scholarly journals Evaluation of hypofunctioning thyroid nodules with technetium-99m MIBI and ultrasonography

2017 ◽  
Vol 21 (1) ◽  
Author(s):  
Abubakar Farate ◽  
Aadil A. Gutta ◽  
Karien De Graaf ◽  
Trevor Mdaka
Keyword(s):  
Predictive Value ◽  
Thyroid Nodules ◽  
Follicular Adenoma ◽  
Follicular Carcinoma ◽  
Needle Aspiration ◽  
Regional Environment ◽  
Technetium 99M ◽  
Significant Difference ◽  
99Mtc Mibi ◽  
Mibi Scintigraphy

Background: Fine needle aspiration cytology (FNAC) cannot reliably differentiate follicular adenoma from follicular carcinoma (FC), which requires histological evidence of capsular or vascular invasion. FC is the most predominant thyroid cancer in our loco-regional environment, indicating the need for improvement in preoperative diagnostic accuracy of thyroid nodules to ensure appropriate and timely interventions.Objective: The purpose of this study was to assess the role of technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy and ultrasonography (USG) in the differential diagnosis of thyroid nodules.Methods: Forty-two patients with hypofunctioning thyroid nodules were prospectively studied with 99mTc-MIBI scintigraphy and USG to differentiate benign from malignant nodules. An injection of 740 MBq of 99mTc-MIBI was intravenously administered, followed by semiquantitative analysis of dual-phase scans using a 4-point (0 to 3) scoring system. USG was subsequently performed and interpretation was based on some sonographic criteria for malignancy. In the following days and weeks, patients underwent FNAC followed by surgery and histopathologic examination.Results: All malignant nodules were positive on 99mTc-MIBI and all but two malignant nodules were positive on USG. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy are, respectively, 100%, 70%, 65%, 100%, and 81% for 99mTc-MIBI scintigraphy; 87%, 78%, 68%, 91% and 81% for USG; and 83%, 100%, 100%, 96% and 64% for FNAC. There was no statistically significant difference between 99mTc-MIBI scintigraphy and USG performance for both benign (p = 0.317) and malignant (p = 0.573) nodules.Conclusion: 99mTc-MIBI scintigraphy and USG are important imaging modalities in the evaluation of thyroid nodules, particularly follicular neoplasms which are frequently associated with non-diagnostic cytology.

MIBI scintigraphy in hypofunctioning thyroid nodules

2009 ◽  
Vol 48 (04) ◽  
pp. 144-152 ◽  
Author(s):  
M. Schmidt ◽  
T. Ivanova ◽  
M. Dietlein ◽  
H. Schicha ◽  
P. Theissen
Keyword(s):  
Iodine Deficiency ◽  
Predictive Value ◽  
Selection Criteria ◽  
Thyroid Nodules ◽  
Risk Estimation ◽  
Thyroid Volume ◽  
Needle Aspiration ◽  
99Mtc Mibi ◽  
Thyroid Malignancies ◽  
Mibi Scintigraphy

Summary Aim: Several authors have investigated the value of technetium-MIBI scanning to predict the dignity of hypofunctioning, cold thyroid nodules (HTN) in regions with differing levels of iodine supply. They concluded that an MIBI scan can exclude thyroid malignancy, although comparisons between the studies are of limited value owing to differences in methodology and wide variations in patient selection criteria. The present study investigates whether the above claim is also valid in Germany, a country with a long-standing and persistent, mild iodine deficiency and a high incidence of nodules in large goiters with a low prevalence of malignancy. Patients, methods: The study compares the results of 99mTc-MIBI scintigraphy (incl. SPECT and planar images) in HTN (MIBI) with those of fine-needle aspiration biopsy (FNAB) and histology. Of 154 consecutive patients (121 women, 33 men; mean age 56 ± 12 years), 73 underwent thyroid surgery from which the results of FNAB and MIBI were assessed. Selection criteria were risk estimation or conditions limiting the feasibility of FNAB. The mean thyroid volume was 42 ± 25 ml, with 2.1 ± 1.4 nodules per patient. Results: Histology revealed thyroid malignancies in 8 out of 73 patients (11.0%). The negative predictive value for MIBI was 97%, which is comparable to FNAB (94%). However, in 19.5% of patients FNAB was indeterminate. Lower specificity (54%) and low positive predictive value (19%) showed that MIBI accumulation cannot differentiate between malignant and benign thyroid nodules. However, comparison with cytological and/or histological findings indicated that it could distinguish between lesions with differing rates of mitochondrial metabolism. Conclusion: Even in areas of former or mild iodine deficiency MIBI forms a basis for choosing between wait-and-see and surgical strategies if FNAB is unfeasible or not representative. However, even for pathological MIBI results, the prevalence of malignancy is not very high.

