scholarly journals Thy3 cytology: what to do next?

2011 ◽  
Vol 93 (3) ◽  
pp. 225-228 ◽  
Author(s):  
Raj Lakhani ◽  
Thomas Rourke ◽  
Anthony Jefferis ◽  
Louise Perry ◽  
Sabour Ghiacy ◽  
...  
Keyword(s):  
Relevant Literature ◽  
Significant Risk ◽  
Case Series ◽  
District General Hospital ◽  
Needle Aspiration ◽  
Thyroid Fine Needle Aspiration ◽  
Risk Of Malignancy ◽  
Thyroid Fna ◽  
The Uk ◽  
Lost To Follow Up

INTRODUCTION Cytological analysis of thyroid fine needle aspiration (FNA) is aided by the ‘Thy’ classification. However, there is often confusion surrounding the management of patients with a Thy3 classification. A subdivision of Thy3 has been created to help reduce this dilemma but its use within the UK appears to by infrequent. This paper analyses the management of patients with Thy3 cytology from FNA of a thyroid nodule in a UK case series and reviews the relevant literature. It also describes the results of a survey of selected UK ENT departments on the use of the Thy3 classification and its subdivisions. PATIENTS AND METHODS A retrospective analysis of a case series of patients was undertaken. In addition, a telephone survey of local/regional pathology departments was conducted to assess the utilisation of the Thy classification and to assess the awareness and usage of the Thy3 subdivisions. RESULTS A total of 39 Thy3 results (11 males, 28 females) were identified from 2007 to 2009. Of these, 24 patients went on to have surgery, 8 had a further FNA, 2 had a Tru-cut biopsy and 5 were lost to follow-up. Eleven (28.2%) patients were subsequently diagnosed with a thyroid malignancy. The survey identified that none of the departments had adopted the Thy3 subclassifications and only 40% were aware of them. CONCLUSIONS Thy3 results from thyroid FNA have a significant risk of malignancy but there remains confusion surrounding their management. This district general hospital has adopted and recommends the use of the Thy3 (i) and Thy3 (ii) subdivisions in order to assist decision-making and avoid delays in treatment or unnecessary surgery.

scholarly journals The Bethesda System for Reporting Thyroid Cytopathology: Proposed Modifications and Updates for the Second Edition from an International Panel

2016 ◽  
Vol 60 (5) ◽  
pp. 399-405 ◽  
Author(s):  
Marc Pusztaszeri ◽  
Esther Diana Rossi ◽  
Manon Auger ◽  
Zubair Baloch ◽  
Justin Bishop ◽  
...  
Keyword(s):  
Needle Aspiration ◽  
Thyroid Cytology ◽  
Management Algorithm ◽  
International Panel ◽  
Thyroid Fine Needle Aspiration ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Thyroid Fna ◽  
Thyroid Cytopathology ◽  
The Bethesda System

The Bethesda System for Reporting Thyroid Cytology (TBSRTC) was proposed in 2007 at the National Cancer Institute Thyroid Fine Needle Aspiration State of the Art and Science Conference held in Bethesda, Maryland. The aim was to address the inconsistent and sometimes confusing reporting terminologies used for thyroid FNA throughout the world. The TBSRTC consists of 6 diagnostic categories, each associated with an implied risk of malignancy that translates directly into a clinical management algorithm. Since the publication of the TBSRTC cytology Atlas in January 2010, considerable experience has been gained regarding its application in cytology practice, clinical impact, and limitations. In conjunction with the International Academy of Cytology (IAC), an international panel composed of sixteen cytopathologists and an endocrinologist with special interest in thyroid cytology, including several co-authors of the 2010 TBSRTC Atlas, was created to: (1) analyze the current worldwide impact of TBSRTC, (2) report on the current state of TBSRTC based upon a review of the published literature, and (3) provide possible recommendations for a future update of TBSRTC. Herein, we summarize the panel's deliberations and key recommendations that our panel hopes will be useful during the preparation of the second edition of TBSRTC.

A simplified economic approach to thyroid FNA cytology and surgical intervention in thyroid nodules

2013 ◽  
Vol 66 (7) ◽  
pp. 583-588 ◽  
Author(s):  
David Nigel Poller ◽  
Prashanth Kandaswamy
Keyword(s):  
Needle Aspiration ◽  
Diagnostic Efficacy ◽  
Cost Treatment ◽  
Thyroid Fine Needle Aspiration ◽  
Adequacy Assessment ◽  
Thyroid Fna ◽  
Cancer Networks ◽  
Uk National Health Service ◽  
The Uk ◽  
Thyroid Cytopathology

