Consistency analysis of ultrasound-guided fine-needle aspiration and histopathology results in thyroid nodules (original) (raw)
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Saudi Journal of Medicine and Medical Sciences, 2019
Classifying thyroid lesions is challenging; nonetheless, using ultrasonography may allow for accurate diagnosis, differentiation and management of thyroid lesions and help avoid unnecessary biopsy. The main objective of the study is to determine the diagnostic accuracy of ultrasonography in classifying thyroid nodules compared with fine-needle aspiration. This retrospective study included all 68 patients diagnosed with thyroid nodules at King Fahd Hospital of the University, Al Khobar, Saudi Arabia, between June 1, 2014, and November 30, 2016. Parameters were selected based on the Society of Radiologists in Ultrasound criteria. Ultrasonographic features, namely, nodule margins, echotexture, vascularity and calcifications, and fine-needle aspiration cytology (FNAC) results were reviewed by two radiologists blinded to each other's findings and validated by another experienced interventional radiologist. Ultrasonography results were compared against that of FNAC to calculate sensit...
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.
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.
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.
Value of fine-needle aspiration in evaluating large thyroid nodules
Head & Neck, 2016
Background. The American Thyroid Association (ATA) recommends using ultrasound-guided fine-needle aspiration (FNA) in order to evaluate supracentimetric and suspect thyroid nodules. The purpose of this study was to evaluate the effective use of FNA before surgery for nodules over 3 cm in diameter. Methods. In this retrospective study, we analyzed the results of ultrasound-guided FNA and postoperative histological analysis in 843 nodules >3 cm. Results. The FNA was informative in 42.6%. The correlation with the final histological analysis was 94.8% for benign nodules and 71.0% for malignant nodules. The FNA had a positive predictive value of 71%, a specificity of 97%, a sensitivity of 56%, and a 4.7% rate of falsenegative results. Conclusion. Because there is a nonnegligible FNA risk of error, notably allowing the evolution of a cancer in 1 of 20 cases, the FNA data should not delay surgical intervention for potentially suspect nodules >3 cm in diameter. V
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.
Assessing the Ultrasound Guided Fine Needle Aspiration in Diagnosis of Thyroid Nodules
Pakistan postgraduate medical institute, 2016
Objective: To decide the number of punctures in a biopsy procedure, Fine Needle Aspiration (FNA), needed for secured cytological evaluation of thyroid nodules. Materials and Methods: This cross-sectional analysis was carried out at Pakistan Institute of Medical Science, Islamabad (PMIS) during the period from January to December, 2016. A total of 94 patients participated in the population study according to the inclusion criteria. The diagnosis was the focal point of the research. Results: The participants in the study group aged around 51 years, while 86.2% among the patients were females. Since punctures were considered as an independent event, the first puncture produced decisive results in 77.5% of cases. The second and third puncture produced results in 82.1% and 73.2% of all cases relatively. With a view to increase the conclusive analysis at each puncture, two punctures have demonstrated indisputable results in 87.2% of cases, and three punctures, in 91.2% of cases with no less than one decisive result. Conclusion: Two punctures in fine-needle desire biopsies of thyroid nodules have prompt determination in 86.2% of cases in the evaluation recommending that there is no requirement for further punctures to securely acquire the analysis of thyroid nodules.
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.
Ultrasound in Medicine & Biology, 2012
The objective of this study was to determine the rate of malignancy in thyroid nodules with an initial nondiagnostic fine needle aspiration. From October 2001 to April 2007, biopsies were performed on 1344 thyroid nodules in our practice. Biopsies were performed on nodules using 25-27 gauge needles, ultrasound guidance and multiple passes using both suction and capillary action. We retrospectively reviewed the results of these biopsies as well as any further management of nodules that received nondiagnostic results (IRB HUM00006459). Following initial biopsy, 295/1344 (21.9%) of nodules received nondiagnostic pathologic results. Of this population, 39 nodules (13.1%) were lost to follow-up. Of the remaining 256 nodules that received a repeat FNA, surgical excision, or greater than 24 months of clinical and imaging follow-up, only five cancers were detected, representing only 2% of the population that received an initial nondiagnostic biopsy result. All of these cancers were papillary neoplasms. When rigorous, ultrasound-guided, fine needle aspiration of thyroid nodules is performed, a nondiagnostic histopathologic result should not be interpreted as suspicious for thyroid cancer. Given the low rate of malignancy in this population (2%), we suggest that clinical and imaging follow-up of these nodules, opposed to repeat sampling, is warranted.
IOSR Journal of Dental and Medical Sciences, 2017
Introduction: About 70% of discrete thyroid swelling is clinically "isolated" and 30% are dominant. In India the prevalence of a palpable thyroid nodule in the community is about 12.2% Material and Method: A total of 100 patients of thyroid swelling entered the study. This is a prospective comparative study of patients admitted for solitary thyroid nodule at Rajendra Institute of Medical sciences (RIMS). Results: The sensitivity and specificity of FNAC was 85.71% and 100% respectively. All malignant lesions on FNAC were confirmed by histopathology indicating its excellence. Therefore FNAC helps in planning the correct management and avoids second surgery and the sensitivity and specificity of USG was 78.94 % and 85.33% respectively. Therefore use of ultrasound along with FNAC will improve the diagnostic accuracy to higher level and help in better management Conclusion: Combination of both FNAC and Ultrasound will give optimal results and avoid mismanagement.