scholarly journals The Gold Standard of Thyroid Nodule Examination? Prospective Validation of the ACR TI-RADS in a Secondary Referral Center

2020 ◽  
pp. S329-S337
Author(s):  
T. GRIMMICHOVÁ ◽  
P. PAČESOVÁ ◽  
L. SRBOVÁ ◽  
J. VRBÍKOVÁ ◽  
T. HAVRDOVÁ ◽  
...  
Keyword(s):  
Gold Standard ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
American Thyroid Association ◽  
Referral Center ◽  
Proper Group ◽  
Pattern Group ◽  
Selection Of

The aim of this prospective study was the validation of the risk stratification of thyroid nodules using ultrasonography with the American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS) and partly in comparison to American Thyroid Association (ATA) guidelines in a secondary referral center. Fine needle aspiration biopsy (FNA) (n=605) and histological examinations (n=63) were the reference standards for the statistical analysis. ACR TI-RADS cut-off value: TR4 with sensitivity 85.7 %, specificity 54.1 %, PPV 58.5 %, accuracy 67.7 % (AUC 0.738; p<0.001). ATA cut-off value: “high suspicion” with sensitivity 80 %, specificity 83.3 %, PPV 80 %, accuracy 81.8 % (AUC 0.800; p=0.0025). 18.4 % nodules (3 malignant) could not be assigned to a proper ATA US pattern group (p<0.0001). Both ACR TI-RADS and ATA have allowed fair selection of nodules requiring FNA with superiority of ACR TI-RADS according to classification of all thyroid nodules to the proper group. According to ACR TI-RADS almost one third of the patients were incorrectly classified with 17.9 % missed thyroid carcinomas, exclusively micropapillary carcinomas, even though, the amount of FNA would be reduced to 48 %.

scholarly journals Ultrasonography Classification of the American Thyroid Association for Predicting Malignancy in Thyroid Nodules >1cm with Indeterminate Cytology: A Prospective Study

2018 ◽  
Vol 50 (08) ◽  
pp. 597-601 ◽  
Author(s):  
Tiara Rocha ◽  
Pedro Rosario ◽  
Alexandre Silva ◽  
Maurício Nunes ◽  
Tulio Silva ◽  
...  
Keyword(s):  
Prospective Study ◽  
Thyroid Nodules ◽  
Thyroid Neoplasms ◽  
Needle Aspiration ◽  
American Thyroid Association ◽  
Molecular Tests ◽  
Indeterminate Cytology ◽  
A Prospective Study ◽  
Doppler Analysis

AbstractThe objective of this prospective study was to evaluate the ultrasonography classification of the American Thyroid Association (ATA) for predicting malignancy in thyroid nodules >1 cm with indication for fine-needle aspiration (FNA) whose cytology was indeterminate. Additionally, the combination of the ATA classification with Doppler analysis was evaluated. All patients with thyroid nodules >1 cm were eligible. Each nodule was assigned to one of the ATA categories. Exclusively or predominantly intranodular vascularity was considered suspicious. One hundred and thirty-seven patients with 143 nodules underwent FNA and those with indeterminate cytology (Bethesda category III or IV) were selected. All patients were referred for surgery. Among the 143 nodules evaluated, 92 were benign, 33 were malignant, 13 were noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), and 5 were tumors of uncertain malignant potential (TUMP). The rate of malignancy, including NIFTP and TUMP in this definition, was 80%, 42.8%, 13%, 10%, and 23% for nodules with a high suspicion, intermediate suspicion, low suspicion, very low suspicion, and undefined ultrasonographic pattern, respectively. Considering NIFPT and TUMP as benign, these rates were 72%, 22.4%, 4.3%, 0%, and 15.4%, respectively. The addition of Doppler analysis did not significantly improve the prediction of malignancy obtained with the ATA classification alone. The results of this prospective study show the usefulness of the ATA ultrasonographic classification for predicting malignancy specifically in thyroid nodules >1 cm with indeterminate cytology. The ATA category of the nodule should influence the decision for follow-up, molecular tests, or surgery.

scholarly journals Comparison of power Doppler and thermography for the selection of thyroid nodules in which fine-needle aspiration biopsy is indicated

2016 ◽  
Vol 49 (5) ◽  
pp. 311-315 ◽  
Author(s):  
Maria Lucia D'Arbo Alves ◽  
Manoel Henrique Cintra Gabarra
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Power Doppler ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Fine Needle ◽  
Needle Aspiration Biopsy ◽  
Selection Of