Afirma Testing in Thyroid Nodules with Indeterminate Cytology: A single Medical Institute Experience

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S94-S95
Author(s):  
Z Yang ◽  
T Zhang ◽  
L Layfield ◽  
M Esebua
Keyword(s):  
Predictive Value ◽  
Thyroid Nodules ◽  
False Negative ◽  
Follicular Adenoma ◽  
Follicular Carcinoma ◽  
Medical Institute ◽  
Cell Adenoma ◽  
Indeterminate Cytology ◽  
Thyroid Fna

Abstract Introduction/Objective About 10 to 30% of thyroid fine needle aspiration (FNA) nodules have indeterminate cytology, including Bethesda III, IV, and V. Afirma Gene Expression Classifier (GEC) measuring the expression of 167 mRNA was designed to classify the indeterminate thyroid nodules into benign and suspicious categories. This study aimed to evaluate the clinical performance of the Afirma GEC testing in these indeterminate thyroid lesions. Methods Medical records of patients with indeterminate thyroid FNA results and corresponding Afirma GEC results from November 2012 to December 2019 were retrieved. Subsequent surgical follow-up results were obtained. GEC results were compared to the histologic diagnoses. Results 1. There were 77 cases with indeterminate thyroid FNA results. Cytology diagnosis included 67 Bethesda III and 10 Bethesda IV. Afirma GEC results were benign for 41 cases (53%), suspicious for 32 cases (42%), and non- diagnostic for 4 cases (5%). Twenty seven of 32 cases (84%) with suspicious GEC results had surgical follow-up which revealed 12 malignant and 15 benign histologic diagnoses. Only 11 of 41 cases (27%) with benign GEC results had surgery which showed 8 benign and 3 malignant diagnoses. Based on the data, the sensitivity of this test is 80% and specificity is 65%. Positive predictive value (PPV) is 44% and negative predictive value (NPV) is 73%. The false positive cases include 5 Hurthle cell adenoma, 4 nodular hyperplasia, 3 follicular adenoma, 2 Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFPT), and 1 lymphocytic thyroiditis. The false negative cases include 2 minimally invasive follicular carcinoma (from same patient) and 1 papillary thyroid carcinoma. Conclusion 1. We demonstrated in this study that a little more than half of the cases with indeterminate thyroid cytology had negative Afirma GEC results. 2.Afirma test has relatively low specificity (65%) and PPV (44%). The sensitivity (80%) and NPV (73%) is relatively higher but is lower than the values in most literature. This could be due to the fact that majority of the Afirma GEC negative cases in this study did not have surgical follow-up and the sample size is small. 3.Afirma GEC test is a relatively good “rule-out” molecular test for indeterminate thyroid nodules but is not a reliable “rule-in” test due to the low specificity and PPV.

scholarly journals Could Negative Tc-99m-Methoxyisobutylisonitrile (MIBI) Scintigraphy Obviate the Need for Surgery for Bethesda III and IV Thyroid Nodules?

Surgeries ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 260-267
Author(s):  
Stella Armefti ◽  
Jasmin Mettler ◽  
Matthias Schmidt ◽  
Michael Faust ◽  
Marianne Engels ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
University Hospital ◽  
Molecular Testing ◽  
High Negative Predictive Value ◽  
Indeterminate Cytology ◽  
Sensitivity Specificity ◽  
Mibi Scintigraphy

