Performance Differences Between Conventional Smears and Liquid-Based Preparations of Thyroid Fine-Needle Aspiration Samples: Analysis of 47 076 Responses in the College of American Pathologists Interlaboratory Comparison Program in Non-Gynecologic Cytology (original) (raw)
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Jornal Brasileiro de Patologia e Medicina Laboratorial, 2013
Introduction: Despite the fact that the fine needle aspiration biopsy (FNA) is commonly used in the initial evaluation and distinction of benign and malignant lesions of thyroid nodules, it may yield variable results, inasmuch as it is contingent on the pathologist's analysis and expertise in collecting appropriate samples. Objective: To check the diagnostic accuracy between FNA and pathological examination of thyroid nodules, both performed in a diagnostic pathology service. Methods: Retrospective study carried out in a diagnostic pathology service in Chapecó, Santa Catarina, Brazil. All patients who underwent FNA and pathological examination in the period from January 1 st 2005 to December 31 2010 were included in this study. Results: 1,172 FNA were conducted during this period and 265 patients underwent both FNA and pathological examination. Most patients were female (85%), with mean age 47.75 years (standard deviation [SD] = 14.93 years). Cytopathological examinations yielded the following results: benignity (43.77 %), suspected malignancy (23.77%), follicular neoplasm (5.28%), atypical follicular lesion of undetermined significance (1.51%) and unsatisfactory sample (1.51%). In the pathological examination, the most predominant diagnoses were colloid goiter (38.87%), follicular adenoma (22.64%) and classic papillary carcinoma (18.87%). In satisfactory samples (n = 261), the following results were obtained: diagnostic accuracy (89.66%), sensitivity (82.14%), specificity (93.22%), negative predictive value (91.67%) and positive predictive value (75.19%). Conclusion: We concluded that FNA provides a good predictive value for benign thyroid, constituting a reliable and effective tool for diagnosis and surgical indication.
Conventional Cytological Smear Versus Liquid Based Preparation (E-Prep) in Thyroid Lesions.
IOSR Journals , 2019
Background and Objective Fine needle cytology (FNC) has gained tremendous popularity in recent times among clinicians and pathologist. Liquid based cytology is a new technology for fine needle aspiration samples. It is used for mainly for cervical cancer screening , now also used for non gynaecological samples. In this study thyroid lesions( 30 cases) are compared with both techniques of FNAC Conventional preparation and Liquid based preparation (EPREP) Materials and Methods This study is a prospective study conducted at Government Mohan Kumaramangalam Medical College, Salem during the year 2017. This study included samples obtained from 30 patients who attended cytology department for FNAC of thyroid lesions. Collection of clinical data of patients attending the cytology department for FNAC for thyroid lesions and preparing conventional smears(CS) & Liquid Based Preparation(LBP). Results On analysing and comparing average score obtained by both methods (CS & LBP) in thyroid lesions and the P value calculated by Pearson Chi-Square test, the difference was found to be statistically insignificant P> 0.05. Conclusion The decision to make, use either Conventional method or LBP may depend on basis of nature of the lesion ( solid or cystic) and other ancillary tests to perform in the sample & each method has its own advantages and disadvantages and both methods can be combined to obtain a superior quality smears and lower the failure rates.
Archives of pathology & laboratory medicine, 2009
Fine-needle aspiration (FNA) is recommended as an initial screening tool for the diagnosis of thyroid nodules. Approximately 10% of thyroid FNA diagnoses are "suspicious for neoplasm," warranting surgical resection. To examine the role of a patient's age, sex, size of nodule, and morphologic features as possible predictors of malignancy in patients with cytologic diagnosis of "suspicious for neoplasm." Cytopathology slides and reports of 402 consecutive thyroid FNAs from 2000-2005 interpreted as "suspicious" were reviewed. Of these, 180 cases that had subsequent surgical resection were selected. Of the 108 cases suspicious for follicular neoplasm on cytologic evaluation, histologic follow-up showed malignancy in 26 (24%). Of the 37 cases suspicious for Hürthle cell neoplasm, 15 (41%) had malignancy. Of the 35 cases suspicious for malignancy, 29 had malignant histologic diagnoses. Among cases with cytologic diagnoses of "suspicious for follicula...
