Predictors of non-diagnostic cytology in surgeon-performed ultrasound guided fine needle aspiration of thyroid nodules (original) (raw)
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Evaluation of a dedicated ultrasound fine needle aspiration service for thyroid nodules
Sonography, 2018
Introduction: We studied whether: (1) a quality-focused thyroid fine needle aspiration (FNA) service reduced the non-diagnostic (ND) rate of FNA; (2) the implementation of thyroid FNA selection criteria resulted in higher proportion of Bethesda V and VI cytology and malignant histopathology; and (3) impact of radiologist's level of experience on ND rates. Method: The imaging and pathology computer databases were retrospectively searched for all patients who had thyroid FNAs at our hospitals from July 2004 to December 2016. Results: Three hundred thirty-eight and 609 patients in pre-thyroid and post-thyroid service groups, respectively, were evaluated. The ND rate of 36.7% in pre-thyroid service was significantly higher than post-thyroid service at 14.6% (p < 0.0001). The rates of Bethesda V and VI cytology in the pre-thyroid service group did not differ significantly from the post-thyroid group (p = 0.266; p = 0.069). There was no significant difference in the histopathologic malignancy rates between the two groups (p = 0.531). There was no significant difference in the ND rates of radiologists with varying experience (p = 0.873). Discussion: On-site cytology improved the ND rate of ultrasound-guided thyroid FNA. Implementation of FNA selection criteria did not alter the rates of Bethesda V and VI cytology and malignant histopathology. The experience of radiologists did not significantly influence ND rates.
Annals of Surgical Oncology, 2008
Background: Certain ultrasound features can predict malignancy in patients with thyroid nodules. The purpose of this study was to determine the value of surgeon-performed ultrasound (SUS) in predicting thyroid malignancy in patients with indeterminate fine-needle aspiration (FNA) cytology. Methods: 477 consecutive patients with dominant thyroid nodules were referred to our institution from 2002 to 2007. Of these, 180/477(38%) were judged to have indeterminate cytology: follicular neoplasm (FN, n = 108), Hu¨rthle neoplasm (HN, n = 29), and suspicious for papillary thyroid cancer (SPTC, n = 43). SUS characteristics for thyroid nodules were recorded in a prospective database prior to thyroidectomy. Variables analyzed included patients' age and sex, nodule size, shape, echogenicity, consistency, borders, multiplicity/multicentricity, and presence of microcalcifications. SUS features of thyroid nodules were correlated with final pathology. The accuracy of individual SUS features as well as the presence of two or more adverse features in predicting malignancy was also examined. Results: There were 144 females and 36 males. Mean age was 52 years (range 17-87 years). Mean tumor size was 2.7 cm (range 0.65-6.6 cm). Overall, final pathology revealed cancer in 92/180 (51%) patients. Malignancy was present in 40/108 (37%) FN, 12/29 (41%) HN, and 40/43 (93%) SPTC. Nodule borders (irregular), shape (height > width), hypoechogenicity, and presence of microcalcifications were significantly associated with malignancy. The presence of 2 or ‡3 adverse SUS thyroid nodule features was associated with a ‡55% or ‡78% risk of malignancy, respectively. Conclusion: Adverse thyroid nodule features seen on SUS may predict malignancy and help determine the initial extent of thyroidectomy in patients with indeterminate FNA cytology.
Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation
Cancer, 2007
BACKGROUND. The diagnostic evaluation of patients with thyroid nodules is imprecise. Despite the benefits of fine-needle aspiration (FNA), most patients who are referred for surgery because of abnormal cytology prove to have benign disease. Recent technologic and procedural advances suggest that this shortcoming can be mitigated, although few data confirm this benefit in unselected patients.
Thyroid : official journal of the American Thyroid Association, 2016
Fine needle aspiration (FNA) of thyroid nodules is commonly performed, and despite the use of ultrasound (US) guidance, the rate of non-diagnostic FNAs is still significant. The risk of malignancy of thyroid nodules with a non-diagnostic FNA is not clearly defined. However, most studies exclude the majority of patients without a repeat biopsy or surgery, thus increasing the likelihood of selection bias. The aim of our study was to determine the malignancy risk in nodules with an initial non-diagnostic FNA, and to identify the factors associated with malignancy. We performed a retrospective cohort study of patients with thyroid nodules that underwent US-guided FNA between 2004 and 2010 and had a non-diagnostic result. Patients were followed until confirmatory diagnosis of the nature of the nodule was made. The outcome of malignant or benign disease was based on one of the following: 1) final surgical pathology following thyroidectomy; 2) repeat biopsy; 3) clinically, based on repeat ...
