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 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.

scholarly journals Impact of Molecular Testing in the Diagnosis of Thyroid Fine Needle Aspiration Cytology: Data from Mainland China

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Hui-qin Guo ◽  
Huan Zhao ◽  
Zhi-hui Zhang ◽  
Yan-li Zhu ◽  
Ting Xiao ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Molecular Testing ◽  
Benign Lesions ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Thyroid Fine Needle Aspiration ◽  
Needle Aspiration Cytology

Background. The molecular work-up of thyroid nodules from fine needle aspiration samples has given clinicians a new level of diagnostic information. The aim of the present study was to evaluate the utility of molecular analysis in thyroid fine needle aspiration samples from a Chinese population.Methods. Specimens were collected from thyroid nodules by fine needle aspiration. Cytology diagnosis and genes analysis were performed and correlated with histology outcome.Results. A total of 83 patients with thyroid nodules were enrolled, including 20 benign lesions and 63 papillary carcinomas. BRAF and RAS mutations and RET/PTC gene rearrangements were found in 65.1%, 0%, and 1.6% of papillary carcinomas, respectively. No gene alterations were found in benign lesions. The combination of BRAF testing and cytology improved the accuracy of cytology from 69.9% to 89.2%(P<0.05). Moreover, BRAF testing confirmed 82.4% of papillary carcinomas with suspicious cytology and identified 33.3% of papillary carcinomas with atypia cytology.Conclusions. Of the three candidate markers, BRAF testing showed diagnostic utility in fine needle aspiration. Combining BRAF testing with cytology improves the accuracy of fine needle biopsy. Those who have positive BRAF and malignant or suspicious malignant cytology can undergo thyroidectomy without a frozen section.

Fine-needle aspiration biopsies of thyroid nodules

2018 ◽  
Vol 57 (06) ◽  
pp. 211-215 ◽  
Author(s):  
Christian Schmidkonz ◽  
Karen Horstrup ◽  
Matthias Weppler ◽  
Torsten Kuwert ◽  
Michael Cordes
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Predisposing Factors ◽  
American Thyroid Association ◽  
Self Assessment ◽  
Needle Size ◽  
Fine Needle ◽  
Number Of Patients ◽  
Nodule Volume

Summary Objective: The purpose of the study was the characterization of adverse events (AEs) after fine-needle aspiration biopsies (FNABs) of thyroid nodules, as well as possible predisposing factors. Methods: A total of 205 patients, each of whom had undergone an FNAB of a thyroid nodule, were included in the study (15 of whom were taking anticoagulant medication). The thyroid nodules were classified according to the ultrasound criteria of the American Thyroid Association (ATA). The FNABs were carried out by four trained nuclear medicine specialists from two institutions. To detect AEs, all patients were asked to fill out a standardized self-assessment questionnaire. Results: Out of 205 patients, 189 (92 %) reported no AEs. Fourteen patients (6.8 %) had mild or moderate AEs, such as short-term pain at the puncture site. In two patients (1 %), the AEs were classified as significant, and required medical followup, which revealed an intrathyroid hematoma in one patient and dysphonia in the other. All AEs were reversible. None of the patients taking anticoagulants experienced any AEs. The parameters of age, sex, nodule volume, ATA nodule type, needle size, and physician performing the biopsy were not predisposing factors for side effects (p = 0.54, p = 0.73, p = 0.75, p = 0.94, p = 0.35, and p = 0.24, respectively). Conclusions: The vast majority of patients tolerated the FNAB very well. AEs were seldom observed. A small number of patients experienced AEs that required no intervention or could be self-managed by the patient. Considering the almost negligible risk of the procedure, FNAB should be increasingly used for the classification of thyroid nodules.