Thyroid, 2015
Background: Increased recognition of the indolent nature of non-invasive follicular variant of papillary thyroid carcinoma (NFVPTC) along with greater insight into the molecular alterations of these tumors has prompted endocrine pathologists to question whether these tumors warrant a diagnosis of carcinoma. However, a change in terminology would affect the rate of malignancy of fine needle aspiration (FNA) diagnostic categories. Therefore, the aim of this study was to determine the percentage decrease in associated risk of malignancy for each FNA diagnostic category were NFVPTCs are no longer termed carcinomas. Methods: We evaluated a cohort of 655 FNAs with subsequent resection specimens over a 22month time period. The diagnoses of the preceding FNAs were recorded according to the Bethesda System for Reporting Thyroid Cytopathology. For cases with more than one preceding FNA, the FNA diagnosis associated with the highest risk of malignancy was identified. Slides for all resection specimens with a diagnosis of FVPTC were reviewed to identify non-invasive tumors. By definition, all of these tumors were encapsulated, partially-encapsulated, or wellcircumscribed and lacked any indication of infiltrative growth, capsular penetration, or lymphovascular invasion. Results: Our cohort of 655 FNAs with subsequent resection specimens included 53 (8.1%) nondiagnostic (ND), 167 (25.5%) benign, 97 (14.8%) atypia/follicular lesion of undetermined significance (AUS/FLUS), 88 (13.4%) suspicious for follicular neoplasm (SFN) , 94 (14.4%) suspicious for malignancy (SUS), and 156 (23.8%) malignant cases (POS). Surgical resections demonstrated benign findings in 309 (47.2%) and malignant tumors in 346 (52.8.0%),
Predictive Value of Cytologic Atypia in Indeterminate Thyroid Fine-Needle Aspirate Biopsies
Annals of Surgical Oncology
Background Fine-needle aspiration (FNA) biopsies are the most accurate method for diagnosis of thyroid nodules. Unfortunately, biopsies are indeterminate 15–30% of the time and surgery is thus required for a definitive diagnosis. We aimed to determine whether specific descriptors of cytologic atypia mentioned in indeterminate FNA reports were associated with malignancy on final histopathology. Methods Retrospective review of 1000 surgery patients identified 466 indeterminate FNA lesions that underwent either a hemi- or total thyroidectomy between 1998 and 2009. We screened FNA reports for specific descriptors of nuclear atypia. Univariate and multivariate analyses were performed to evaluate the independent effect of cytologic atypia descriptors on the risk of malignancy. Results Nuclear atypia on FNA conferred a risk of malignancy of 42% (P < 0.0001). Risk of malignancy increased from 17% for zero descriptors to 81.2% when four or more descriptors of atypia were described. Nuclear grooves and inclusions together conferred a risk of malignancy, specificity, and false positive rate of 79.3%, 98.2% and 1.8% respectively. Conclusions The presence of four or more descriptors of cytologic atypia or the presence of both nuclear inclusions and grooves together confers a high risk of malignancy on final histopathology and a low false positive rate. These findings should be taken into consideration when interpreting FNA reports and total thyroidectomy should be considered for those patients at higher risk.
