The diagnostic value of fine needle aspiration in comparison with frozen section in thyroid nodules: A 20-year study (original) (raw)
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Role of fine needle aspiration and frozen section in determining the extent of thyroidectomy
European Archives of Oto-Rhino-Laryngology, 2007
The routine use of Wne needle aspiration (FNA) and frozen section (FS) in the management of a thyroid nodule is controversial and needs to be evaluated on an institution to institution basis. Our aim was to determine the role of FNA and FS in determining the extent of thyroidectomy. We performed a comparative study of FNA and FS examination of all patients presenting with nodular thyroid disease between September 2002 and December 2005. Data were collected on a proforma by reviewing FNA, FS and histopathological reports. Data were analyzed on SPSS 11. Sensitivity, speciWcity, accuracy, positive predictive value and negative predictive values were calculated. We included 44 patients with preoperative FNA, intraoperative FS examination and Wnal histopathology reports available. We excluded patients with local invasion and distant metastases. Final histopathological report was taken as gold standard. FNA reported 8 benign, 7 papillary carcinoma, 22 follicular neoplasm, 1 medullary and 6 suspicious lesions. On Wnal pathology there were 16 benign and 28 malignant cases. Thus a total of 20 carcinomas were missed by FNA. When routine FS was done, a total of ten patients who had malignancy were missed. Both FNA and FS have high speciWcity for diagnosis of thyroid cancer but lacked sensitivity at our instituition. This is mainly because of high false negative results.
Role of Fine Needle Aspiration and Frozen Section in the Diagnosis of Thyroid Lesions
The Internet Journal of Pathology, 2010
The study compares fine needle aspiration cytology and frozen section of thyroid to final histopathologic diagnosis and characterizes the pitfalls in their use. Material and Methods : FNAC and FS were evaluated in 50 patients who underwent a thyroid surgery. Accuracy of FNAC and FS were assessed by definitive histological section as reference. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for both FS and FNAC. Results. On frozen section evaluation 9 0f the13 (69.2%) malignancies could be diagnosed. Of the 6 deferred diagnosis only 2 turned out to be malignant on histopathology No false positivity was reported with frozen section while. False negativity was seen in 2 cases. Fine needle aspiration cytology was able to detect only 6 out of 13 malignant cases where as 10 were labelled as suspicious and 2 showed inadequate cellularity. Two of the 4 cases missed on frozen section were papillary microcarcinomas. The other 2 cases were follicular carcinoma where capsular and vascular invasion could not be demonstrated on frozen section. Sensitivity, specificity and accuracy of frozen section was reported to be 81.8%, 100% and 95.4% respectively as compared to 60%, 100%, and 89.4% of that of FNAC. Conclusion. Frozen section evaluation remains a useful tool, complimentary to FNAC. Frozen section can be avoided when the FNAC is consistent with benign or malignant, but could be of value (i) When FNAC result is reported as suspicious or inadequate. (ii) In diagnosis of unsuspected nodule found at surgery.
European Journal of Surgical Oncology (EJSO), 2007
Aims: The utilization of fine needle aspiration (FNA) biopsy is an accurate and cost-effective method in the diagnosis of thyroid diseases. However, the non-diagnostic cases and cases of suspicious carcinoma remain a dilemma, and in these cases thyroidectomy is usually recommended, even if only 15e20% of these patients really need a thyroidectomy. To avoid unnecessary surgical treatment, frozen section (FS) is usually performed. This method is well recognized, but is not useful for the diagnosis of follicular lesions. Therefore, many authors have tried to increase the specificity and sensibility of intraoperative examination, supporting it with an intraoperative cytological technique (IC). To clarify the role of intraoperative exam (FS and IC), also comparing to FNA, we have reviewed our own experiences. Methods: In a period covering 6 years (2000e2005), FS was performed in 1472 cases out of 11 420 total thyroidectomy operations. FS diagnosis and definitive diagnosis, were reviewed and confirmed, moreover, FNA diagnosis and definitive diagnosis were also considered and all intraoperatory cytological slides were reviewed. Diagnostic accuracy was assessed for FNA and FS with or without intraoperative cytology. We compared 1472 FS diagnoses with their definitive histological diagnosis; 728 FNA out of 1472 patients with definitive histological diagnosis, and 564 FS associated with IC out of 1472 patients with definitive diagnosis. Results: The diagnostic accuracy of these three methods were, respectively, 88.8%, 88.8% and 95.7%. Conclusion: We can assert that FS associated with IC remains the most accurate technique in the surgical management of thyroid nodules.
