FNAC IN THE MANAGEMENT OF SOLITARY THYROID NODULE

Objective: To determine the significant role of FNAC upon other diagnosticmodalities in pre-operative investigations of patients presenting with solitary thyroid nodules and to compare the postoperative histopathological results with the results of FNAC. Design: A Comparative study. Place and Duration ofStudy: Department of Surgery Combined Military Hospital Quetta and Combined Military Hospital Rawalpindi fromDecember 1999 to December 2001. Patients and Methods: In this study 46 patients with solitary thyroid nodule werestudied. Only 2 patients were toxic while remaining 44 were with euthyroid. In this study only one case was suspectedto be malignant clinically out of 5 malignant cases. All 46 patients under went thyroid scanning, ultrasound examinationand fine needle aspiration biopsy and the diagnostic accuracy was assessed. Results: 36 patients (78.26%) wereoperated while 10(21.73%) were managed conservatively. There were 5(10.86%) malignant nodules while 41(89.13%)were benign. All the 5 cases with malignancy were with ‘cold’ nodules on scan as most of others, while ‘solid’ onultrasound examination and so were most of other benign nodules. All cases diagnosed malignant pre-operatively onFNAC, proved to be malignant on histopathology after surgery and the others diagnosed as benign on FNAC provedto be benign. Conclusion: This study shows that conventional investigations for evaluation of solitary thyroid nodulesare inaccurate in identifying the malignant from the benign nodules and their routine use in such patients should beabandoned, while the use of FNAC should be encouraged more in our hospitals as this technique is with high degreeof sensitivity and specificity, cost effective and safe.

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Role of Midkine in Predicting Malignancy in Patient with Solitary Thyroid Nodule

Journal of Cancer and Tumor International ◽

10.9734/jcti/2019/v9i230102 ◽

2019 ◽

pp. 1-10

Author(s):

Nesma A. Ibrahim ◽

Ahmed M. Hamam

Keyword(s):

Thyroid Nodule ◽

Thyroid Nodules ◽

Clinical Problem ◽

Needle Aspiration ◽

Heparin Binding ◽

Significant Difference ◽

Solitary Thyroid Nodule ◽

Needle Aspiration Cytology ◽

Benign Nodules

Background: Solitary thyroid nodules are a common clinical problem. None of sonographic features is sufficient to discard or detect malignancy efficiently. Midkine is a novel heparin-binding growth factor, plays critical roles in carcinogenesis. In this study, we aimed to evaluate serum midkine levels in patients with solitary thyroid nodules to predict malignancy. Methods: A total of 100 patients who had solitary thyroid nodules were enrolled in the study. Serum midkine levels were measured. Fine needle aspiration cytology was done to all nodules (25 suspicious/ malignant and 75 benign). Results: Serum midkine levels were significantly higher in patients who had nodules with the following sonographic features; hypoechoic nodules compared to isoechoic and hyperechoic nodules (P=0.024), nodules with microcalcification compared to nodules with macrocalcification or without calcification (P = 0.011), nodules with irregular borders compared to nodules with regular borders (P = 0.014) and nodules more than 2 cm in length than shorter ones (P = 0.011). Serum midkine levels were also higher in nodules with absent halo compared to those with clear halo but with no significant difference (P = 0.660). Also, levels of serum medikine were significantly higher in suspicious/ malignant nodules than in benign nodules (P < 0.001). Conclusion: Serum midkine can predict malignancy in solitary thyroid nodule and also well correlated with sonographic features of thyroid nodules. We suggest that midkine levels may serve as a novel biochemarker in association with sonographic features in evaluation of solitary thyroid nodules.

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Correlation of Fine Needle Aspiration Cytology with Histopathology in the Diagnosis of Solitary Thyroid Nodule

Journal of Thyroid Research ◽

10.4061/2010/379051 ◽

2010 ◽

Vol 2010 ◽

pp. 1-5 ◽

Cited By ~ 30

Author(s):

Manoj Gupta ◽

Savita Gupta ◽

Ved Bhushan Gupta

Keyword(s):

Thyroid Nodule ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Cytology ◽

Thyroid Nodules ◽

Cost Effective ◽

Needle Aspiration ◽

Aspiration Cytology ◽

Fine Needle ◽

Solitary Thyroid Nodule ◽

Needle Aspiration Cytology

Background. Fine needle aspiration cytology is considered the gold standard diagnostic test for the diagnosis of thyroid nodules. Fine needle aspiration cytology is a cost effective procedure that provides specific diagnosis rapidly with minimal complications. Based on the cytology findings, patients can be followed in cases of benign diagnosis and subjected to surgery in cases of malignant diagnosis thereby decreasing the rate of unnecessary surgery. Purpose of the present study was to correlate the fine needle aspiration cytology findings with histopathology of excised specimens.Material and Methods. This was a prospective study conducted on 75 consecutive patients between January 2003 and December 2005. All patients with clinically diagnosed solitary thyroid nodule who were clinically and biochemically euthyroid were included for study. Patients with multinodular goitre and who were hypothyroid or hyperthyroid were excluded from the study.Results. The sensitivity, specificity, accuracy, false positive rate, false negative rate, positive predictive value, and negative predictive value of FNAC for the diagnosis of neoplastic solitary thyroid nodules were 80%, 86.6%, 13.3%, 20%, 80%, and 86.6%, respectively. Commonest malignancy detected was papillary carcinoma in 12 patients.Conclusions. Fine needle aspiration cytology is a simple, easy to perform, cost effective, and easily repeated procedure for the diagnosis of thyroid cancer. It is recommended as the first line investigation for the diagnosis of solitary thyroid nodule.