In about 20% of all cases, the fine needle aspiration cytology (FNAC) results are equivocal, delivering the two common categories of indeterminate cytology, Bethesda III and IV. The observed rates of malignancy vary widely among institutions, with the urgent need for a more precise risk stratification. 99mcTc methoxyisobutylisonitrile scintigraphy (MIBI) is less expensive than molecular testing and has been shown to have a high negative predictive value. For this reason, the results of MIBI scintigraphy in adult patients with indeterminate FNAC were collected, and correlated with the final pathology reports of surgical specimens. Patients receiving FNAC, MIBI scintigraphy and surgery for sonographic suspicious hypofunctional thyroid nodules between 2015 and 2019 at the University Hospital of Cologne, Germany were identified. Sensitivity, specificity, positive predictive and negative predictive value of MIBI scintigraphy were calculated. Seventy-eight patients with sonographic suspicious hypofunctional thyroid nodules underwent surgery after interdisciplinary case discussion of both FNAC and MIBI results. In 49 (62.5%) cases, FNAC consisted of Bethesda III and IV results. In 39 (79.6%) of these cases, MIBI scintigraphy resulted in mismatch and intermediary results, but in only 4 (10.2%) of these cases was a carcinoma diagnosed. The negative predictive value of MIBI scintigraphy was 90–100%, respectively. Relying on the negative predictive value of MIBI match results might have obviated the need for surgery in 20.4% cases; one papillary microcarcinoma, however, would have been missed. MIBI scintigraphy has an underused potential for improving the diagnostic precision of hypofunctional thyroid nodules.

Diagnostic Accuracy of Fine Needle Aspiration in Thyroid Nodules Arising in Patients with Graves Disease

2017 ◽  
Vol 61 (2) ◽  
pp. 117-124 ◽  
Author(s):  
Jen-Fan Hang ◽  
Mohammed T. Lilo ◽  
Justin A. Bishop ◽  
Syed Z. Ali
Keyword(s):  
Predictive Value ◽  
Thyroid Nodules ◽  
Follicular Adenoma ◽  
Clinical Information ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Graves Disease ◽  
Fine Needle ◽  
Cellular Atypia ◽  
Sensitivity Specificity

Objective: Cytopathologic interpretation in Graves disease (GD) is considered challenging due to significant cellular atypia. Study Design: We retrospectively identified 55 fine needle aspirations (FNAs) from 43 patients with GD that subsequently underwent thyroidectomy from 1995 to 2016. Results: There were 5 patients with papillary thyroid carcinoma (PTC) and 4 with follicular adenoma (FA). Of the 5 patients with PTC, FNA was interpreted as PTC in 3, atypia of undetermined significance (AUS) in 1, and adenomatoid nodule (AN) in 1 (with a 0.5-cm incidental microcarcinoma). Of the 4 patients with FA, FNA was interpreted as follicular neoplasm (FN) in 2, AUS in 1, and AN in 1. Of the 46 nonneoplastic nodules, FNA was interpreted as nondiagnostic in 2, benign in 26, AUS in 15, FN in 1, and suspicious for PTC in 2. None was diagnosed as malignant. The sensitivity, specificity, positive predictive value, and negative predictive value of PTC diagnosis in FNA were 60, 100, 100, and 96.2%, respectively. Conclusion: FNA is a useful tool for identifying neoplastic nodules arising in GD. However, cytologic atypia often leads to indeterminate diagnoses (18/46, 39.1%). Awareness of clinical information regarding prior treatment for GD may be helpful to avoid overinterpretation.

scholarly journals Correlation between fine needle aspiration cytology and histopathological examination in thyroid swellings-a pilot study

2020 ◽  
Vol 7 (11) ◽  
pp. 4381
Author(s):  
Sanjay V. Gupta ◽  
Manish Munjal ◽  
Devyani Gupta ◽  
Siddharth Gupta ◽  
Shubham Munjal ◽  
...  
Keyword(s):  
Papillary Carcinoma ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Thyroid Nodules ◽  
Follicular Adenoma ◽  
Follicular Carcinoma ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Needle Aspiration Cytology

Background: Thyroid swellings are an enigma that necessitates either, a partial thyroidectomy and a tissue diagnosis to be followed by completion surgery or straightaway a radical intervention. A preoperative presumptive diagnosis of a thyroid swelling, solitary or otherwise is correlated with the post-surgical histopathological finding in the present study.Methods: 30 patients of thyroid nodules were selected from the head-neck tumour clinic of Dayanand medical college hospital, Ludhiana. Pre-operative fine needle aspiration cytology (FNAC) was performed and subjects taken for thyroidectomy, partial or total as the case maybe.Results: There were 20 (66.6%) females in the age group 25-65 years and 10 males (33.3%) 19-50 years with thyroid nodules. 86.6%, 26 patients were of follicular adenoma, 10% 3 patients of papillary carcinoma and 3.33% 1 patient of follicular carcinoma. No case in this study was reported as medullary carcinoma. In the cytological diagnosis of follicular neoplasm in 5 cases, 3 were diagnosed as thyroid adenoma, 2 were finally found to be papillary carcinoma. Overall sensitivity of fine needle aspiration was 40%. There was 84.6% agreement in follicular adenoma; 33% in papillary carcinoma and 100% in follicular carcinoma, and overall accuracy was 85.7%.Conclusion: FNAC is an ideal preoperative investigative modality in thyroid swellings with overall accuracy of 85 % and can differentiate preoperatively a benign from a   malignant thyromegaly; and thereby plan extent of surgery, with or without a neck dissection, Maximum cases of follicular adenoma could be easily diagnosed with this aspiration modality.                                               

