Diagnostic adequacy of surgeon-performed ultrasound-guided fine needle aspiration biopsy of thyroid nodules (original) (raw)
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Journal of Otolaryngology - Head & Neck Surgery, 2014
Background: Fine needle aspiration (FNA) is the standard of care for the diagnostic work-up of thyroid nodules but despite its proven utility, the non-diagnostic rate for thyroid FNA ranges from 6-36%. A non-diagnostic FNA is problematic for the clinician and patient because it can result in repeated procedures, multiple physician visits, and a delay in definitive treatment. Surgeon-performed FNA has been shown to be safe, cost-effective, as accurate as those performed by other clinicians, and has the added benefit of decreasing wait times to surgery. Several studies have examined rates and factors that may be predictive of a non-diagnostic cytology in non-surgeon FNA, but none have evaluated this in surgeon-performed thyroid FNA. If these factors are unique in surgeon-performed vs. non-surgeon performed thyroid FNA, then patients may be more appropriately triaged to FNA by alternate clinicians. Objectives: The purpose of this study was to determine the rate and factors predictive of a non-diagnostic FNA in surgeon performed ultrasound-guided FNA of thyroid nodules.
Adequacy of surgeon-performed ultrasound-guided thyroid fine-needle aspiration biopsy
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2008
To determine the diagnostic accuracy of specimens obtained by a surgeon performing office-based ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) of thyroid nodules. From 2003 to 2006, a single surgeon performed 447 consecutive office-based US-guided FNABs without on-site cytological specimen evaluation. Adequate specimens had at least six clusters of follicular cells from at least two separate needle passes. Non-diagnostic specimens occurred in 16 of 447 (3.6%) nodules, whereas suboptimal specimens occurred in 17 of 447 (3.8%). Adequate samples were obtained in 413 of 447 (92.6%) of specimens. Malignancy was present in 20 of 447 (4.5%) and atypical features were present in 37 of 447 (8.3%). Benign diagnoses were rendered in 357 of 447 (79.9%) of specimens, of which four of 357 (1.1%) represented false-negative results. Prior publications recommend that obtaining adequate thyroid cytology specimens requires use of US-guided FNAB and on-site evaluation of cytology adequacy....
Thyroid, 2011
Background: Although fine-needle aspiration biopsy (FNAB) is considered the standard for preoperative evaluation of thyroid nodules, the value of this has been questioned for large thyroid nodules. Here, we evaluated the diagnostic accuracy of ultrasound-guided FNAB (US-FNAB) for thyroid nodules that were 3 cm or larger as well as the sonographic differences between benign and malignant nodules in this size group. Materials and Methods: There were 661 thyroid masses equal to or larger than 3 cm who underwent US-FNAB from February 2002 to December 2006 and were included in this study. The cytology and surgical pathology readings in these patients were reviewed along with the ultrasonography features, the last from the retrospective review by one radiologist. Histopathology was used to calculate accuracy parameters for the US-FNAB cytology readings. In addition, the likely diagnoses for patients with a benign cytology reading were ascertained. Results: Thyroid surgery was performed for 206 of the 661 nodules in the same number of patients (31.2%). All subjects who had inadequate, indeterminate, or suspicious for malignancy cytology readings had thyroid surgery. All of the patients who did not have thyroid surgery were considered likely to have benign disease because of their initial cytology reading and follow-up, and finally, 587 (88.8%) were benign and 74 (11.2%) were malignant. When considering malignant, suspicious for malignancy, and indeterminate cytology readings as positive and benign cytology as negative, the sensitivity was 96.7%, specificity 85.9%, positive predictive value 76.6%, negative predictive value 98.2%, and accuracy 89.4%. Ultrasonography features of malignancy were more prevalent in thyroid nodules that were malignant compared with those that were benign or considered likely to be benign (70.3% vs. 1.2%, p < 0.001), and ultrasonography features of a benign nodule were more prevalent in thyroid nodules that were benign or considered likely to be benign than those that were malignant (94.9% vs. 29.7%, p < 0.001). Conclusion: In this study, US-FNAB appeared to be a relatively accurate method to evaluate thyroid nodules larger than 3 cm, with false-negative rates of about 2%. Much larger series would be required to determine its utility in this setting.
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.
The objective of this study is to elucidate the use of ultrasonography guided fine-needle aspiration biopsies (UG-FNAB) in the evaluation of thyroid nodules. The study population consisted of 790 UG-FNAB in 719 patients whom were admitted to the our endocrinology clinic. The cytological results were classified as benign, follicular lesion or suspicious for malignancy, malignant and non-diagnostic. The results of 790 UG-FNAB of 719 patients were as follows: 567 (71.77%) benign, 97 (12.28%) non-diagnostic cytology, 43 (5.44%) atypia with undetermined significance, 81 (10.25%) follicular lesion or suspicious for malignancy, 2 (0.25%) malignant. In our study, thyroid carcinoma rate was found to be lower than current literature. Of the malignant nodules which were reported as papillary thyroid carcinoma by UG-FNAB cytology, both were female, euthyroid and have single nodule in their thyroid gland. One of the patient (39 years old) had a micro nodule (< 1 cm in diameter) that it had an isoechoic pattern with regular margin on thyroid ultrasonography; whereas the other one (79 years old) had macro nodule (>1 cm diameter) that it had, hypoechoic pattern with irregular margin. None of them have calcifications in their nodules. Multidisciplinary approach including endocrinologists, radiologists and pathologists is essential for the management of patients with thyroid nodules to avoid missestimation of the risk of thyroid cancer.