Abstract Objective: To compare two methods-power Doppler and thermography-for the analysis of nodule vascularization and subsequent selection of nodules to be biopsied. Materials and Methods: A total of 510 subjects with thyroid nodules were analyzed by power Doppler and submitted to fine-needle aspiration biopsy (FNAB). Thirty-seven patients were submitted to nodule excision (29 due to carcinoma or suspected carcinoma and 8 by patient choice). Among those patients, power Doppler had raised the suspicion of malignancy in 39 lesions, compared with 48 for FNAB. Another group, comprising 110 patients, underwent thermography, which raised the suspicion of malignancy in 124 thyroid nodules, as did FNAB. Malignant nodules were excised in all 110 of those patients (95 underwent nodulectomy and 15 underwent thyroidectomy), malignancy being confirmed by intraoperative examination of frozen biopsy samples. Results: In relation to the FNAB findings, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of power Doppler were 95.16%, 23.52%, 96.22%, 16.70%, and 89.51%, respectively, compared with 100%, 58.06%, 87.73%, 100%, and 89.51%, respectively, for thermography. Conclusion: Thermography was more precise than was power Doppler for the selection of thyroid nodules to be biopsied.

scholarly journals Evaluation of the fine needle aspiration biopsy in the preoperative selection of cold thyroid nodules

Cancer ◽  
1991 ◽  
Vol 67 (8) ◽  
pp. 2137-2141 ◽  
Author(s):  
Giacomo Lucio la Rosa ◽  
Antonino Belfiore ◽  
Dario Giuffrida ◽  
Carmela Sicurella ◽  
Orazio Ippolito ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Fine Needle ◽  
Preoperative Selection ◽  
Needle Aspiration Biopsy ◽  
Cold Thyroid Nodules ◽  
Selection Of

scholarly journals Dependence of Thyroid Sonographic Markers of Malignancy and Its Influence on the Diagnostic Value of Sonographic Findings

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Kosma Woliński ◽  
Adam Stangierski ◽  
Ewelina Szczepanek-Parulska ◽  
Edyta Gurgul ◽  
Marek Ruchała
Keyword(s):  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Medical Condition ◽  
Nodular Goiter ◽  
Diagnostic Value ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Independent Variables ◽  
Risk Of Malignancy ◽  
Selection Of

Introduction. Thyroid nodules constitute frequent medical condition. Ultrasonographic (US) examination remains the basis in the diagnostics of nodular goiter and selection of the suspected ones requiring fine-needle aspiration biopsy (FNAB). The aim of this study was to evaluate if the features so far considered to be US malignancy markers are dependent or independent variables and to check if these data are clinically relevant.Materials and Methods. Patients with diagnosed thyroid nodular goiter admitted for thyroidectomy, irrespectively of the indications for surgery, were involved. The following parameters were assessed: echogenicity, the presence of calcifications, presence of halo, shape, margins, structure (solid, partially or pure cystic), and elasticity of the nodules (assessed quantitatively).Results. 122 consecutive patients with 393 thyroid nodules were included. There were significant associations between halo absence and irregular borders, micro- and macrocalcifications, taller-than-wide feature and macrocalcifications, irregular margins and macrocalcifications, and also decreased elasticity of nodules and several attributes (partially cystic character, micro- and macrocalcifications).Conclusions. Not only diagnostic value of particular sonographic features but also data about cooccurrence and associations between them are clinically relevant. Although most of these features turned out to be independent, omitting significant association can lead to incorrect assessment of the risk of malignancy.

scholarly journals The usefulness of sonographic features in selection of thyroid nodules for biopsy in relation to the nodule's size

2009 ◽  
Vol 161 (1) ◽  
pp. 103-111 ◽  
Author(s):  
Bożena Popowicz ◽  
Mariusz Klencki ◽  
Andrzej Lewiński ◽  
Dorota Słowińska-Klencka
Keyword(s):  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Width Ratio ◽  
Imaging Features ◽  
Focal Lesions ◽  
The Us ◽  
Independent Risk Factors ◽  
Optimal Set ◽  
Selection Of