Surgery, 2010
Background. Follicular thyroid carcinoma cannot be distinguished reliably from benign follicular neoplasia by fine needle aspiration (FNA) biopsy. Given an estimated 20% risk of malignancy, many patients with indeterminate FNA biopsies require thyroidectomy for diagnosis. Some centers have shown significant discordance when a second pathologist evaluates the same FNA biopsy. We sought to determine whether routine second-opinion cytopathology reduces the need for diagnostic thyroidectomy, especially in patients with indeterminate FNA biopsies. Methods. In all, 331 thyroid FNA biopsy specimens obtained from outside centers from 2004 to 2009 were reviewed at our institution. The FNA biopsy results were categorized into nondiagnostic (Bethesda I), benign (Bethesda II), indeterminate (follicular/Hurthle cell neoplasm, follicular/Hurthle cell lesion; Bethesda III & IV), and malignant (papillary or suspicious for papillary or other malignancy; Bethesda V and VI). Second-opinion cytology was compared with the initial opinion in 331 cases and with final operative pathology in the 250 patients who progressed to thyroidectomy. Results. The average patient age was 51 with a predominant number of female (79%) participants. The overall cytology concordance for all 331 FNA biopsies was 66% (218/331). Concordance was highest at 86% (74/86) with malignant FNA biopsies. Concordance in the 129 patients with indeterminate FNA biopsies was only 37% (48/129). Indeterminate FNA biopsies were reread as nondiagnostic in 21% (27/129) of patients and as benign in 42% (54/129) of patients. Twenty-two patients with an indeterminate FNA biopsy reread as benign progressed to operative therapy for reasons other than cytology (eg, symptomatic nodule and radiation exposure/high risk) and were found to be benign in 95% (21/ 22) of patients on operative pathology for a 95% negative predictive value. An additional 11 patients with an indeterminate FNA reread as benign had follow-up FNA biopsies, each of which was benign. Indeterminate FNA biopsies on initial cytology had a malignancy rate of 13% (17/129) on operative pathology compared with 29% (14/48) for indeterminate FNA biopsies from second opinion. A second opinion improved FNA biopsy accuracy from 60% to 74%. Overall, second-opinion cytology of indeterminate FNA biopsies avoided diagnostic operation in 25% (32/129). Conclusion. Routine second opinion review of indeterminate thyroid FNA biopsies can potentially obviate the need for diagnostic thyroidectomy in 25% of patients without increases in false negatives. (Surgery 2010;148:1294-301.) From the Robert Wood Johnson Medical School, New Brunswick, NJ THYROID NODULES are present in 19-67% of the population. 1 Approximately 5-15% of thyroid nodules contain thyroid malignancy. 2 Follicular thyroid carcinoma accounts for 10-25% of all thyroid malignancies. 3 Fine needle aspiration biopsy (FNA) is the most accurate and cost-effective method for evaluating thyroid nodules. 4 FNA cytology is useful for identifying features of papillary thyroid carcinoma, which is the most common form of thyroid cancer. It is also useful for the less common medullary and anaplastic thyroid carcinoma as well as other rare thyroid tumors. 5 Unfortunately, follicular thyroid carcinoma (FTC) cannot be distinguished reliably from benign follicular neoplasia on cytology. This is because the diagnosis of follicular carcinoma requires evidence
The Role of Fine Needle Aspiration Cytology (Fnac) In the Evalution of Thyroid Lesions
Abstract: Objective: To determine the sensitivity, specificity and diagnostic accuracy of fine needle aspiration cytology in the management of thyroid lesions. Material and Methods: A prospective study of Fine needle aspiration cytology of the thyroid gland was undertaken to evaluate its diagnostic utility, during the period from June 2011 to December 2013 in the Department of Pathology, S.P. Medical College Bikaner. A total of 52 patients presenting with palpable thyroid nodule was included in the study. All the patients underwent fine needle aspiration of the nodule. Among 52 cases, 37 were biopsied subsequently and subjected to histopathological study. A comparison of FNA cytology and biopsy results was made. Results: Age of the patients ranged from 15-70 yrs with a mean age of 42.44 yrs. The majority of the patients were females in the present study with 45 (86.5%) females and 7 males, with a ratio of 6.41:1. Urban and rural distribution of sample population included 38 (73.1%) cases from rural and 14 (26.9%) cases from the urban population. Of the 52 cases of thyroid lesions, 39 were Non neoplastic lesions and 9 were Neoplastic lesions. Of the Non neoplastic lesions, 34 were Nodular colloid/ Adenomatous goiter, 4 Hashimoto thyroiditis, 1 neoplasm and 1 anaplastic neoplasm. Among 52 cases, 37 were biopsied subsequently and subjected to histopathological study. 