scholarly journals Comparison of Fine Needle Aspiration and Fine Needle Nonaspiration Cytology of Thyroid Nodules: A Meta-Analysis

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Hongming Song ◽  
Chuankui Wei ◽  
Dengfeng Li ◽  
Kaiyao Hua ◽  
Jialu Song ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Meta Analysis ◽  
Needle Aspiration ◽  
Cochrane Library ◽  
Average Score ◽  
Fine Needle ◽  
Advantages And Disadvantages ◽  
Significant Difference

Background. Fine needle aspiration cytology (FNAC) and fine needle nonaspiration cytology (FNNAC) are useful cost-effective techniques for preoperatively assessing thyroid lesions. Both techniques have advantages and disadvantages, and there is controversy over which method is superior. This meta-analysis was performed to evaluate the differences between FNAC and FNNAC for diagnosis of thyroid nodules.Methods. Primary publications were independently collected by two reviewers from PubMed, Web of Science, Google Scholar, EBSCO, OALib, and the Cochrane Library databases. The following search terms were used: fine needle, aspiration, capillary, nonaspiration, sampling without aspiration, thyroid, and cytology. The last search was performed on February 1, 2015.Results. Sixteen studies comprising 1,842 patients and 2,221 samples were included in this study. No statistically significant difference was observed between FNAC and FNNAC groups with respect to diagnostically inadequate smears, diagnostically superior smears, diagnostic performance (accuracy, sensitivity, specificity, negative predictive value, and positive predictive value), area under the summary receiver operating characteristic curve, average score of each parameter (background blood or clot, amount of cellular material, degree of cellular degeneration, degree of cellular trauma, and retention of appropriate architecture), and total score of five parameters.Conclusion. FNAC and FNNAC are equally useful in assessing thyroid nodules.

scholarly journals Clinicopathological study of solitary thyroid nodule in Kolhan belt of Jharkhand

2021 ◽  
Vol 7 (6) ◽  
pp. 959
Author(s):  
Rajeev Saxena ◽  
Shiwani Kanth ◽  
Rohit Kumar Jha ◽  
Devandra Jee
Keyword(s):  
Diagnostic Accuracy ◽  
Thyroid Nodule ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Histopathological Examination ◽  
Follicular Adenoma ◽  
Daily Practice ◽  
Needle Aspiration ◽  
Age Group ◽  
Solitary Thyroid Nodule

<p class="abstract"><strong>Background:</strong> Thyroid disorders are commonly encountered in our daily practice and specially in countries like India and Nepal (foothill areas). There are variety of lesions that can arise within thyroid gland. In such scenario it is important to diagnose neoplastic and non-neoplastic conditions accurately with minimum complications so that proper management can be done as early as possible. The aim of the study was to know clinical spectrum of solitary thyroid nodules and diagnostic accuracy of fine needle aspiration cytology as compared to histopathological examination.</p><p class="abstract"><strong>Methods:</strong> We conducted our study over a period of 21 months from July 2018 to March 2020. 74 patients who gave consent and presented with solitary thyroid swelling were included in the study.  </p><p class="abstract"><strong>Results:</strong> In our study, cases mostly presented in the age group of 31-40 years with a female preponderance. Colloid goiter was the most common pathology which presented as solitary thyroid nodule. Among neoplastic lesions, follicular adenoma was the most common benign neoplasia with papillary thyroid carcinoma being the most common malignancy. FNAC had sensitivity of 78%, specificity-100%, positive predictive value-100%, negative predictive value-88% and diagnostic accuracy-92%.</p><p class="abstract"><strong>Conclusions:</strong> Majority of solitary thyroid nodules are found in females of middle age group. In our study we found FNAC as valuable diagnostic tool specially in benign cases.</p><p class="abstract"> </p><p> </p>