ObjectiveTo evaluate the efficacy of selected ultrasound (US) features of thyroid focal lesions useful for establishing indications for fine-needle aspiration biopsy (FNAB) with regard to the lesion's size.MethodsUS imaging features of 1141 thyroid nodules (shape, echogenicity, pattern of blood flow, presence of microcalcifications and the presence of other nodules in the thyroid) and their palpability were compared with the post-operative histopathological outcomes. The efficacy of the selected sets of the features was assessed for small nodules (SN)≤15 mm and large nodules (LN)>15 mm, as well as separately for nodules≤10 mm.ResultsLogistic regression analysis showed that in SN hypoechogenicity (odds ratios, OR: 3.18), microcalcifications (OR: 19.12), solitary occurrence (OR: 3.29) and height-to-width ratio≥1 (OR: 8.57) were independent risk factors for malignancy. The optimal set of small lesions that should be biopsied includes all lesions presenting at least one of the above-mentioned features (sensitivity 98%, specificity 44%). In the LN group, the selection criteria based on the shape of lesions and hypoechogenicity were less sensitive than in the SN group, but they allowed further reduction in the number of performed FNABs. Large nodules primarily selected for FNAB should be hypoechoic, more tall then wide or contain microcalcifications (sensitivity 84%, specificity 72%).ConclusionsThe obtained results provide rationale for using features from the US examination in selecting both small and large nodules for FNAB. In the case of LN, the usefulness of sonographic features is less sensitive, but more specific than in the case of SN.

scholarly journals The role of fine-needle aspiration biopsy and post-operative histology in the evaluation of thyroid nodules

2021 ◽  
Vol 17 (4) ◽  
pp. 315-321
Author(s):  
E. Xhardo ◽  
D. Xhemalaj ◽  
F. Agaçi ◽  
P. Kapisyzi
Keyword(s):  
Fine Needle Aspiration ◽  
Diagnostic Tool ◽  
Gold Standard ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Fine Needle ◽  
Needle Aspiration Biopsy

Thyroid nodules present a serious problem, and mostly they do not carry neoplastic characteristics. Thus, they do not need to be surgically treated. The risk of malignancy varies from 5 to 15 %. Steps to diagnose malignancy should include a careful clinical evaluation, laboratory tests, a thyroid ultrasound exam and a fine-needle aspiration biopsy. Fine-needle aspiration biopsy (FNAB) is the most important diagnostic tool in the assessment of thyroid nodules. Today it is considered the gold standard for malignancy diagnosis in thyroid cancer. In this review we evaluate the role of FNAB and post-operative cytology in the evaluation of thyroid nodules. FNA results are classified as diagnostic (satisfactory) or nondiagnostic (unsatisfactory). Unsatisfactory smears (5–10 %) result from hypocellular specimens usually caused by cystic fluid, bloody smears, or suboptimal preparation. Diagnostic smears are conventionally subclassified into benign, indeterminate, or malignant categories. Benign cytology (60–70 %) is negative for malignancy, and includes cysts, colloid nodule, or Hashimoto thyroiditis. Malignant cytology (5 %) is almost always positive for malignancy, and includes primary thyroid tumors or nonthyroid metastatic cancers. Indeterminate or suspicious specimens (10–20 %) include atypical changes, Hurthle cells or follicular neoplasms. The new Bethesda Cytologic Classification has a 6-category classification, subdividing indeterminate further by risk factors. Considering the increasing worldwide incidence of thyroid microadenomas, recently it is recommended to undergo FNAB under ultrasound guidance even in small (< 1cm) nodules if they are correlated with suspicious ultrasonographic features or suspicious neck lymph nodes. FNAB is a cheap and reliable diagnostic tool that can be used in the selection candidates for surgery and pre-operative diagnosis of thyroid carcinomas. It was concluded that FNAB is the gold standard in the evaluation of thyroid nodules and can prevent many unnecessary surgeries. False-negative FNA cytology remains a concern for clinicians treating patients with thyroid nodules. Post-operative histology give the definitive diagnosis and studies confirm that it has a significant discordance between pre-operative cytology and post-operative histology in patients with thyroid nodule. Cytopathologists should strengthen their criteria for the identification of adenomatous hyperplasia, thyroiditis, cystic lesions or suspicious thyroid nodules to avoid misdiagnoses.

scholarly journals Validation of TIRADS ACR Risk Assessment of Thyroid Nodules in Comparison to the ATA Guidelines

