0, 65.5, and 89.7%, respectively). Thyroid nodule size was the influencing factor for puncture feeling, FNAC, and FNAC combined with puncture feeling (<i>p</i> &#x3c; 0.05 for all). The area under the curve for puncture feeling, FNAC, and FNAC combined with puncture feeling for thyroid nodules of size ≤1 cm was greater than for modules of size &#x3e;1 cm. Puncture feeling was of great value in diagnosing Bethesda III thyroid nodules (<i>p</i> &#x3c; 0.001), and all Bethesda IV thyroid nodules had puncture feeling of soft. <b><i>Conclusion:</i></b> Puncture feeling is of great value during US-FNAC. “Hard” and “hard with grittiness” were indicators for malignancy, while “soft” indicated that the thyroid nodule was likely to be benign. The diagnostic value of US-FNAC combined with puncture feeling for thyroid nodules is higher than US-FNAC alone, especially when nodule size is ≤1 cm. Puncture feeling is of great value in predicting the nature of Bethesda III thyroid nodules.

scholarly journals Ultrasound Parameters of Thyroid Nodules and the Risk of Malignancy: A Retrospective Analysis

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482094597
Author(s):  
Minxin Wang ◽  
Ping Sun ◽  
Xiaodong Zhao ◽  
Yongmei Sun
Keyword(s):  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Diagnostic Methods ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Risk Of Malignancy ◽  
Needle Aspiration Cytology

Ultrasonography-guided fine-needle aspiration biopsy is the common choice for diagnosis of the suspected thyroid nodule. An algorithm(s) that finds the malignant potential of a nodule preoperatively, to overcome unnecessary diagnostic methods, does not exist. The objective of the study was to correlate thyroid nodule sizes measured by ultrasonography and risk of malignancy assessed by cytologic and histologic examinations. Data regarding fine-needle aspiration cytology and the results of histologic examinations of surgical specimens of 260 nodules were collected and analyzed. The macro or multiple calcifications, the complex echo pattern, and posterior region homogeneity were considered suspicious in ultrasonography. Bethesda system for classification of thyroid nodules was used for cytopathology. Histopathology performed as per the 2004 World Health Organization classification system. The benefit score analysis was performed for determination of clinical usefulness. Twenty-eight of 49 malignant nodules and 46 of 68 malignant nodules detected through ultrasound following fine-needle aspiration cytopathology and histopathology were <2 cm in size. A correlation was found for malignancy rate detected by ultrasonography-guided fine-needle aspiration cytology and those of the surgical specimen ( r = 0.945, P = .015, R 2 = 0.894). Ultrasonography-guided fine-needle aspiration cytology had 0.994 sensitivities, 0.721 accuracies, and 0.08 to 0.945 diagnostic confidence for the detection of malignant nodules. Nodule size less than 2 mm ( P = .011) was associated with the malignancy potential of thyroid nodules. Ultrasonography-guided fine-needle aspiration cytology had 19 (7%) results as a false negative and 1 (1%) results were false positive. Ultrasound-guided fine-needle aspiration cytopathology reported oversize of thyroid nodule than original but can predict the risk of malignancy. Level of Evidence: III.

scholarly journals Thyroid nodule size as an indicator for surgery

2018 ◽  
Vol 5 (7) ◽  
pp. 2401 ◽  
Author(s):  
Mohamed Abdulhameed Hatem ◽  
Sumayya Farheen
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Current Practice ◽  
False Negative ◽  
False Negative Rate ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Risk Of Malignancy ◽  
Needle Aspiration Cytology

Background: Several authors have questioned the accuracy of fine- needle aspiration cytology (FNAC) in large thyroid nodules. It's the current practice to provide thyroidectomy to patient with thyroid nodules 4 cm or larger regardless of the FNAC results. The aim of the study is to answer two questions: is the size of nodule associated with higher risk of malignancy and is the size indication for surgery.Methods: Authors conducted a retrospective review of 201 patients who underwent thyroidectomy between 2011 and 2017 at Bahrain defense force hospital. Authors compared all thyroid nodules with benign FNAC and their final histopathology reports. Patients were divided into two groups based on the size of the nodule (< 4cm or >4cm) and indication of surgery.Results: 201 patients with thyroid nodule underwent thyroid surgery. 136 patients had nodule <4cm and 65 patients were ≥4 cm. For patients with nodules <4 cm, 37 patients (18.4%) had a malignancy, and for those with nodules ≥4 cm, 13 patients (6.4%) had a malignancy. comparison between size of the nodule, FNAC result and final histopathology: FNAC diagnosed 55 cases (27.3%) are malignant, final histopathology reported only 50 cases are malignant. But for benign cases FNAC and histopathology reports are showing same results, (p<0.05).Conclusions: Thyroid nodules ≥4 cm are not risk factor of malignancy. Thyroid nodules ≥4 cm with benign FNAC should not undergo thyroidectomy as false negative rate is low. Therefore, the decision for surgery ought not to be taken based on the size of the nodule.

scholarly journals Usefulness of accessible imaging methods in thyroid nodules with indeterminate cytology

2021 ◽  
Vol 28 (1) ◽  
pp. R1-R9
Author(s):  
Pedro Weslley Rosario ◽  
Tiara Grossi Rocha ◽  
Gabriela Franco Mourão
Keyword(s):  
Fdg Pet ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Diagnostic Methods ◽  
Imaging Method ◽  
Fine Needle ◽  
Risk Of Malignancy ◽  
Indeterminate Cytology ◽  
Rule Out

In thyroid nodules (TN) submitted to fine-needle aspiration (FNA), Bethesda categories III and IV are considered ‘indeterminate’ cytology. This result corresponds to 10–25% of all FNAs and the risk of malignancy (RoM) ranges from 10% to 30% for category III and from 15% to 40% for category IV. This review analyzed the practical applicability of accessible imaging method in the management of patients with cytologically indeterminate TN > 1 cm (ITN). When ITN are highly suspicious on ultrasonography (US), the RoM supports surgical indication even in the absence of additional tests. The same can be applied to ITN of intermediate suspicion but with elevated stiffness on elastography. Follow-up without additional tests is acceptable in the case of ITN with low-risk cytology and low-suspicion appearance on US and elastography (if obtained). In the case of ITN without highly suspicious US appearance, 123I scintigraphy may be obtained in patients with TSH < 1–1.5 mIU/L to rule out hyperfunctioning nodules before requesting diagnostic methods that are more expensive and less accessible. In addition, in ITN with not very suspicious US appearance, 18FDG-PET may be obtained. If this method does not reveal nodular uptake, the risk of the nodule corresponding to a macrocarcinoma is sufficiently low in order to allow follow-up. The positive predictive value of focal nodular uptake on 18FDG-PET depends on the pre-test RoM, cytological findings, and maximum SUV. There is currently no evidence for the use of CT, MRI or imaging using 99mTc-MIBI to define the nature of ITN.

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