scholarly journals The value of routine measurement of serum calcitonin on insufficient, indeterminate, and suspicious thyroid nodule cytology

2021 ◽  
Author(s):  
Murat Çalapkulu ◽  
Muhammed Erkam Sencar ◽  
Sema Hepsen ◽  
Hayri Bostan ◽  
Davut Sakiz ◽  
...  
Keyword(s):  
Thyroid Disease ◽  
Thyroid Nodules ◽  
Medullary Thyroid Cancer ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Serum Calcitonin ◽  
Routine Measurement ◽  
Number Of Patients ◽  
Undetermined Significance

Routine calcitonin measurement in patients with nodular thyroid disease is rather controversial. The aim of this study was to evaluate the contribution of serum calcitonin measurement in the diagnostic evaluation of thyroid nodules with insufficient, indeterminate, or suspicious cytology. Out of 1668 patients who underwent thyroidectomy with the diagnosis of nodular thyroid disease and were screened, 873 patients with insufficient, indeterminate, or suspicious fine needle aspiration biopsy results were included in the study. From the total number of patients in this study, 10 (1.1%) were diagnosed as medullary thyroid cancer (MTC) using histopathology. The calcitonin level was detected to be above the assay-specific cut-off in 23 (2.6%) patients ranging between 6.5 - 4450 pg/mL. While hypercalcitoninemia was detected in all 10 MTC patients, a false positive elevation of serum calcitonin was detected in 13 patients (1.5%). Of the MTC group, 7 patients had cytology results that were suspicious for malignancy (Bethesda V), one patient’s cytology showed atypia of undetermined significance (Bethesda III) and two patient’s cytology results were suspicious for follicular neoplasm (Bethesda IV). Among the cases with non-diagnostic cytology (Bethesda I), none of the patients were diagnosed with MTC. In conclusion, routine serum calcitonin measurement can be performed in selected cases rather than in all nodular thyroid patients. While it is reasonable to perform routine calcitonin measurement in patients with Bethesda IV and Bethesda V, this measurement was not useful in Bethesda I patients. In Bethesda III patients, patient-based decisions can be made according to their calcitonin measurement. Read more in PDF.

scholarly journals Incidental detection of familial medullary thyroid carcinoma by calcitonin screening for nodular thyroid disease

1999 ◽  
pp. 286-289 ◽  
Author(s):  
B Mayr ◽  
G Brabant ◽  
A von zur Muhlen
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Thyroid Disease ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Cost Effective ◽  
Needle Aspiration ◽  
Serum Calcitonin ◽  
Medullary Thyroid ◽  
Calcitonin Screening

Serum calcitonin screening has recently been found to be a useful supplement to fine-needle aspiration biopsy, ultrasound and radionuclide imaging in the evaluation of thyroid nodules. We describe a case where introduction of routine calcitonin screening in nodular thyroid disease led to the detection of a family with medullary thyroid carcinoma. The benefits and problems of basal and stimulated serum calcitonin testing and ret-proto-oncogene mutation studies are exemplified and we discuss the appropriate use and interpretation of these tests. We conclude that routine basal serum calcitonin measurement in nodular thyroid disease and thoughtful use of ret-mutation analysis is cost-effective in detecting medullary thyroid carcinoma and multiple endocrine neoplasia type II.

scholarly journals Surgical Outcome of Thyroid Nodules with Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Fine Needle Aspiration Biopsy

2017 ◽  
Vol 9 (3) ◽  
pp. 100-103
Author(s):  
Saad Alqahtani ◽  
Saif Alsobhi ◽  
Riyadh I Alsalloum ◽  
Saleh N Najjar ◽  
Hindi N Al-Hindi
Keyword(s):  
Fine Needle Aspiration ◽  
Surgical Outcome ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Fine Needle ◽  
Risk Of Malignancy ◽  
Needle Aspiration Biopsy ◽  
Undetermined Significance

ABSTRACT Aim To correlate selected clinical and ultrasonographic (US) characteristics with the final histopathological diagnosis in patients with atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS), and whether this information can be used in planning the surgical approach. Materials and methods It is a retrospective study including the operated cases of AUS/FLUS from 2011 to 2014 treated at one center. Results This cohort included 87 women and 28 men. To test for independence between categorical variables, the chi-square test was used. There was no significant correlation between age or US variables and final pathological diagnosis. However, final diagnosis of malignancy was higher in men compared with women (64.3 and 41.4% respectively; p = 0.035). Furthermore, a significant association between the diagnosis of repeated fine needle aspiration biopsy (FNAB) and the final pathological diagnosis was noted (benign vs malignant, p = 0.005). Conclusion The FNAB has a significant role in the assessment of thyroid nodules. Our results showed no correlation between age, US variables, and the risk of malignancy. Male gender is associated with higher risk of malignancy. Clinical significance Determining the risk of malignancy and prediction of surgical outcome may help triaging cases for repeat FNA or proceeding to surgery. How to cite this article Alqahtani S, Alsobhi S, Alsalloum RI, Najjar SN, Al-Hindi HN. Surgical Outcome of Thyroid Nodules with Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Fine Needle Aspiration Biopsy. World J Endoc Surg 2017;9(3):100-103.