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Can sonographic features of microcalcification predict thyroid nodule malignancy? a prospective observational study

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00498-x ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Mehrdad Nabahati ◽

Rahele Mehraeen ◽

Zoleika Moazezi ◽

Naser Ghaemian

Keyword(s):

Thyroid Nodule ◽

Roc Analysis ◽

Thyroid Nodules ◽

Area Under The Curve ◽

Positive Association ◽

Needle Aspiration ◽

Northern Iran ◽

Significant Positive Association ◽

Irregular Margin ◽

Benign Nodules

Abstract Background The aim of this study was to investigate the diagnostic accuracy of microcalcification, as well as its associated sonographic features, for prediction of thyroid nodule malignancy. We prospectively assessed the patients with thyroid nodule, who underwent ultrasound-guided fine-needle aspiration during 2017–2020 in Babol, northern Iran. The ultrasonographic characteristics of the nodules, as well as their cytological results, were recorded. We used regression analysis to evaluate the relation between sonographic findings and nodule malignancy. A receiver operator characteristics (ROC) analysis was also used to estimate the ability of ultrasound to predict the characteristic features of malignancy, as estimated by the area under the curve (AUC). Results Overall, 1129 thyroid nodules were finally included in the study, of which 452 (40%) had microcalcification. A significant positive association was found between nodule malignancy and microcalcification in both univariate (OR=3.626, 95% CI 2.258–5.822) and multivariable regression analyses (OR=1.878, 95% CI 1.095–3.219). In the nodules with microcalcification, significant positive relations were seen between malignancy and hypoechogenicity (OR=3.833, 95% CI 1.032–14.238), >5 microcalcification number (OR=3.045, 95% CI 1.328–6.982), irregular margin (OR=3.341, 95% CI 1.078–10.352), and lobulated margin (OR=5.727, 95% CI 1.934–16.959). The ROC analysis indicated that AUC for hypoechogenicity, >5 microcalcification number, irregular margin, and lobulated margin were 60%, 62%, 55%, and 60%, respectively, in predicting malignant thyroid nodules. Conclusion The findings indicated that microcalcification can be a potential predictor of thyroid nodule malignancy. Also, the presence of irregular or lobulated margins, multiple intranodular microcalcification (>5 microcalcifications), and/or hypoechogenicity can improve the ability of microcalcification in distinguishing malignant from benign nodules.

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Punção Aspirativa de Nódulos da Tiroide: Vale a Pena Repetir?

Acta Médica Portuguesa ◽

10.20344/amp.8215 ◽

2017 ◽

Vol 30 (6) ◽

pp. 472

Author(s):

Vera Fernandes ◽

Tânia Pereira ◽

Catarina Eloy

Keyword(s):

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Significant Proportion ◽

Cost Effective ◽

Needle Aspiration ◽

Fine Needle ◽

High Concordance ◽

Benign Nodules ◽

Cytology Result ◽

Undetermined Significance

Introduction: The fine-needle aspiration has a significant role in assessing the malignancy risk of thyroid nodules. There is uncertainty regarding the value of repeat fine-needle aspiration in benign nodules. This study aims to evaluate the concordance of results in consecutive fine-needle aspiration and to study the relevance of repetition in benign results.Material and Methods: Retrospective study of the 4800 thyroid nodules fine-needle aspiration held in Instituto de Patologia e Imunologia Molecular da Universidade do Porto between January 1, 2014 and May 2, 2016. Of the initial sample, we selected the repeated fine-needle aspiration on the same nodule.Results: The first fine-needle aspiration result of the 309 nodules underwent revaluation was non-diagnostic in 103 (33.3%), benign in 120 (38.8%) and atypia/follicular lesion of undetermined significance in 86 (27.8%). The agreement between the first and second fine-needle aspiration was significantly higher in cases with an initial benign result (benign: 85.8%, non-diagnostic: 27.2% and atypia/ follicular lesion of undetermined significance: 17.4%, p < 0.005). The fine-needle aspiration repeating motifs in initially benign nodules (n = 78) were repetition suggestion in 58, nodule growth in 17 and suspicious ultrasonographic features in 3.Discussion: The fine-needle aspiration repetition in nodules with initial non-diagnostic and atypia/follicular lesion of undetermined significance result changed the initial diagnosis in a significant proportion of patients, modifying their therapeutic approach. The high concordance of results in initially benign nodules makes fine-needle aspiration repetition not cost-effective in most cases.Conclusion: The fine-needle aspiration should be repeated when the initial cytology result is non-diagnostic or atypia/follicular lesion of undetermined significance.

