scholarly journals Rate and Clinical Predictors of Malignancy in Thyroid Nodules with Indeterminate Cytology

2021 ◽  
Vol 5 (4) ◽  
pp. 01-08
Author(s):  
Feron Getachew Tefera ◽  
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Binary Logistic Regression ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Clinical Predictors ◽  
Hürthle Cell ◽  
Ultrasound Evaluation ◽  
Indeterminate Cytology ◽  
Thyroid Lesions

Background: Fine needle aspiration cytology (FNAC) cannot differentiate between benign and malignant conditions in cytologically indeterminate thyroid lesions. Therefore, a minimum of diagnostic lobectomy is required for definitive diagnosis. The objective of this study is to identify the rate of malignancy and clinical features that may possibly predict malignancy in patients with these lesions, in Ethiopian hospitals. Methods: This was a retrospective review of the medical records of patients who underwent surgery for cytologically indeterminate thyroid lesions in three referral hospitals between September 2015 and September 2020. Results: Of 85 patients with indeterminate cytology findings, 56 (63.5%) were follicular, and 29 (34.1%) were reported to be hurthle cell neoplasms. Follicular lesions of undetermined significance (FLUS) and suspicious for follicular neoplasm were each reported in single cases (1.7%). Malignant disease was diagnosed in 19 (22.4%) of patients. A follicular variant of papillary cancer was detected in 7 (11.5%) patients. Hard nodule consistency was reported in 9 of 11 malignant lesions and 5 of 66 benign lesions. In multivariate binary logistic regression, hard nodule consistency was found to be associated with malignancy (P = 0.012, AOR = 7.28 (1.5, 34.54) 95% CI ). The ill-defined surface of a nodule was found to be associated with malignancy though the association was not statistically significant (P = 0.088, AOR = 0.162 (0.020, 1.313) 95% CI. Ultrasound evaluation of thyroid nodule was performed only in 41 (47.7%) of patients. Conclusion: The rate of malignancy in thyroid nodules with indeterminate cytology was 22.4%. The risk of malignancy was higher in patients with hard thyroid nodule consistency and ill-defined surface. Despite the established benefits of ultrasound for the evaluation of thyroid nodules, the current practice of its use in our setup is suboptimal. Keywords: Follicular; hurthle cell; indeterminate cytology; predictors of malignancy

scholarly journals Hürthle Cells on Fine-Needle Aspiration Cytology Are Important for Risk Assessment of Focally PET/CT FDG Avid Thyroid Nodules

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3544
Author(s):  
David N. Poller ◽  
Hakim Megadmi ◽  
Matthew J. A. Ward ◽  
Pierpaolo Trimboli
Keyword(s):  
Fine Needle Aspiration ◽  
Fdg Pet ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Fine Needle ◽  
Hürthle Cell ◽  
Pet Ct ◽  
Risk Of Malignancy ◽  
Fdg Pet Ct

This study assesses the role of [18F] FDG PET/CT, fine needle aspiration (FNA) cytology and ultrasound in the 1–2% of patients with focally positive thyroid nodules on FDG PET/CT. All FDG PET/CT scans with focally increased thyroid FDG PET/CT uptake performed over 37 months in one institution were matched to patients undergoing thyroid FNA. Diffuse FDG PET/CT uptake patients were excluded. A total of 47 patients showed focally increased thyroid uptake. Consistent with previous studies, 18 (38.2%) patients had malignancy—12 primary thyroid carcinoma, 1 parathyroid carcinoma, 3 metastatic carcinoma to the thyroid and 2 lymphoma. A total of 15 (31.9%) lesions categorized as non-malignant contained Hürthle cells/oncocytes. A total of 14 lesions (29.8%) had focally increased FDG PET/CT uptake with no specific cytological or histopathological cause identified. No focally PET avid Hürthle cell/oncocytic lesions were found to be malignant. Exclusion of oncocytic lesions increased the calculated risk of malignancy (ROM) of focally PET avid nodules from 38% to 68%. It may be useful to exclude focally FDG PET/CT avid Hürthle cell/oncocytic lesions, typically reported as follicular neoplasm or suspicious for a follicular neoplasm, Hürthle cell type (Oncocytic) type, RCPath Thy 3F: Bethesda IV or sometimes Thy 3a: Bethesda III FNAs) from ROM calculations. Oncocytic focally PET/CT FDG avid lesions appear of comparatively lower risk of malignancy and require investigation or operation but these lesions should be readily identified by FNA cytology on diagnostic work up of focally PET avid thyroid nodules.