Impact of the Afirma Gene Expression Classifier Result on the Surgical Management of Thyroid Nodules with Category III/IV Cytology and Its Correlation with Surgical Outcome

2016 ◽  
Vol 60 (3) ◽  
pp. 205-210 ◽  
Author(s):  
Shweta Chaudhary ◽  
Yanjun Hou ◽  
Rulong Shen ◽  
Shveta Hooda ◽  
Zaibo Li
Keyword(s):  
Gene Expression ◽  
Predictive Value ◽  
Surgical Outcome ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Molecular Test ◽  
Gene Expression Classifier ◽  
Sensitivity Specificity ◽  
Undetermined Significance

Objective: The Afirma gene expression classifier (GEC) is a molecular test to further classify indeterminate fine-needle aspiration (FNA) as benign or suspicious for malignancy. Study Design: A total of 158 FNAs with Bethesda category III/IV cytology were sent for an Afirma GEC test. We correlated the Afirma GEC results with surgical outcome and also compared the data after Afirma's implementation with the data before. Results: Among the 158 FNAs, the Afirma result was benign in 63 (40%), suspicious in 85 (54%) and unsatisfactory in 10 (6%). In total, 73 (86%) suspicious Afirma cases had surgery and 28 (38%) showed carcinoma. In contrast, only 8 (13%) benign Afirma cases had surgery and all of them were benign. The sensitivity, specificity, negative predictive value and positive predictive value (PPV) of Afirma were 100, 15, 100 and 38%, respectively. The PPV was 20% in cases with follicular lesion of undetermined significance, but was 50% in cases suspicious for follicular neoplasm (SFN). The surgical excisional rate was significantly decreased in SFN cases after the Afirma test. Conclusions: The Afirma GEC is useful for further risk stratifying SFN cases.

scholarly journals Cytology Versus Calcitonin Assay in Fine-needle Aspiration Biopsy Wash-out Fluid (FNAB-CT) in Diagnosis of Medullary Thyroid Microcarcinoma.

2021 ◽  
Author(s):  
Ziyuan Liu ◽  
Wenzhong Zhou ◽  
Rulai Han ◽  
Wei Zhou ◽  
Jie Zhang ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Elevated Serum ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Serum Calcitonin ◽  
Fine Needle ◽  
Needle Aspiration Biopsy

Abstract Purpose Widespread use of sensitive ultrasound examination led to an increasing detection of medullary thyroid microcarcinoma (micro-MTC). This prospective study evaluated the diagnostic accuracy of Fine-needle Aspiration Biopsy Cytology (FNAB-C) and calcitonin assay in Fine-needle Aspiration Biopsy wash-out fluid (FNAB-CT) in thyroid nodules less than 1cm with elevated serum calcitonin. Methods 87 thyroid nodules from 60 patients with elevated serum calcitonin(＞10pg/ml) were included and 51 were thyroid nodules less than 1cm. FNAB-CT and FNAB-C was performed to distinguish MTC lesions before surgery, histopathologic diagnoses served as main reference standards.Results FNAB-CT had a greater performance over FNAB-C for preoperative diagnosis of MTC (diagnostic accuracy: 98.85％vs 61.90％, sensitivity: 98.55％ vs 55.07％, specificity: 100％ vs 97.44％), especially for micro-MTC: FNAB-C established a sensitivity and diagnostic accuracy of 48.78％ and 58％ respectively, while FNAB-CT reached 97.56% sensitivity and 98.04% diagnostic accuracy. Conclusions FNAB-CT demonstrated high diagnostic accuracy in diagnosing micro-MTC. Patients with micro thyroid nodules and elevated sCT level should perform FNAB-CT to exclude the diagnosis of MTC lesions.

scholarly journals Predictive factors of malignancy in pediatric patients with thyroid nodules and performance of the Italian classification (SIAPEC 2014) in the outcome of the cytological FNA categories

Endocrine ◽  
2021 ◽  
Author(s):  
Gerdi Tuli ◽  
Jessica Munarin ◽  
Erica Agosto ◽  
Patrizia Matarazzo ◽  
Francesco Quaglino ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Pediatric Age ◽  
Multicenter Studies ◽  
Bethesda System ◽  
And Performance ◽  
Reported Data ◽  
Undetermined Significance