ObjectiveFew studies have modelled the economics of thyroid FNA.MethodsA simple spreadsheet economic model for delivery of thyroid fine needle aspiration (FNA) cytology is described using the UK Royal College of Pathologists’ Classification for thyroid FNA which is based on The Bethesda System for Reporting Thyroid Cytopathology.ResultsWe show an estimated 27.8% cost treatment reduction per patient if low rates of non-diagnostic for cytological diagnosis (Thy 1) and neoplasm possible atypia/non-diagnostic (Thy 3a) are achieved, which require rapid onsite FNA adequacy assessment of aspiration samples. If we assume that the number of thyroid FNAs performed in the UK annually is around 500 per million, and the UK population is 62 million, this could save the UK National Health Service significant sums, as the additional cost per patient treated in this model varies from £781 for a scenario with ultrasound guided FNA and inclinic cell adequacy assessment to £998 where aspirates are taken in conventional fashion without any inclinic adequacy assessment.ConclusionsThis model makes a strong economic case for the introduction of rapid onsite assessment of thyroid FNA across cancer networks, to improve the diagnostic efficacy of thyroid FNA.

scholarly journals Correlation study of thyroid nodule cytopathology and histopathology at two institutions in Jordan

CytoJournal ◽  
2018 ◽  
Vol 15 ◽  
pp. 24 ◽  
Author(s):  
Niveen Abdullah ◽  
Manar Hajeer ◽  
Loay Abudalu ◽  
Maher Sughayer
Keyword(s):  
Test Performance ◽  
Predictive Value ◽  
Diagnostic Category ◽  
Needle Aspiration ◽  
Correlation Study ◽  
Follicular Neoplasm ◽  
Risk Of Malignancy ◽  
Thyroid Fna ◽  
Undetermined Significance

Background: Fine-needle aspiration (FNA) plays a fundamental role in determining the appropriate management for patients presenting with thyroid nodules. Aims: The aims of this study are to evaluate thyroid FNA test performance parameters through a cytohistological correlation. Materials and Methods: A retrospective analysis of all thyroid FNAs received over a period of 18 months was carried out. The findings were compared to their subsequent definite diagnoses on surgical specimens as well as to their follow-up repeat FNA results. A total of 499 thyroid FNAs were collected and reviewed against The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The percentage of each diagnostic category was calculated, and the implied risk of malignancy was determined by comparing the cytology results to their definite diagnoses obtained on the resection specimens. Analytical procedures were performed using Microsoft Excel. Results: Out of 499 thyroid FNAs, a benign interpretation was found in 273 patients (54.7%), atypia of undetermined significance in 81 (16.2%), follicular neoplasm in 20 (4%), suspicious for malignancy in 36 (7.2%), malignant in 32 (6.4%) and were nondiagnostic in 57 patients (11.4%). Only 101 patients (20.2%) underwent surgical resection and 47 (9.4%) underwent a follow-up FNA. After cytohistological correlation, FNA test performance, calculated by excluding the inadequate and undetermined categories revealed test sensitivity, specificity, and diagnostic accuracy of 95.6%, 54.8%, and 78.9%, respectively. The positive predictive value was 75.4%, and the negative predictive value was 89.5%. Conclusions: Our results are comparable to those previously published figures. The rate of atypia of undetermined significance/follicular lesion of undetermined significance is higher than what is currently recommended in TBSRTC.

Fine-needle aspiration biopsies in the management of indeterminate follicular and Hurthle cell thyroid lesions

2009 ◽  
Vol 140 (5) ◽  
pp. 715-719 ◽  
Author(s):  
Tamara Mijović ◽  
Louise Rochon ◽  
Olguta Gologan ◽  
Michael P. Hier ◽  
Martin J. Black ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
False Negative ◽  
False Negative Rate ◽  
Diagnostic Category ◽  
Case Series ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Cytologic Atypia ◽  
Hürthle Cell ◽  
Risk Of Malignancy

Objectives: To determine the value of fine-needle aspiration biopsies (FNABs) of the thyroid and stratify the risk of malignancy within the indeterminate FNAB diagnostic category at our institution. Study design: Case series with chart review of preoperative FNABs of consecutive patients who underwent total thyroidectomy between 2005 and 2007. Subjects and Methods: A total of 115 cases were reviewed, and FNABs were categorized into four groups: benign, positive or suspicious for malignancy, indeterminate (follicular or Hurthle cell lesions), and nondiagnostic. Cytohistologic correlation was then established. Results: The accuracy of FNAB in detecting thyroid malignancy was 88 percent with false-negative and false-positive rates of 13 percent and 7 percent, respectively. Overall, 52 percent of the indeterminate cases were carcinomas (48 percent of follicular lesions and 62 percent of Hurthle cell lesions). In the presence of cytologic atypia, the rate of malignancy increased to 75 percent and 83 percent for the follicular and Hurthle cell lesions, respectively. Conclusions: FNAB is an accurate and helpful method for the evaluation of thyroid nodules with results directly correlating with management. Surgery should be considered for FNABs categorized as indeterminate, especially in the presence of cytologic atypia. Because of the high false-negative rate, benign FNABs require close follow-up with ultrasound examination and periodic biopsies.

scholarly journals Impact of Bethesda System of Reporting for Thyroid Cytopathology