scholarly journals Approach to the Patient with a Cytologically Indeterminate Thyroid Nodule

2008 ◽  
Vol 93 (11) ◽  
pp. 4175-4182 ◽  
Author(s):  
Erik K. Alexander
Keyword(s):  
Thyroid Cancer ◽  
Cancer Risk ◽  
Thyroid Nodule ◽  
Surgical Procedures ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Fine Needle ◽  
Thyroid Cancer Risk

Background: Fine-needle aspiration remains the primary diagnostic intervention for the evaluation of most thyroid nodules larger than 1–1.5 cm. Although most aspirates provide diagnostic cytology, approximately 15–25% will be classified indeterminate (often referred to as follicular neoplasm, suspicious for carcinoma, or atypical). In such cases, abnormal cellular findings preclude interpretation of benignity, although only a minority will prove cancerous upon final histopathology. Nonetheless, patients with indeterminate aspirates are commonly referred for consideration of hemi- or near-total thyroidectomy. Recently, improved understanding and novel investigation of clinical, radiological, cytological, and molecular factors has allowed improved stratification of cancer risk. Conclusion: Although surgery continues to be commonly recommended, strategies for such patients should increasingly seek to define treatment based on the estimation of an individual’s thyroid cancer risk in comparison with associated operative risk and morbidity. In doing so, the rate of unnecessary surgical procedures and associated complications can be reduced.

scholarly journals CYTO-HISTOPATHOLOGICAL CORRELATION OF THYROID LESIONS

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Dharmendra Singh Bhadouria ◽  
Shikha Raghuwanshi ◽  
Arun Saxena
Keyword(s):  
Papillary Carcinoma ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Patient Acceptance ◽  
Histopathological Diagnosis ◽  
Thyroid Lesion ◽  
Follicular Hyperplasia ◽  
Neoplastic Lesion ◽  
Thyroid Lesions

Introduction: Thyroid nodules show an overall incidence rate of 4-7% & high probability of malignancy, constituting 5% to 35%. FNAC of Thyroid is most economical and reliable preoperative procedure to distinguish between neoplastic and non- neoplastic lesion. Objectives: To Study Cyto-Morphology of Fine Needle Aspiration of Thyroid nodules. To find out incidence of various types of lesions as per age & sex and to confirm the findings with Histomorphological diagnosis of same nodule. Material & Methods: 100 patients with Thyroid nodule who underwent FNAC & Thyroidectomy taken for an observational study from January 2019 to June 2020. The cytological findings were correlated with histopathological diagnosis. Results: Out of 100 cases 14 cases were  found to be malignant and 86 were found to be benign on histology while cytology showed 93 cases benign and 7  malignant cases .Out of 5 cases suspicious for neoplasm and 3 cases were of follicular neoplasm on cytology which confirmed as papillary carcinoma on histopathology.2 cases which were diagnosed as Benign Thyroid lesion turned out to be papillary carcinoma and 2 cases which were diagnosed as colloid goitre on cytology turned out to be papillary carcinoma on histo pathology .1 case diagnosed as follicular hyperplasia turned out to be papillary carcinoma on histology.1 case diagnosed as MNG in cytology was turned out to be papillary carcinoma on histo pathology. Conclusion: Thyroid cytology proves to be a reliable, simple and cost-effective first line diagnostic procedure with high patient acceptance and without complications. FNAC serves as useful screening test for thyroid lesions. However, inability in distinguishing follicular lesion and inadequate sampling in cystic lesion lead to false diagnosis. Keywords: Histopathology, Thyroid , Lesion.

scholarly journals Incidence of Microcarcinoma and Non-Microcarcinoma in Ultrasound-Found Thyroid Nodules

2021 ◽  
Author(s):  
Zhi Chen ◽  
Singla Sethiel Mosha ◽  
Tong Zhang ◽  
Ming Xu ◽  
Yanli Li ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Malignant Tumors ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Normal Thyroid ◽  
Ultrasound Evaluation ◽  
Missed Diagnosis ◽  
Malignant Lesions ◽  
Bethesda System ◽  
The Bethesda System