Abstract Purpose The rate of malignancy (ROM) among pediatric studies using the Bethesda System is 39.5% and 41.5% for atypia of undetermined significance/follicular lesion of undetermined significance and for suspected follicular neoplasm, respectively. Data reported on the basis of Bethesda System showed lower ROM in adults with indeterminate nodules (30.5 and 28.9% respectively). Studies on adults based on the Italian Society of Anatomic Pathology and Cytology (SIAPEC) classification, report ROM of 14.2% for TIR3a and 44.6% for TIR3b category, showing greater sensitivity in detecting malignancy. To date, no performance data are available about SIAPEC classification in pediatric age. Methods Retrospective data were collected from 200 pediatric subjects with thyroid nodules in the period 2000–2020. Results The distribution of cytological categories after fine needle aspiration biopsy (FNAB) was 7 TIR1, 4 TIR1c, 22 TIR2, 14 TIR3a, 9 TIR3b, 3 TIR4, and 16 TIR5. The surgical approach was performed in 40/200 subjects, with total ROM of 65% (0% for TIR1-TIR3a, 77.8% for TIR3b, and 100% for TIR4–TIR5). Total FNAB accuracy was 95%, while the sensibility and specificity were 92.3 and 92.6%, respectively. Conclusions The reported data seem to confirm a greater sensitivity of SIAPEC classification to identify malignancy within the indeterminate category also in pediatric age and not only in adulthood. This finding may orient clinicians toward clinical follow-up for the indeterminate TIR3a group and toward surgical approach with total thyroidectomy in the indeterminate TIR3b group, although this indication should be confirmed in further national multicenter studies including larger cohorts.

scholarly journals The diagnostic ability of core needle biopsy in nodular thyroid disease

2017 ◽  
Vol 99 (3) ◽  
pp. 233-236 ◽  
Author(s):  
E Aysan ◽  
T Kiran ◽  
UO Idiz ◽  
B Guler ◽  
H Akbulut ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Thyroid Disease ◽  
Needle Biopsy ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Accurate Method ◽  
Needle Aspiration ◽  
Diagnostic Ability ◽  
Core Needle ◽  
Pathology Specimen

INTRODUCTION Non-diagnostic results of fine needle aspiration biopsy (FNAB) remain an important limitation of this technqiue. The aim of our study was to evaluate the results of core needle biopsy (CNB) of thyroid nodules and its effectiveness in non-diagnostic FNAB cases. METHODS CNBs were performed in 1,000 patients (154 male, 846 female; mean age: 50.2 years, range: 18–86 years) with a spring loaded 20G needle. Of these, 143 had initially had FNABs that were insufficient for evaluation. The CNB reports were reviewed. Patients with suspicious or malignant CNB results underwent total thyroidectomy. RESULTS When considering all 1,000 CNBs, the non-diagnostic rate was 1.5% (15/1,000). However, when the first 100 cases were eliminated as a learning curve, this reduced to 0.9% (8/900). Of the 143 cases with initial FNABs that were non-diagnostic, 0.7% (1/143) were also non-diagnostic on CNB. Twelve patients underwent surgery because of malignant CNB reports and all of these cases were confirmed as malignant by the postoperative pathology specimen results (100% accuracy). There were no major complications although three self-limiting minor complications were observed. CONCLUSIONS CNB is a safe and accurate method. It is more diagnostic than FNAB for nodular thyroid disease.

scholarly journals Thyroid cytology during the COVID-19 pandemic: a single centre experience

2021 ◽  
Vol 9 (1) ◽  
pp. 1
Author(s):  
Ozgur Kulahci ◽  
Zeynel Abidin Tas
Keyword(s):  
Malignant Tumour ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Follicular Neoplasm ◽  
Calendar Period ◽  
Thyroid Cytology ◽  
Number Of Patients ◽  
Before And After ◽  
Thyroid Fine Needle Aspiration ◽  
Undetermined Significance

Background: In our study, thyroid fine-needle aspiration biopsy (FNAB) data in the same calendar period of 1 year before and after the COVID-19 pandemic were compared.Methods: Thyroid FNAB data for the same calendar period of 1 year before and after the COVID-19 pandemic were included in the study. The patients were grouped according to age, gender and thyroid FNABs according to the Bethesda system for reporting thyroid cytopathology, and the data of both groups were compared considering the diagnoses of the patients who underwent thyroid surgery afterwards.Results: In the post-pandemic period, the number of thyroid FNABs and the number of patients over the age of 40 decreased (all p<0.001). In the post-pandemic period, the rates of atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm or suspicious for a follicular neoplasm (FN/SFN), suspicious for malignancy, and malignant cytology increased despite the decrease in the number of patients (p=0.001). Furthermore, the malignant tumour rate was 1.4% before the pandemic in patients who underwent surgical thyroidectomy and/or lobectomy; this rate was 3.5% in the post-pandemic period (p=0.045).Conclusions: We found an increase in the percentage of AUS/FLUS, FN/SFN, suspicious for malignancy, and malignant cases during the period when there were restrictions, such as pandemics, and the sampling was reduced. This finding is valuable in terms of detecting an increased malignancy rate by performing less thyroid FNAB by carefully determining the indications for thyroid aspiration biopsy regarding the latest guidelines.