Risk Stratification of Thyroid Nodules With Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS) Cytology Using Ultrasonography Patterns Defined by the 2015 ATA Guidelines

2017 ◽  
Vol 126 (9) ◽  
pp. 625-633 ◽  
Author(s):  
Ji Hye Lee ◽  
Kyunghwa Han ◽  
Eun-Kyung Kim ◽  
Hee Jung Moon ◽  
Jung Hyun Yoon ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Fine Needle Aspiration ◽  
Clinical Characteristics ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
American Thyroid Association ◽  
Fine Needle ◽  
Malignancy Rate ◽  
Undetermined Significance

Purpose: The purpose of this study was to evaluate the predictive value of ultrasonography (US) patterns based on the 2015 American Thyroid Association (ATA) guidelines for malignancy in atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) nodules. Methods: From January 2014 to August 2015, 133 thyroid nodules that were initially diagnosed as AUS/FLUS on fine needle aspiration (FNA) were included in this study. Each nodule was assigned a category with US patterns defined by the ATA guidelines. Clinical characteristics and US patterns were compared between the benign and malignant nodules, and malignancy rates were calculated according to the ATA guidelines. Results: The malignancy rate in the very low suspicion group was 0.0% in AUS/FLUS nodules. When applying the ATA guidelines, significant differences existed for US patterns between the benign and malignant nodules in the AUS group ( P = .032) but not the FLUS group ( P = .168). Conclusions: Ultrasonography patterns by the 2015 ATA guidelines can provide risk stratification for nodules with AUS cytology but not for ones with FLUS cytology. For nodules with AUS/FLUS cytology with the very low suspicion pattern of the ATA guidelines, follow-up US might be recommended instead of repeat FNA.

Validation of American Thyroid Association Ultrasound Risk Assessment of Thyroid Nodules Selected for Ultrasound Fine-Needle Aspiration

Thyroid ◽  
2017 ◽  
Vol 27 (8) ◽  
pp. 1077-1082 ◽  
Author(s):  
Alice L. Tang ◽  
Mercedes Falciglia ◽  
Huaitao Yang ◽  
Jonathan R. Mark ◽  
David L. Steward
Keyword(s):  
Risk Assessment ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
American Thyroid Association ◽  
Fine Needle

Diagnostic value of the candidate microRNAs in thyroid fine-needle aspiration biopsy (FNAB) samples

2020 ◽  
Vol 41 (2) ◽  
Author(s):  
Mohammad-Reza Mahmoudian-Sani ◽  
Maryam Amrollahi-Sharifabadi ◽  
Abdolmajid Taheri ◽  
Seyed Masih Hosseini ◽  
Kamran Tahmasebi ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Thyroid Tumor ◽  
Aspiration Biopsy ◽  
Fine Needle ◽  
Thyroid Fine Needle Aspiration ◽  
Needle Aspiration Biopsy ◽  
Benign Thyroid

AbstractBackgroundThyroid cancer (TC) is known to be the most common endocrine malignancy with an incidence rate which has increased by 2.3-fold over the past 30 years. Approximately, 30% of the thyroid fine-needle aspiration biopsy (FNAB) outcomes are indecisive. Moreover, researchers recognized multiple differentially expressed microRNAs (miRNAs) as candidate diagnostic markers for thyroid nodules. The purpose of this study was to identify thyroid tumor-associated miRNAs in FNAB with the capacity to be developed as unique biomarkers.Materials and methodsAccording to the study design, a quantitative real time reverse transcription polymerase chain reaction (qRT-PCR) was applied to evaluate the expression levels of nine miRNAs (Let7, miR-34a, miR-146b, miR-221, miR-151, miR-155, miR-181b, miR-222 and miR-375) among 224 FNA samples as the training set.ResultsThe findings of this study revealed that miR-181b and miR-146b are the best predictors to diagnose benign thyroid FNA samples from malignant samples. However, the remaining miRNAs were co-expressed and had no significant effect on the predictor model. On the other hand, sensitivity and specificity of miR-181b and miR-146b were reported at 83.0%–83.0% and 83.0%–66.0%, respectively.ConclusionsAccording to the results of this study, miR-146b and miR-181b might be considered as adjunct markers contributing to thyroid FNAB in tumor types. In addition, miR-146b and miR-181b were recognized as biomarkers for discriminating benign thyroid nodules from malignant ones. It is suggested that further prospective clinical trials be conducted to evaluate the accuracy of such findings in a larger cohort and determine the clinical uses.

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