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Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage

Cancers ◽

10.3390/cancers13215439 ◽

2021 ◽

Vol 13 (21) ◽

pp. 5439

Author(s):

Davide Seminati ◽

Giulia Capitoli ◽

Davide Leni ◽

Davide Fior ◽

Francesco Vacirca ◽

...

Keyword(s):

Thyroid Nodule ◽

Thyroid Nodules ◽

Scoring Systems ◽

Needle Aspiration ◽

Data Systems ◽

Predictive Values ◽

Radiological Features ◽

Benign Nodules ◽

Design And Methods ◽

The Eu

Objective: The American College of Radiology (ACR) and the European Thyroid Association (EU) have proposed two scoring systems for thyroid nodule classification. Here, we compared the ability of the two systems in triaging thyroid nodules for fine-needle aspiration (FNA) and tested the putative role of an approach that combines ultrasound features and cytology for the detection of malignant nodules. Design and Methods: The scores obtained with the ACR and EU Thyroid Imaging Reporting and Data Systems (TIRADS) from a prospective series of 480 thyroid nodules acquired from 435 subjects were compared to assess their performances in FNA triaging on the final cytological diagnosis. The US features that showed the highest contribution in discriminating benign nodules from malignancies were combined with cytology to improve its diagnostic performance. Results: FNA was recommended on 46.5% and 51.9% of the nodules using the ACR and EU-TIRADS scores, respectively. The ACR system demonstrated a higher specificity as compared to the EU-TIRADS (59.0% vs. 52.4%, p = 0.0012) in predicting >TIR3A/III (SIAPEC/Bethesda) nodules. Moreover, specific radiological features (i.e., echogenic foci and margins), combined with the cytological classes improved the specificity (97.5% vs. 91%, p < 0.0001) and positive predictive values (77.5% vs. 50.7%, p < 0.0001) compared to cytology alone, especially in the setting of indeterminate nodules (TIR3A/III and TIR3B/IV), maintaining an excellent sensitivity and negative predictive value. Conclusions: The ACR-TIRADS system showed a higher specificity compared to the EU-TIRADS in triaging thyroid nodules. The use of specific radiological features improved the diagnostic ability of cytology.

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Role of fine needle aspiration biopsy in the management of thyroid nodules

East African Medical Journal ◽

10.4314/eamj.v78i8.8991 ◽

2001 ◽

Vol 78 (8) ◽

Author(s):

G. E. A. Khairy ◽

K. R. Murshid

Keyword(s):

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Aspiration Biopsy ◽

Fine Needle ◽

Needle Aspiration Biopsy

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THE RISK OF THYROID CANCER IN PATIENTS WITH THYROID NODULE 3 CM OR LARGER

Endocrine Practice ◽

10.4158/ep-2020-0136 ◽

2020 ◽

Vol 26 (11) ◽

pp. 1286-1290

Author(s):

Edy Kornelius ◽

Shih-Chang Lo ◽

Chien-Ning Huang ◽

Yi-Sun Yang

Keyword(s):

Thyroid Cancer ◽

Positive Predictive Value ◽

Thyroid Carcinoma ◽

Thyroid Nodule ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Thyroid Nodules ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Fine Needle

Objective: There are conflicting data on the risk of thyroid cancer in thyroid nodules 3 cm or larger, and few such studies on this issue have been conducted in Asia. This study aimed to examine the risk of thyroid cancer in patients with thyroid nodules 3 cm or larger. Methods: This was a 7-year retrospective study conducted in a tertiary referral hospital in Taiwan. All patients with a thyroid nodule measuring ≥3 cm who underwent thyroid operation with or without fine-needle aspiration biopsy (FNAB) were included. The prevalence rate of thyroid cancer, as well as the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and false-negative rate of FNAB for thyroid nodule ≥3 cm were also examined. Results: A total of 132 patients were included in this study. Thyroid cancer was detected in 19 of 132 (14.4%) thyroid nodules measuring ≥3 cm. The performance of FNAB for detecting cancer in nodules 3 cm or larger without considering other ultrasonography parameters was relatively poor with a sensitivity of 50%, but the specificity (100%), PPV (100 %), and NPV (93.4 %) were excellent. Conclusion: The risk of thyroid cancer for thyroid nodules ≥3 cm in this study was low. The PPV and NPV of FNAB were high for the detection of cancer in large nodules. The decision to perform thyroidectomy should not be solely based on nodule size and should include other factors, such as ultrasound characteristics and surgical risk. Abbreviations: ATA = American Thyroid Association; FNAB = fine-needle aspiration biopsy; mPTC = micropapillary thyroid carcinoma; NPV = negative predictive value; PPV = positive predictive value; PTC = papillary thyroid carcinoma

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