Abstract Backgrounds: The incidence of thyroid nodules is increasing year by year around the world. However, ultrasound is not recommended as a screening test for the general population or patients with a normal thyroid on palpation by the American Association of Clinical Endocrinologists (AACE). In practice, some individuals with normal thyroid palpation have nodules that can just be found out by ultrasound. No studies have directly described the risk of nodules found by ultrasound or by palpation up to now. More evidence is needed to carry out for helping us balance the over diagnosis and missed diagnosis of malignant lesions. Therefore, we carried out a retrospective study to investigate the incidence of malignant lesions in ultrasound-found nodules in a large cohort.Methods: We conducted a retrospective analysis involving 2957 patients who underwent thyroid ultrasound evaluation and fine-needle aspiration (FNA) between Jan 2013 and Dec 2019. The cytologic examinations were analyzed based on the Bethesda system. For nodules suspected to be follicular neoplasm or other malignant tumors by cytological tests, patients were recommended for surgery and histopathology examinations.Results: Compared with palpation-found nodules, ultrasound-found nodules were presenting less as purely cystic nodules (10.1% vs 39.9%, x2=355.69, p=0.000), smaller size (17.5±9.9 mm vs 28.0±12.5 mm, t=23.876 p=0.000), and higher TI-RADS score (5.5±2.9 vs 3.4±3.3, t=18.084, p=0.000), respectively. More ultrasound-found nodules were diagnosed as carcinoma by histology examinations [136 (11.2%) nodules found by ultrasound vs 68 (3.9%) by palpation, x2=59.737, p=0.000], and 88 (64.7%) nodules found by ultrasound were non-microcarcinoma. Among the malignant nodules confirmed by histopathology, a higher proportion of microcarcinoma was detected in ultrasound-found nodules [35.3% (48/136) vs 16.2% (11/68), x2=8.183, p=0.004]. Conclusions: In view of the results observed in our research that malignant nodules were more common screened out by ultrasound, and nearly two thirds of them were non-microcarcinoma. We recommend reassessment of the recommendations for thyroid nodule screening.

scholarly journals Cytomorphological Study of Various Thyroid Nodules as per Bethesda Criteria

2021 ◽  
Vol 8 (12) ◽  
pp. 722-725
Author(s):  
Sharath Chandra Keshapaga ◽  
Tiwari Sundari Devi ◽  
Byrapuram Vijaya Nirmala ◽  
Durga Hari Prasanna Kumar Kalla
Keyword(s):  
Diagnostic Criteria ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Cost Effective ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Fine Needle ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
Thyroid Lesions

BACKGROUND Thyroid nodules are common and occur in 4 % - 7 % of the general population. Diseases of the thyroid are of great importance because they are most amenable to medical or surgical management. The benefit of thyroid fine needle aspiration (FNA) derives in large part from the ability to make a reliably benign interpretation that avoids unnecessary surgery. A uniform reporting system for thyroid FNA will facilitate effective communication among cytopathologist and the referring physician and allow easy and reliable sharing of data from different laboratories for national and international collaborative studies. For uniformity of reporting cytological smears “The Bethesda System for Reporting Thyroid Cytopathology” was recommended and the smears were divided into 6 diagnostic categories. We wanted to know the age and sex distribution and prevalence of various thyroid lesions as per Bethesda diagnostic criteria. We wanted to study the cytological and morphological features of thyroid lesions by fine needle aspiration cytology (FNAC). METHODS The present study is a prospective type of descriptive study, carried out from January 2016 to December 2017 at Andhra Medical College, Visakhapatnam. A total of 1291 cases were evaluated and classified according to Bethesda system of cytopathology. FNAC was done and the smears were immediately fixed in isopropyl alcohol and stained with haematoxylin and eosin. RESULTS In the present study a total of 1291 cases was analysed out of which 1193 were benign, 13 were AFLUS, 32 were follicular neoplasms, 10 were suspicious of malignancies and 36 malignant. All the lesions were classified as per Bethesda diagnostic criteria. CONCLUSIONS FNAC is a simple and cost-effective procedure which guides the clinical practitioner to choose the right form of treatment for the patient subsequently avoiding unnecessary surgery and ensuing morbidity. KEYWORDS Thyroid, Cytopathology, FNAC, Bethesda, Follicular Neoplasm, Benign, Malignant

scholarly journals Incidence of microcarcinoma and non‐microcarcinoma in ultrasound‐found thyroid nodules

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhi Chen ◽  
Singla Sethiel Mosha ◽  
Tong Zhang ◽  
Ming Xu ◽  
Yanli Li ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Malignant Tumors ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Normal Thyroid ◽  
Ultrasound Evaluation ◽  
Missed Diagnosis ◽  
Malignant Lesions ◽  
Bethesda System ◽  
The Bethesda System