ISRN Endocrinology, 2011
The objective was to analyze the results of UG-FNAB, performed in unselected consecutive patients with thyroid nodules. Methods. The UG-FNAB records were analyzed in this retrospective study. Indication for biopsy was the presence of at least one nodule detected by ultrasound. Results. 330 patients at mean age ± SD 48.4 ± 11.2 years; women/men = 12.8/1 were analyzed. From the total 596 nodules found 546 (91.6%) were investigated with 1231 punctures (2.3 per nodule and 3.7 per patient). Benign solitary nodules had 42.7%, multinodular goiter (MNG) 44.8%, inconclusive 4.8%, and others 2.1% and malignant nodules 5.5% of the patients (6.6% of solitary and 5.1% of MNG patients). The risk for a separate nodule in MNG to be malignant was 2.7%. Conclusions. UG-FNAB is a safe and reliable diagnostic approach for thyroid nodules. It is the method of choice for hypo- and isoechoic not purely cystic solitary nodules, regardless of the nodule size. In MNG, its positive predictive value and diagno...
International journal of clinical and experimental medicine, 2013
The large number of patients that require fine needle aspiration biopsy (FNAB) to discriminate malignant from benign thyroid nodules is a practical problem especially in iodine deficient area. To obtain an ultrasound (US) score and for predicting malignant nodules and reduce the number of unnecessary and expensive FNAB. A total of 280 thyroid nodules observed from August 2009 to August 2011 that had underwent FNAB were evaluated by US for echogenicity, peripheral halo, microcalcifications and intranodular vascularity. showed that nodules with two ultrasonographic features (US score = 4) were characterized by a 67.9% sensitivity and a 87% specificity for prediction of malignant thyroid nodules. According to our data, we suggest FNAB for nodules with US score ≥ 4. The practical use of this US score may help reduce unnecessary and expensive FNAB especially in iodine-deficient areas.
OTO Open
Objective To study the feasibility, safety, and learning curve of ultrasound-guided fine-needle biopsy (USGFNB) performed by a newly trained otolaryngologist in a community office in a setting. Study Design Collect USGFNB data of all thyroid nodules in a prospective manner. Setting A dedicated ultrasound clinic in a large community-based practice, operated by a single surgeon with the purpose of providing office-based point-of-care diagnostic ultrasonography and USGFNB. Subjects and Methods Data on the first 1000 unselected consecutive thyroid nodules that underwent USGFNB over a 3-year period were analyzed. Chi-square analysis was used to assess the statistical significance of characteristics of diagnostic vs nondiagnostic nodules. A multivariate regression analysis was conducted to determine nodule characteristics predictive of adequate sampling. Diagnostic yield and time efficiency data were plotted over a 3-year period to study the learning curve for the USGFNB procedure perform...
Endocrine Practice, 2006
Objective: To investigate the role of thyroid ultrasonography in our outpatient endocrine practice. Methods: We compared the efficacy of ultrasoundguided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules with that of palpation-guided aspiration (P-FNAB) and determined the malignancy rates of palpable and nonpalpable nodules. All patients referred for assessment of thyroid nodular disease from October 1997 through August 2001 were included in the study. Fineneedle aspirations were performed by palpation guidance until October 1999, after which US-FNAB was exclusively performed. All thyroid examinations, ultrasound imaging, and aspiration biopsies were performed by the same endocrinologist in an office-based setting. Histopathologic and cytologic diagnoses were compared for patients who underwent thyroidectomy. Results: A total of 376 nodules in 276 patients were aspirated during a 47-month period. P-FNAB was used on 157 nodules, and US-FNAB was performed on 219 nodules (both procedures were done on 21 nodules). For palpable thyroid nodules that were resected, the cytologic diagnostic accuracy rate was 60.9% and 80% for P-FNAB and US-FNAB, respectively. With use of ultrasound guidance, the sensitivity, positive predictive value, and negative predictive value increased significantly. In addition, the inadequate specimen rate decreased from 11.2% in the P-FNAB group to 7.1% in the US-FNAB group. Among the nodules that were not palpable, the malignancy rate was similar to that for the palpable thyroid nodules (5.1% versus 6.8%). Conclusion: US-FNAB improved the cytologic diagnostic accuracy, sensitivity, and positive predictive value and reduced the false-negative rate in comparison with P-FNAB. The malignancy rate for nonpalpable thyroid nodules was similar to that for palpable nodules.