The Application of Fine Needle Aspiration Biopsy in the Diagnosis of Axillary Masses

2021 ◽  
pp. 1-7
Author(s):  
Cong-Gai Huang ◽  
Meng-Ze Li ◽  
Shao-Hua Wang ◽  
Xiao-Qin Tang ◽  
Johannes Haybaeck ◽  
...  
Keyword(s):  
Lymph Node ◽  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Benign Lesions ◽  
Fine Needle ◽  
Significant Difference ◽  
Malignant Lesions ◽  
Axillary Mass

<b><i>Introduction:</i></b> We intend to determine the diagnostic power of fine needle aspiration biopsy (FNAB) for differentiation between malignant and benign lesions on axillary masses and draw the physicians’ attention to the benefits of FNAB cytology in the diagnosis of axillary masses. <b><i>Methods:</i></b> In this study, 1,328 patients with an axillary mass diagnosed by FNAB were retrospectively reviewed. These cases were registered at the affiliated hospital of Southwest Medical University (China), July 2014 to June 2017. Cytological results were verified either by histopathology following surgical resection or clinical follow-up. <b><i>Results:</i></b> Of the 1,328 patients affected by axillary masses, 987 (74.3%) cases were female, and 341 (25.7%) cases were male. The highest incidence of patients was in the age group of 41–50 years (375, 28.2%). There were 1,129 (85.0%) patients with benign lesions and 199 (15.0%) with malignant lesions. Of the 199 malignant lesions cases, 21 cases were lymphomas, 2 cases were accessory breast cancers, and 176 cases were lymph node metastatic tumors. Under lymph node metastases, the most frequent primary tumors were breast cancer (141, 80.1%), followed by lung cancer (21, 11.9%). According to the study, the characters of 1,328 cases showed statistically significant difference (χ<sup>2</sup> = 4.534, <i>p</i> = 0.033), and the incidence of females with axillary mass was significantly higher than that of males. There was a statistically significant difference in the distribution of benign and malignant cases in the patient age groups (χ<sup>2</sup> = 1.129, <i>p</i> = 0.000), and the incidence of patients of 41–50 years of age was significantly higher than that of other patients. The diagnostic accuracy of FNAB in axillary masses was analyzed with the results of 95.98% of sensitivity, 99.56% of specificity, 97.45% of positive predictive value, and 99.29% of negative predictive value. <b><i>Conclusion:</i></b> Our results confirm that FNAB is a valuable initial screening method regarding pathologic diagnosis of axillary mass, in particular with respect to malignancy in 41- to 50-year-old female patients.

scholarly journals Is it possible to eliminate the number of inappropriate thyroid surgeries combining scintigraphy and cytology?

2021 ◽  
Vol 3 (5) ◽  
pp. 01-03
Author(s):  
Smaroula Divani
Keyword(s):  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Thyroid Nodules ◽  
Follicular Carcinoma ◽  
Accurate Method ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Needle Aspiration Cytology ◽  
Indeterminate Cytology

Objective: Although fine needle aspiration cytology (FNAC) is the most reliable, safe and accurate method for the clinical management of abnormal thyroid nodules, 5%-15% of cases lead to indeterminate diagnoses and surgery is the recommended practice for them as they may be malignant. Nevertheless, the majority of cases with indeterminate cytology are benign, so the risk of unnecessary surgery is significant. In our study we combined FNAC and scintigraphy in order to reduce the number of inappropriate surgeries. Subjects and Methods: From 219 patients with thyroid fine needle aspiration cytology 33(9 males and 24 females) aged 18-73 years, had indeterminate FNAC diagnoses and were referred for scintigraphy. Surgery was performed in all cases. The results of FNAC, scintigraphy and histology were collected and compared. Results: From 33 cases with indeterminate cytology 32 had a benign histological diagnosis and only one was malignant (follicular Ca). That case had a positive scan. All cases with negative thyroid scans (29/33) were benign. False positive scans were 3, whereas one scan was true positive with final diagnosis follicular carcinoma. Conclusion: This study showed that combining the FNAC with the thyroid scintigraphy in cases of thyroid nodules with indeterminate cytology it is possible to reduce the number of inappropriate surgeries from 32 to 3.

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