2014 ◽  
Vol 6 (1) ◽  
pp. 15-22
Author(s):  
Varsha Dhume ◽  
Vikas Kavishwar
Keyword(s):  
Healthcare Providers ◽  
Needle Aspiration ◽  
Management Approach ◽  
Risk Category ◽  
Major Step ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Thyroid Fna ◽  
Thyroid Cytopathology ◽  
The Bethesda System

ABSTRACT FNAC though considered the gold standard diagnostic test in the evaluation of a thyroid nodule, has many issues regarding the terminologies and interpretation. The National Cancer Institute (NCI) hosted the NCI Thyroid Fine needle Aspiration State of the Science Conference in 2007, which acknowledged the importance of developing a uniform terminology for reporting thyroid FNA results to facilitate effective communication among cytopathologists, endocrinologist, surgeons, radiologists and other healthcare providers. The NCI Conference concluded the terminology and morphologic criteria which formed the framework for The Bethesda system for reporting thyroid cytopathology (TBSRTC). It is a 6 tiered ‘The Bethesda System for Reporting Thyroid Cytopathology’ (TBSRTC) for unifying the terminology and morphologic criteria along with the corresponding risk of malignancy. Bethesda also offers management approach for all the categories. Bethesda system is presently widely accepted in western countries and is being introduced in rest of the world. This system of reporting undoubtedly represents a major step toward standardization, reproducibility and ultimately improvement in clinical significance, usefulness and predictive value of thyroid FNAC. The problems faced by the cytopathologist while implementing Bethesda during reporting are centred on AUS/FLUS category. The heterogeneity of this low-risk category leads to significant variability in its reported percentage as well as reported rate of malignancy. How to cite this article Dhume V, Kavishwar V. Impact of Bethesda System of Reporting for Thyroid Cytopathology. Int J Otorhinolaryngol Clin 2014;6(1):15-22.

scholarly journals MON-479 Acute Thyroid Edema: A Rare Complication of Thyroid Fine Needle Aspiration

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Rachael Bree Hosein ◽  
Neel L Shah ◽  
Marc Cillo
Keyword(s):  
Thyroid Gland ◽  
Neck Pain ◽  
Fine Needle Aspiration ◽  
Rare Complication ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Thyroid Fine Needle Aspiration ◽  
Thyroid Swelling ◽  
Thyroid Fna ◽  
Thyroid Parenchyma

Abstract Background: Acute thyroid swelling is a rare complication of thyroid fine needle aspiration (FNA). The first documented case was in 1982 and to date there are less than 20 cases currently reported in the literature (1). Case Presentation: A 66-year-old female with a history of non-ischemic cardiomyopathy and heart failure was admitted to hospital to expedite heart transplant evaluation. A neck ultrasound was performed due to voice hoarseness and concern for vocal cord nodules. The ultrasound showed a 1.3 cm hypoechoic nodule in the right thyroid lobe. Given that the nodule had irregular borders and microcalcifications, a thyroid FNA was recommended. The patient’s home warfarin had been held for at least three days prior to the biopsy and her INR on the procedure date was 1.4. Her heparin drip was held four hours prior to the thyroid FNA. Immediately following the procedure, a 3.2 cm hematoma formed inferior to the thyroid gland. The heparin drip was restarted 6 hours post-FNA as per radiology’s recommendation. Cytology of the nodule was benign. The patient recovered well post FNA and improvement in the hematoma was noted on exam. Her hemoglobin was stable and she was restarted on warfarin. On day two post thyroid FNA, she reported significant neck pain, with no corresponding increase in the extra-thyroidal hematoma. No stridor or other concerning features were present on exam. A repeat thyroid ultrasound was performed three days after the FNA. It demonstrated fluid filled ‘cracks’ within the thyroid parenchyma and tripling in the volume of the thyroid gland, concerning for diffuse edema. No heterogeneity or subcapsular thickening was seen to suggest hemorrhage, and the previously demonstrated 3.2 cm extra-thyroidal hematoma was not visualized. She was treated with ibuprofen 800 mg and prednisone 30 mg, and noted an improvement in her neck pain with these measures. A repeat ultrasound done three weeks after initial thyroid FNA showed marked improvement of the diffuse swelling. Conclusion: The phenomenon of diffuse thyroid edema after fine need aspiration has been termed acute thyroid swelling (ATS). Given how frequently thyroid fine needle aspirations are performed, ATS appears to be a very rare complication. The etiology of ATS remains unknown, but the use of blood thinners, such as in our patient, does not appear to be a risk factor (1). The radiological appearance of fluid filled ‘cracks’ within the thyroid parenchyma suggests a more diffuse process, rather than a localized reaction. While NSAIDs or steroids may help with symptoms, patients appear to improve irrespective of whether or not medications are given. This suggests that ATS is a self-limiting condition without long term complications. Reference: (1) Polyzos SA, Anastasilakis AD, Arsos. Acute transient thyroid swelling following needle biopsy: An update. Hormones. 2012;11(2);147-150

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 < .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.

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