28 cases were Non-neoplastic, 9 cases were Neoplastic. Out of 9 cases of Neoplastic lesions, 4 were Papillary carcinoma, 5 were Follicular adenoma. The diagnostic accuracy of non neoplastic and neoplastic lesions is 96.42% and 88.9% respectively. The sensitivity, specificity, positive predictive value and negative predictive value for FNAC of thyroid lesion neoplasm in the present study are 92.86%, 95.65%, 92.86% and 95.65% respectively. Conclusion: It helps to categorize Non-neoplastic from Neoplastic thyroid lesions. Its use has decreased the number of surgeries performed. FNAC of thyroid lesions has been shown to be safe, simple, cost effective and accurate method for the management of palpable thyroid lesions. However, in view of a small number of false negative results, the FNA results should be interpreted in the light of clinical findings. In case of doubt the true nature of the disease should be confirmed by biopsy. Keywords: Palpable thyroid lesions, Fine Needle Aspiration Cytology, Histopathology, Sensitivity, Specificity
Indian Journal of Pathology and Oncology, 2023
Introduction and Objectives: Fine needle aspiration (FNA) has about 90% diagnostic accuracy for papillary thyroid carcinoma (PTC) in an adequate sample. Ignorance of relative significance of individual cytologic features may lead to misdiagnosis due to reliance on a single or few features. Our objective was to determine the usefulness of individual and most appropriate combined cytologic features, for diagnosis of PTC. Materials and Methods: H&E stained FNA smears of fifty cases each, of consecutive histologically confirmed PTC and benign thyroid cases (controls), reported over 3 years, were retrieved from the files. A total of 31 architectural, cytological and background features were assessed, blind to the final diagnosis and compared amongst the two groups. The statistical significance (p<0> Discussion: Twenty features were found to be statistically significant. Fourteen highly significant (p<0 p=0.000> Conclusion: Using correct combination of cytologic features will increase accuracy of FNA diagnosis of PTC. Keywords: Fine needle aspiration, Papillary thyroid carcinoma, Cytologic.
Ultrasound guided FNA of thyroid performed by cytopathologists enhances Bethesda diagnostic value
Diagnostic Cytopathology, 2016
Background: Ultrasound (US) guided fine needle aspiration (FNA) biopsy of thyroid are examined and reported by cytopathologists based usually on The Bethesda System for Reporting Thyroid Cytopathology (BTC) regardless of the procedure's performers. This study is designed to determine whether there is any performer-dependent difference. Methods: Six hundred and fifty-one thyroid US-FNAs in correlation with surgical follow-up (SFU) were studied. The statistical analysis was performed using the surgical pathology diagnosis as the gold standard. Results: Among the 283 cases performed by cytopathologists, there were 8 (2.8%) nondiagnostic (BTC I), 197 (69.6%) benign (BTC II), 31 (11%) atypical (BTC III), 14 (5%) suspicious for follicular neoplasm (BTC IV), 12 (4.2%) suspicious for malignancy (BTC V), and 21 (7.4%) positive for malignancy (BTC VI), and there were 55 (19.4%) cases with SFU. The 368 cases performed by others showed 76 (21%) BTC I, 238 (65%) BTC II, 26 (7%) BTC III, 10 (3%) BTC IV, 9 (2.5%) BTC V 5, and 9 (2.5%) BTC VI, and there were 26 (7%) cases with SFU. The cytopathologist group achieved better sensitivity (91.3 vs.78%); slightly better specificity (83.3 vs. 82%); better positive predictive value (87.5 vs. 70%); similar negative predictive value (88.2 vs. 88%); and better overall accuracy (87.8 vs. 81%) compared with the non-cytopathologist group. Overall the difference for all statistical values is significant different (P 5 0.041). Conclusion: US-FNA performed by cytopathologists showed a lower unsatisfactory rate and significantly better overall statistical values. Cytopathologists may play an important role in thyroid patient care.
American Journal of Clinical Pathology, 2010
Fine-needle aspiration (FNA) is an important test for triaging patients with thyroid nodules. The 2007 National Cancer Institute Thyroid Fine-Needle Aspiration State-of-the-Science Conference helped instigate the recent publication of The Bethesda System for Reporting Thyroid Cytopathology. We reviewed 3,080 thyroid FNA samples and recorded interpretations according to the proposed standardized 6-tier nomenclature, and pursued follow-up cytology and histology. Of the 3,080 FNAs, 18.6% were nondiagnostic, 59.0% were benign, 3.4% were atypical follicular lesion of undetermined significance (AFLUS), 9.7% were "suspicious" for follicular neoplasm (SFN), 2.3% were suspicious for malignancy (SM), and 7.0% were malignant. Of 574 cases originally interpreted as nondiagnostic, 47.9% remained nondiagnostic. In 892 cases, there was follow-up histology. Rates of malignancy were as follows: