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

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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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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Correlation of Ultrasonography Guided Fine Needle Aspiration Cytology with Postoperative Histopathology in Diagnosis of Thyroid Nodule

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v27i1.53203 ◽

2021 ◽

Vol 27 (1) ◽

pp. 36-43

Author(s):

Md Jaber Al Sayied ◽

A Allam Choudhury ◽

Sonia Jahan Bithi ◽

Ashim Kumar Biswas ◽

Riashat Azim Majumder ◽

...

Keyword(s):

Thyroid Nodule ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Needle Aspiration ◽

Follicular Neoplasm ◽

Ultrasound Guided ◽

Aspiration Cytology ◽

Fine Needle ◽

Needle Aspiration Cytology ◽

Undetermined Significance

Background: Fine-needle aspiration cytology (FNAC) is recommended as a decisive diagnostic step in the workup of patients with nodular thyroid disease. Unfortunately, FNAC can miss malignancies in smaller and deeper nodule. Ultrasound guided FNAC (US-FNAC) can reduce this error in suspicious thyroid nodule. Objectives: To find out the correlation of USG guided FNAC with postoperative histopathology in diagnosis of thyroid nodule. Methods: After obtaining clearance and approval from Institutional Review Board, all 45 patients of thyroid nodule who were admitted in the Department of Otolaryngology – Head & Neck surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from April 2017 to August 2018 and had fulfilled the inclusion and exclusion criteria were selected for the study. Each patient was assessed before surgery by USG guided FNAC and post operatively by histopathology. Results: In this study mean age of the respondents was 33.33 yearswith SD±10.84. Male female ration was 1:5.4. USG guided FNAC was reported by ‘The Bethesda System for Reporting Thyroid Cytopathology’ (TBS-RTC).Of the 45 specimens 2 samples were nondiagnostic or unsatisfactory (Class I), 26 samples were benign (Class II), 2 samples were showing Atypia of Undetermined Significance or Follicular lesion of Undetermined Significance (Class III), 6 were showing follicular neoplasm or suspicious for a follicular neoplasm (Class IV), 5 samples were suspicious for malignancy (Class V) and 4 samples were positive for malignancy (Class VI). On comparison of ultrasound guided FNAC with histopathology the sensitivity for correct diagnosis was 94%, specificity was 93%, positive predictive value was 88%, negative predictive value was 96% and accuracy was 93%. Pearson’s correlation coefficient was 0.85 which is very strong for positive relationship. Conclusion: USG guided FNAC is the most accurate method for diagnostic evaluation of thyroid nodules. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 36-43

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Approach to the Patient with a Cytologically Indeterminate Thyroid Nodule

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2008-1328 ◽

2008 ◽

Vol 93 (11) ◽

pp. 4175-4182 ◽

Cited By ~ 73

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.

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Should we perform fine needle aspiration cytology of subcentimetre thyroid nodules? A retrospective review of local practice

Ultrasound ◽

10.1177/1742271x18820556 ◽

2019 ◽

Vol 27 (1) ◽

pp. 64-68 ◽

Cited By ~ 2

Author(s):

Jasmine ME Chua ◽

Jonathan YM Tang ◽

Desmond SW Lim ◽

Nanda Venkatanarasimha ◽

Sivanathan Chandramohan ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Cytology ◽

Thyroid Nodules ◽

Surgical Excision ◽

Needle Aspiration ◽

Aspiration Cytology ◽

Fine Needle ◽

Malignancy Rate ◽

Needle Aspiration Cytology

In light of the rising rate of incidentally detected subcentimetre thyroid nodules due to improved surveillance and diagnostic imaging, the decision of whether to perform fine needle aspiration cytology is increasingly pertinent. We aim to assess (1) the sampling adequacy of fine needle aspiration cytology, (2) malignancy rate, (3) thyroidectomy rate and (4) diagnostic accuracy of fine needle aspiration cytology. A total of 245 subcentimetre nodules in 220 patients underwent fine needle aspiration cytology between 2011 and 2014. Medical records were reviewed for cytology results, subsequent management and histopathological results in the event the patient underwent thyroidectomy. Sampling adequacy was calculated as the percentage of diagnostic results (Bethesda II–VI). Malignancy rate was defined as the percentage of Bethesda IV–VI diagnoses. Amongst patients with Bethesda IV–VI diagnoses who underwent thyroidectomy, their cytology reports were correlated with post-operative histopathological findings. The sampling adequacy of fine needle aspiration cytology was 77.1%. Malignancy rate (Bethesda IV–VI) was 9.7%. The respective malignancy rates in the < 5 mm nodule group and ≥ 5 mm nodule group were 6.67 and 10.0%. In total, 79.2% (19/24) of the malignant nodules underwent surgical excision. The rest declined surgery and/or were lost to follow-up. Amongst the malignant nodules which were surgically resected, 84.2% (16/19) had definitive malignant histology. Five of these demonstrated multifocal carcinoma and/or extrathyroidal extension of carcinoma on histology. Initial fine needle aspiration cytology and subsequent histopathological diagnoses matched in all cases except for three that had false-positive fine needle aspiration cytology results. Majority of our patients with suspicious cytology results subsequently underwent thyroidectomy, notwithstanding the relatively lower diagnostic accuracy of fine needle aspiration cytology in subcentimetre thyroid nodules.

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Diagnostic accuracy of fine needle aspiration cytology of thyroid nodules

Diagnosis ◽

10.1515/dx-2019-0039 ◽

2020 ◽

Vol 7 (1) ◽

pp. 61-66

Author(s):

Taskin Erkinuresin ◽

Hakan Demirci

Keyword(s):

Diagnostic Accuracy ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Fine Needle Aspiration Cytology ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Histopathological Diagnosis ◽

Aspiration Cytology ◽

Fine Needle ◽

Needle Aspiration Cytology

AbstractBackgroundRoutine application of fine needle aspiration cytology (FNAC) has decreased unnecessary referral of thyroid nodules for surgical treatment and has also increased the cancer rates found in surgery materials. Success of thyroid FNAC depends on skilled aspiration, skilled cytological interpretation and rational analysis of cytological and clinical data. The aim of this study was to determine the diagnostic accuracy rates of thyroid FNAC results obtained in our institution.MethodsThe data from FNAC and thyroidectomy reports of patients presenting with goiter and who had been evaluated from 1st January 2014 to 1st March 2018 were used. There were 149 patients in total who had undergone thyroidectomy following FNAC. The Bethesda System for Reporting Thyroid Cytology was used in all cytological diagnoses.ResultsThe sensitivity of thyroid FNAC for malignant cases was 57.89%, specificity was 88.10%, false-positive rate was 11.90%, false-negative rate was 42.11%, positive predictive value was 52.38%, negative predictive value was 90.24% and accuracy rate was 82.52%. “Focus number” variable was detected as the factor that affected the accurate prediction of FNAC and thyroidectomy results by the pathologist.ConclusionsThis study showed that there was a moderate conformity between thyroid FNAC and thyroidectomy cyto-histopathological diagnosis in malignant cases. As two or more nodules have a negative effect on the physician’s diagnosis of malignant nodules, we think that a more sensitive approach is needed in the determination of these cases. Sampling defects may affect this non-matching.

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NO BENEFIT OF DEDICATED THYROID NODULE SCREENING IN PATIENTS WITH ACROMEGALY

Endocrine Practice ◽

10.4158/ep-2019-0254 ◽

2020 ◽

Vol 26 (1) ◽

pp. 16-21 ◽

Cited By ~ 2

Author(s):

Ngan Betty Lai ◽

Dave Garg ◽

Anthony P. Heaney ◽

Marvin Bergsneider ◽

Angela M. Leung

Keyword(s):

United States ◽

Growth Hormone ◽

Thyroid Cancer ◽

Growth Factor ◽

Thyroid Nodule ◽

Fine Needle Aspiration ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Papillary Thyroid ◽

Fine Needle

Objective: Acromegaly results from the excessive production of growth hormone and insulin-like growth factor-1. While there is up to a 2-fold increased prevalence of thyroid nodules in patients with acromegaly, the incidence of thyroid cancer in this population varies from 1.6 to 10.6% in several European studies. The goal of our study was to determine the prevalence of thyroid nodules and thyroid cancer among patients with acromegaly at a large urban academic medical center in the United States (U.S.). Methods: A retrospective chart review was performed of all patients with acromegaly between 2006–2015 within the University of California, Los Angeles health system. Data were collected regarding patient demographics, thyroid ultrasounds, thyroid nodule fine needle aspiration (FNA) biopsy cytology, and thyroid surgical pathology. Results: In this cohort (n = 221, 49.3% women, mean age 53.8 ± 15.2 [SD] years, 55.2% Caucasian), 102 patients (46.2%) underwent a thyroid ultrasound, from which 71 patients (52.1% women, mean age 52.9 ± 15.2 [SD] years, 56.3% Caucasian) were found to have a thyroid nodule. Seventeen patients underwent a thyroid nodule FNA biopsy and the results revealed 12 benign biopsies, 1 follicular neoplasm, 3 suspicious for malignancy, and 1 papillary thyroid cancer (PTC), from which 6 underwent thyroidectomy; PTC was confirmed by surgical pathology for all cases (8.5% of all nodules observed). Conclusion: In this sample, the prevalence of thyroid cancer in patients with acromegaly and coexisting thyroid nodules is similar to that reported in the general U.S. population with thyroid nodules (7 to 15%). These findings suggest that there is no benefit of dedicated thyroid nodule screening in patients newly diagnosed with acromegaly. Abbreviations: AACE = American Association of Clinical Endocrinologists; ATA = American Thyroid Association; DTC = differentiated thyroid cancer; FNA = fine needle aspiration; GH = growth hormone; IGF-1 = insulin-like growth factor-1; PTC = papillary thyroid cancer; U.S. = United States

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Comparison on the Use of Spinal (Stylet) Needle and Simple Needle in Ultrasound Guided Thyroid Nodule FNA; Does the Needle Affect Thyroid FNA Result?

Iranian Journal of Radiology ◽

10.5812/iranjradiol.98754 ◽

2020 ◽

Vol 17 (2) ◽

Author(s):

Alireza Aziz Ahari ◽

Mohammad Ali Mohammadi Vajari ◽

Navid Khatibi Moghadam ◽

Hassan Hashemi ◽

Mahmoud Parvin ◽

...

Keyword(s):

Thyroid Nodule ◽

Fine Needle Aspiration ◽

Significant Relationship ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Fine Needle ◽

Needle Type ◽

Expert Radiologist ◽

Diagnostic Samples ◽

Thyroid Fna

Background: Thyroid fine needle aspiration (FNA) is currently the most acceptable method for evaluating thyroid nodules. Non-satisfactory sample is the main limitation of FNA. It has been shown that spinal needles can reduce the number of non-diagnostic samples. Objectives: In this study, we decided to compare the results obtained using spinal (stylet) needle and simple needle in thyroid nodule FNA according to the agreement between them and with the pathology results as the gold standard. Patients and Methods: Sampling of thyroid nodules of 156 patients was performed by a simple non-stylet 23 gauge needle (A) and a spinal 22 gauge needle with stylet (B). The samples were provided to the pathologist for blind examination. All samples were obtained by an expert radiologist and the pathology examination was also performed by a pathologist expert in thyroid gland diseases. Blind analysis was done using SPSS Statistics for Windows, version 16 (SPSS Inc., Chicago, Ill., USA). Results: The results of FNA with needles A and B were reported unsatisfactory in 11.51 (18 subjects) and 3.84 (six subjects), respectively (P = 0.01). The result in 63.46% (99 subjects) of the participants, in whom FNA was obtained by needle B was introduced as a better sample by the pathologist in comparison with 36.44% (57 subjects) (P < 0.001). Cancer was diagnosed in 9.56 and 7.66 of the samples yielded by needles B and A, respectively, which was not statistically significant (P = 0.54). There was also a significant relationship between thyroid imaging reporting and data system (TI-RADS) score and FNA result. Conclusion: A significant relationship between the adequate sampling results, the qualitative examination result, TI-RADS score and the needle type indicates the importance of needle type on the results of thyroid FNA. Using spinal (stylet) needles may reduce the number of non-diagnostic samples in fine needle aspiration of thyroid nodules and therefore, can have a better effect on the results of this method.

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