2021 ◽  
Vol 11 ◽  
pp. 37
Author(s):  
Goni Merhav ◽  
Sagit Zolotov ◽  
Ahmad Mahagneh ◽  
Leonid Malchin ◽  
Michal Mekel ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Risk Stratification ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
American Thyroid Association ◽  
Fine Needle ◽  
Clinically Significant ◽  
Benign Nodules

Objectives: The prevalence of thyroid nodules in adults, detected by ultrasound (US), is reported as high as 68%. US-guided fine-needle aspiration biopsy (FNAB) is the test of choice used to determine the nature of the nodules. However, not more than 15% are found to be malignant. Reducing the number of unnecessary FNAB while identifying clinically significant malignant nodules is imperative. There are several guidelines suggested for risk stratification of thyroid nodules by US. The aim of our study was to validate and compare Thyroid Imaging Reporting and Data System (TIRADS) American College of Radiology (ACR) and American Thyroid Association (ATA) risk stratification, specifically pertaining to reduction of unnecessary biopsies. Material and Methods: The study included 281 nodules in 245 patients who underwent FNAB between May 2018 and June 2019. Statistical analysis was performed only on 235 nodules that according to the TIRADS ACR and/ or ATA guidelines were eligible for FNAB. Data collected included nodule characteristics with corresponding TIRADS and ATA grading and cytological results using Bethesda scoring. Results: An agreement was found between the two criteria methods in 58.2% (137/235) of the cases. In 35.3% (83/235), ATA recommended FNAB while TIRADS did not. The specificity for ATA criteria was 7% (15/221) and for TIRADS was 37% (81/221). The sensitivity was 100% (14/14) for ATA and 86% (12/14) for TIRADS. Conclusion: Application of ACR TIRADS criteria can reduce the number of US-guided FNAB performed on benign nodules compared to ATA criteria, by 35%, with a cost of only two missed carcinomas that remained on further follow-up.

Pediatric Thyroid Nodules: Disease Demographics and Clinical Management as Determined by Fine Needle Aspiration Biopsy

PEDIATRICS ◽  
1995 ◽  
Vol 95 (1) ◽  
pp. 46-49
Author(s):  
Stephen S. Raab ◽  
Jan F. Silverman ◽  
Tarik M. Elsheikh ◽  
Patricia A. Thomas ◽  
Paul E. Wakely
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
False Negative ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Benign Nodule ◽  
Fine Needle ◽  
Minimal Invasiveness ◽  
Needle Aspiration Biopsy

Objective. The prevalence of thyroid nodularity in children has been estimated to be 1.8%. The reported prevalence of specific diseases which comprise these nodules is conflicting as evidenced by a reported range of malignancy of 2 to 50% in solitary nodules. In order to better classify pediatric (&lt;18 years old) thyroid disease and evaluate the utility of fine needle aspiration biopsy (FNAB) in this patient population, we retrospectively reviewed 66 FNABs from 64 thyroid nodules and 2 perithyroid lymph nodes from 57 patients. Methodology. Patients: The study was composed of 8 males and 49 females who ranged in age from 1 to 18 years old (mean = 13.1). Design: Surgical and/or clinical follow-up was obtained in all patients. The 66 FNAB diagnoses were initially classified into specific diseases. However, for the purpose of this review, the cases were classified as: 3 insufficient, 51 benign, 8 suspicious, and 4 malignant. Results. There were no "false positives" and one "false negative" (a papillary carcinoma was misdiagnosed as a benign nodule). Overall, 10 patients (18%) had malignant thyroid lesions, including 8 papillary carcinomas and 2 follicular carcinomas. Benign diagnoses included benign nodule, cyst, lymphocytic thyroiditis, granulomatous thyroiditis, hyperplasia, and abscess. Conclusions. The prevalence of malignancy in pediatric patients with thyroid nodules was 18%. We conclude that, because of its high diagnostic accuracy and minimal invasiveness, FNAB is useful in the management of pediatric thyroid nodules.

Fine-needle aspiration biopsy of cold thyroid nodules

Cancer ◽  
1988 ◽  
Vol 62 (7) ◽  
pp. 1337-1342 ◽  
Author(s):  
Annette R. Nathan ◽  
Kristen B. Raines ◽  
Yeu-Tsu Margaret Lee ◽  
E. Lawrence Sakas ◽  
Judy M. Ribbing
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Fine Needle ◽  
Needle Aspiration Biopsy ◽  
Cold Thyroid Nodules
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