scholarly journals Bethesda System for Reporting Thyroid Cytopathology in Pediatric Thyroid Nodules: Experience of a Tertiary Care Referral Center

2019 ◽  
Vol 144 (4) ◽  
pp. 473-477 ◽  
Author(s):  
Amer Heider ◽  
Stacy Arnold ◽  
Xin Jing
Keyword(s):  
Thyroid Nodules ◽  
Pediatric Population ◽  
Adult Population ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
American Thyroid Association ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
Undetermined Significance

Context.— The Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer from The American Thyroid Association recommends fine-needle aspiration (FNA) as an essential tool for evaluation and management of pediatric thyroid nodules, and The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) as a guideline to categorize FNA cytologic findings. A few publications have focused on TBSRTC categorization in children. Objective.— To evaluate our institutional experience of using TBSRTC in the pediatric population. Design.— We conducted a retrospective data search for thyroid FNA specimens from patients younger than 21 years who were assessed by using TBSRTC categorization between January 1, 2011, and September 30, 2017. Cytologic and histologic diagnoses, rate of surgical follow-up, rate of histology-proven malignancy, and cytologic-histologic concordance were assessed in comparison with our previously published adult experience. Results.— Among a total of 201 specimens, benign category accounted for 103 (51.2%), followed by 35 (17.4%) malignant, 30 (14.9%) atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 14 (7.0%) nondiagnostic, 10 (5.0%) follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), and 9 (4.5%) suspicious for malignancy (SFM) categories. Surgeries were subsequently performed in 100 of the 201 cases (49.8%). All surgically removed nodules categorized as malignant and SFM by FNA showed malignancy, while malignancy was evident in various proportions of specimens classified as AUS/FLUS (5 of 16; 31.3%), FN/SFN (1 of 9; 11.1%), and nondiagnostic (1 of 7; 14.2%). No malignancy was identified in the benign category. Cytologic-histologic concordance achieved 100% in malignant, SFM, and FN/SFN categories, and exceeded beyond 85% and 50% for benign and AUS/FLUS categories, respectively. Conclusions.— TBSRTC is effective for appropriate categorization of pediatric thyroid nodules. Risk of malignancy in thyroid nodules is higher for the pediatric than adult population. Understanding the difference in TBSRTC categorization between children and adults may aid in achieving more appropriate evaluation and management of pediatric thyroid nodules.

Reclassification of cytologically atypical thyroid nodules based on radiologic features in pediatric patients

2015 ◽  
Vol 28 (7-8) ◽  
Author(s):  
Nicoleta C. Arva ◽  
Sarah G. Deitch
Keyword(s):  
Thyroid Nodules ◽  
Pediatric Patients ◽  
Imaging Techniques ◽  
Malignant Neoplasm ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Accurate Information ◽  
Risk Of Malignancy ◽  
Radiologic Features ◽  
Undetermined Significance

AbstractIn children the percentage of “Atypia of undetermined significance/follicular lesion of undetermined significance” (“AUS/FLUS”) cases is greater and the risk of malignancy is higher than expected. Our study aimed to determine if cytologically atypical nodules can be better characterized using imaging techniques for appropriate management of pediatric patients.Thyroid fine needle aspiration (FNA) specimens were reclassified using the Bethesda System for Reporting Thyroid Cytopathology (BSRTC). Cytologic-histologic correlation was performed to determine if the cytopathologic groups had different associations with the surgical outcome. The “AUS/FLUS” lesions were then subdivided based on radiologic features and the outcome was analyzed for each subgroup.Histologically benign follicular nodules showed uniform distribution between the “benign” vs. “AUS/FLUS” (p=0.09) or between the “AUS/FLUS” vs. “follicular neoplasm” (“FN”) cytologic groups (p=0.27). The follicular neoplasms were also evenly distributed between the “FN” vs. “AUS/FLUS” categories (p=0.31). “Benign”, “AUS/FLUS”, and “FN” designations showed comparable associations with papillary thyroid carcinoma classical variant (PTC-cv). Reclassification of atypical lesions based on ultrasound findings yielded two subcategories with different risk of malignancy: one similar to the “benign” group (11% malignancy rate) and one comparable with the “FN” category (28% risk of malignant neoplasm).“AUS/FLUS” designation does not add significant value in categorization of pediatric thyroid nodules. These lesions can be reclassified based on radiologic features to provide accurate information for follow-up.

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