Abstract Backgrounds The incidence of thyroid nodules is increasing year by year around the world. However, ultrasound is not recommended as a screening test for the general population or patients with a normal thyroid on palpation by the American Association of Clinical Endocrinologists (AACE). In practice, some individuals with normal thyroid palpation have nodules that can just be found out by ultrasound. No studies have directly described the risk of nodules found by ultrasound or by palpation up to now. More evidence is needed to carry out for helping us balance the over diagnosis and missed diagnosis of malignant lesions. Therefore, we carried out a retrospective study to investigate the incidence of malignant lesions in ultrasound-found nodules in a large cohort. Methods We conducted a retrospective analysis involving 2957 patients who underwent thyroid ultrasound evaluation and fine-needle aspiration (FNA) between Jan 2013 and Dec 2019. The cytologic examinations were analyzed based on the Bethesda system. For nodules suspected to be follicular neoplasm or other malignant tumors by cytological tests, patients were recommended for surgery and histopathology examinations. Results Compared with palpation-found nodules, ultrasound-found nodules were presenting less as purely cystic nodules (10.1 % vs. 39.9 %, x2 = 355.69, p = 0.000), smaller size (17.5 ± 9.9 mm vs. 28.0 ± 12.5 mm, t = 23.876 p = 0.000), and higher TI-RADS score (5.5 ± 2.9 vs. 3.4 ± 3.3, t = 18.084, p = 0.000), respectively. More ultrasound-found nodules were diagnosed as carcinoma by histology examinations [136 (11.2 %) nodules found by ultrasound vs. 68 (3.9 %) by palpation, x2 = 59.737, p = 0.000], and 88 (64.7 %) nodules found by ultrasound were non-microcarcinoma. Among the malignant nodules confirmed by histopathology, a higher proportion of microcarcinoma was detected in ultrasound-found nodules [35.3 % (48/136) vs. 16.2 % (11/68), x2 = 8.183, p = 0.004]. Conclusions In view of the results observed in our research, malignant nodules were more common in nodules screened out by ultrasound, and nearly two thirds of them were non-microcarcinoma. We suggest the recommendation against screening thyroid nodules by ultrasound needs to be re-evaluated.

scholarly journals Contribution of scintigraphy and ultrasonography to the prediction of malignancy in thyroid nodules with indeterminate cytology

2010 ◽  
Vol 54 (1) ◽  
pp. 56-59 ◽  
Author(s):  
Pedro Weslley Rosário ◽  
Daniela Santos Salles ◽  
Breno Bessa ◽  
Saulo Purisch
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Follicular Neoplasm ◽  
Cytological Diagnosis ◽  
Hot Nodule ◽  
Indeterminate Cytology

OBJECTIVE: To evaluate the contribution of 131I scintigraphy and ultrasonography to the prediction of malignancy in thyroid nodules with indeterminate cytology in euthyroid patients. SUBJECTS AND METHODS: The sample consisted of 102 patients with thyroid nodules, submitted to FNAC and presenting an indeterminate cytological diagnosis (follicular neoplasm). RESULTS: Malignancy was observed in 19/25 (76%) nodules with suspicious ultrasonographic characteristics versus 5/77 (6.5%) without suspicious findings. When 131I scintigraphy showed a cold or hot nodule, the chance of malignancy was 38.5% and 2.5%, respectively. This exam was inconclusive in 10% of the patients. CONCLUSIONS: Surgery is indicated when a thyroid nodule with indeterminate cytology exhibits suspicious ultrasonographic characteristics. Otherwise, 131I scintigraphy can exclude thyroidectomy when reveals uptake in the nodule, which is observed in half the cases.

A core needle biopsy provides more malignancy-specific results than fine-needle aspiration biopsy in thyroid nodules suspicious for malignancy

2013 ◽  
Vol 66 (12) ◽  
pp. 1046-1050 ◽  
Author(s):  
T Hakala ◽  
I Kholová ◽  
J Sand ◽  
R Saaristo ◽  
P Kellokumpu-Lehtinen
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Follicular Neoplasm ◽  
Core Needle ◽  
Fine Needle ◽  
Needle Aspiration Biopsy ◽  
Thyroid Lesions