The Use of Surgeon Performed Ultrasound in the Assessment of Indeterminate Thyroid Nodules
Journal of Thyroid Disorders & Therapy, 2013
While an AUS/FLUS (BSRTC 3) result can be managed by repeated fine needle aspiration (FNA) and conservative approach [1], the standard management for FN/FNS (BSRTC 4) classification is thyroid lobectomy [1,5,14]. Assessing the risk of malignancy in different BSRTC 3 nodules determines which nodule should be surgically excised and which follicular lesion should be managed conservatively, decreasing possible complications and cost following surgery. The clinical role of Ultrasound (US) in the assessment of the thyroid nodule has been widely accepted, and it is been used routinely in the management of thyroid nodules [3,15,16-18]. Despite known limitations such as being user-dependent, US provides valuable
Journal of Surgical Oncology, 2012
Background: Surgeon-performed ultrasonography (US) of thyroid nodules might serve as a potential therapeutic guide to designate accurate surgical or clinical intervention. Objective: To evaluate the diagnostic adequacy of surgeon-performed ultrasonography guided fine needle aspiration biopsy (FNAB) of thyroid nodules, the factors responsible for diagnostic adequacy and the impact of surgeon-performed US on treatment approach. Methods: Retrospective review of a single surgeon performed 621 US-guided FNABs without on-site cytological specimen assessment. Outside US findings were compared to the surgeon-performed US. Measured variables and outcomes for the study included diagnostic adequacy rates and the effects of detected differences between US reports on treatment variability. Results: Diagnostic adequacy rate of surgeon-performed US-guided FNAB was determined to be 94.52% without on-site specimen evaluation by cytologist. Non-diagnostic specimens occurred in 34 of 621 (5.48%) nodules. The differences detected between the outside US and surgeon-performed US altered invasive treatment algorithm in 30 (5.47%) patients. FNAB was avoided for 15 (2.7%) patients. Total thyroidectomy became the preferred surgical option in 15 (2.7%) patients after the discovery of additional nodules in the contralateral lobe. Conclusion: Surgeon-performed US offers clear clinical benefits in terms of diagnostic yield of FNAB with providing valuable additional data that might alter surgical treatment approach.
Medicine Science | International Medical Journal, 2018
To reveal the diagnostic efficacy and accuracy, compared with postoperative histopathological diagnosis, preoperative ultrasonography (US) and fine needle aspiration biopsy (FNAB) in determining benign and malignant disease in patients undergoing thyroidectomy in our clinic. Materials and methods: The research was designed with records of 95 patients who were examined thyroidectomy at our hospital Ear, Nose and Throat Clinic for five years. Preoperative ultrasound findings, FNAB results, postoperative histopathological findings, blood groups, age and sex were recorded. These data were each compared with the histopathological results in order to determine which technique was superior in distinguishing malignant from benign thyroid nodules. Ninety-five patients, aged between 21 and 76, 27 male and 68 female, were included. Mean age of male patients was 51.11±13.54 and mean age of female patients 49.18±11.92. Total thyroidectomy was performed in 82 (86.3%) cases, left lobectomy in 3 (3.2%), right lobectomy in 4 (4.2%) and total thyroidectomy plus neck dissection in 6 (6.3%). Of the cases thought to be benign at US, 76.4% were actually benign, and 83.33% of the cases thought to be malignant were actually malignant. The level of cases incorrectly identified as benign or malignant was 23.16%. Validity (test power) of US on the basis of postoperative diagnosis was 76.84%. In terms of FNAB findings, 27.78% of cases suspected of being malignant were malignant, and 72.73% of the group assessed as having benign cytology was actually benign. The level of cases incorrectly identified as being malignant or benign was 35.79%. FNAB test reliability (test power) on the basis of postoperative diagnosis was 56.1%. In addition, only US findings were significant when compared with histopathological findings in preoperative determination of malignant or benign disease (p=0.001), all other data being not significant (p˃0.05). The use of US findings in differentiating malignant from benign thyroid nodules and in accordingly planning treatment is more effective than use of FNAB.
Diagnostic Accuracy of Fine-Needle Aspiration Cytology (FNAC) in Thyroid Nodule Excision Cases
Curēus, 2024
Introduction: Fine needle aspiration cytology (FNAC) for thyroid nodules has a high diagnostic accuracy, according to several studies worldwide. Patients who experienced preoperative FNAC had more optimal surgical treatment than others who did not perform FNAC. Therefore, achieving an accurate FNAC procedure appears to be an important tool for the proper management of thyroid nodules. We aimed to study the accuracy and challenges of the thyroid FNAC diagnostic tool in the Al-Baha region, Kingdom of Saudi Arabia. Methods: The study involves 52 patients with thyroid nodules who underwent preoperative FNAC and postoperative histopathology with the same surgery and pathology team at Al-Baha region in 2022-2023. Results and Conclusion: The mean age of the included patients was 47.7 years, with a female predominance. The diagnostic accuracy was 90%, and the main cause of inaccurate diagnosis was processing challenges, where the majority of cases were taken on the palpation-only technique, a few cases were ultrasoundguided, and the only technique used in the laboratory was conventional smears. The applied interrater reliability Cohen kappa coefficient (κ) for the clinical-histopathological agreement was "moderate agreement". We recommend using and evaluating more cytological techniques in addition to the currently used conventional smears in pathology laboratories to enhance the efficacy of the FNAC diagnosis of thyroid lesions.