Background and aimsThe most commonly used diagnostic method for the preoperative diagnosis of thyroid nodules is ultrasound-guided fine-needle aspiration biopsy (FNA), which often yields non-diagnostic or non-definitive results and seldom produces definite malignant diagnoses. To improve upon the malignancy-specific sensitivity, we tested core needle biopsies (CNBs) of thyroid lesions taken from surgical specimens.Material and methods52 consecutive patients with malignant or malignant-suspicious thyroid nodules were referred to Tampere University Hospital between May 2010 and December 2011. Preoperative FNAs were categorised as follicular neoplasm (48%), suspicion for malignancy (46%) or malignancy (6%). Intraoperative FNA and CNB samples were acquired from surgical specimens removed during surgery. The results of the needle biopsies were compared with the final pathological diagnosis.ResultsCNBs had a high definitive sensitivity for malignancy (61%, CI 41% to 78%) whereas the definitive sensitivity for malignancy of FNAs was significantly lower (22%, CI 10% to 42%). CNB was not beneficial in the diagnosis of follicular thyroid lesions. When all suspected follicular tumours were excluded, the definitive sensitivity of CNB rose to 70% (CI 48% to 86%).ConclusionsCNB may be beneficial for the diagnosis of papillary thyroid carcinoma and other non-follicular thyroid lesions. CNB may be considered as an additional diagnostic procedure in cases with FNA suspicious for malignancy.

scholarly journals Follicular neoplasm of the thyroid: can clinical, ultrasonographical and cytological factors be used to predict carcinoma and determine extent of surgery

2019 ◽  
Vol 6 (11) ◽  
pp. 4038
Author(s):  
Shivraj Meena ◽  
Sunita Meena ◽  
Seemant Saini
Keyword(s):  
Thyroid Nodules ◽  
Cost Benefit ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
P Value ◽  
Optimal Management ◽  
Indeterminate Nodule ◽  
Extent Of Surgery ◽  
Indeterminate Cytology ◽  
Ultrasonographic Feature

Background: The optimal management of cytologically indeterminate thyroid nodules in follicular neoplasm is controversial. We examined the prevalence of malignancy within cytologically indeterminate follicular thyroid lesions in an attempt to predict malignancy based on clinical, sonographic and cytologic features.Methods: Retrospective study was done in between April 2017 to July 2019 of 46 patients having a diagnosis of follicular neoplasm on fine needle aspiration cytology.Results: A total of 46 patients (8 men, 38 women; mean age 47 year) with indeterminate cytology underwent thyroidectomy and had histopathological diagnoses. The prevalence of malignancy in patients was 34.7%. The size of nodules and ultrasonographic feature were significant predictor of malignancy with p value <0.05.Conclusions: Author can predict malignancy in follicular neoplasm of thyroid with indeterminate nodule by using clinical and sonographic feature for the best compromise between the risk of missing carcinomas and the need for reducing unnecessary surgical procedures and cost benefit of the patients. 

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Thyroid Nodules in Thammasat University Hospital

2021 ◽  
Vol 104 (10) ◽  
pp. 1667-1670
Keyword(s):  
Diagnostic Accuracy ◽  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
The Other ◽  
Follicular Neoplasm ◽  
Fine Needle ◽  
Malignancy Rate

Background: Fine needle aspiration (FNA) cytology is a key investigation of thyroid nodules. There are several reports of FNA accuracy, which ranges from 75.0% to 94.8%, while false negative rates are 5.8% to 21.5%. In Thailand, there is no available data of FNA accuracy according to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The present study reported single-institute data of FNA accuracy, that could be used in thyroid nodule management. Objective: To determine the diagnostic accuracy of FNA cytology results of thyroid nodules collected in Thammasat University (TU) Hospital. Materials and Methods: The present study was a retrospective study collected cytologic results of all thyroid nodules that subsequently had definitive histopathologic diagnoses. The data were gathered from clinics at TU Hospital that performed thyroid nodule FNA between May 2011 and November 2014. The FNA cytology results were classified according to TBSRTC. Each cytopathologic result was compared with its postoperative tissue histopathology. The malignancy rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: The present study included 197 thyroid nodule FNA cytology results. The sensitivity and specificity were 77.8% and 65.4%, respectively. The calculated PPV was found to be 47.7%, and the NPV was 87.9%. The accuracy of these results was 69.0%. The malignancy rate of the unsatisfactory group was 6.25%, benign group 8.05%, atypia of undetermined significance or follicular lesion of unknown significance 22.22%, follicular neoplasm/suspicious for follicular neoplasm 14.20%, suspicious for malignancy 73.68%, and malignant 100%. Conclusion: The FNA cytology in TU Hospital has comparable sensitivity to the other studies. Interestingly, the malignancy rate in the follicular neoplasm category is lower than that of the other institutes because of a high false positive rate in this category. This causes lower specificity and accuracy, which may cause a higher rate of unnecessary operations. Keywords: FNA; Thyroid nodule; Diagnostic accuracy

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