Journal of Preventive Epidemiology, 2021
Introduction: Thyroid nodules are one of the most common diseases. Objectives: The aim of this study was to evaluate the correlation between fine needle aspiration (FNA) and intraoperative frozen section findings for thyroid disease patients. Patients and Methods: In this study, the FNA and intraoperative frozen section findings of 143 patients who were admitted to an educational hospital, Isfahan, Iran were collected and classified using these diagnostic methods during 2015. To find the correlation between FNA and intraoperative frozen section findings, statistical analysis was conducted using SPSS software version 16.0 (Chicago, IL). Results: Sensitivity and specificity of the positive FNA findings were 71% and 86.8%, respectively (P<0.001). The maximum concordance between FNA and intraoperative frozen section for papillary thyroid cancer was seen (P<0.001). Conclusion: In this study, a significant association between FNA and intraoperative frozen section of thyroid cancers,...
Cancer, 2007
BACKGROUND.The Papanicolaou Society of Cytopathology recently proposed 6 diagnostic categories for the classification of thyroid fine-needle aspiration (FNA) cytology. Using these categories, the experience with FNA from 2 institutions was studied with emphasis on cytologic-histologic correlation, source of errors, and clinical management.The Papanicolaou Society of Cytopathology recently proposed 6 diagnostic categories for the classification of thyroid fine-needle aspiration (FNA) cytology. Using these categories, the experience with FNA from 2 institutions was studied with emphasis on cytologic-histologic correlation, source of errors, and clinical management.METHODS.Patient cytology data were retrieved by a retrospective search of thyroid FNA in the institutional databases. Cytologic diagnoses were classified as unsatisfactory, benign, atypical cellular lesion (ACL), follicular neoplasm (FN), suspicious for malignancy, and positive for malignancy. Samples with a histologic discrepancy were re-evaluated, and clinical follow-up information was recorded.Patient cytology data were retrieved by a retrospective search of thyroid FNA in the institutional databases. Cytologic diagnoses were classified as unsatisfactory, benign, atypical cellular lesion (ACL), follicular neoplasm (FN), suspicious for malignancy, and positive for malignancy. Samples with a histologic discrepancy were re-evaluated, and clinical follow-up information was recorded.RESULTS.Of of 4703 FNA samples, 10.4% were classified as unsatisfactory, 64.6% were classified as benign, 3.2% were classified as ACL, 11.6% were classified as FN, 2.6% were classified as suspicious, and 7.6% were classified as malignant. Five hundred twelve patients had at least 1 repeat FNA, mainly for results in the unsatisfactory and ACL categories. One thousand fifty-two patients had surgical follow-up, including 14.9% of patients with unsatisfactory FNA results, 9.8% of patients with benign results, 40.6% of patients with ACL results, 63.1% of patients with FN results, 86.1% of patients with suspicious results, and 79.3% of patients with malignant results. The rates for histologically confirmed malignancy in these categories were 10.9%, 7.3%, 13.5%, 32.2%, 64.7%, and 98.6%, respectively. The cytologic-histologic diagnostic discrepancy rate was 15.3%. Sources of errors included diagnoses on inadequate specimens, sample errors, and overlapping cytologic features between hyperplastic nodules and follicular adenoma. The sensitivity and specificity of thyroid FNA for the diagnosis of malignancy were 94% and 98.5%, respectively.Of of 4703 FNA samples, 10.4% were classified as unsatisfactory, 64.6% were classified as benign, 3.2% were classified as ACL, 11.6% were classified as FN, 2.6% were classified as suspicious, and 7.6% were classified as malignant. Five hundred twelve patients had at least 1 repeat FNA, mainly for results in the unsatisfactory and ACL categories. One thousand fifty-two patients had surgical follow-up, including 14.9% of patients with unsatisfactory FNA results, 9.8% of patients with benign results, 40.6% of patients with ACL results, 63.1% of patients with FN results, 86.1% of patients with suspicious results, and 79.3% of patients with malignant results. The rates for histologically confirmed malignancy in these categories were 10.9%, 7.3%, 13.5%, 32.2%, 64.7%, and 98.6%, respectively. The cytologic-histologic diagnostic discrepancy rate was 15.3%. Sources of errors included diagnoses on inadequate specimens, sample errors, and overlapping cytologic features between hyperplastic nodules and follicular adenoma. The sensitivity and specificity of thyroid FNA for the diagnosis of malignancy were 94% and 98.5%, respectively.CONCLUSIONS.The current results indicated that FNA provides an accurate diagnosis of thyroid malignancy. The 6 diagnostic categories were beneficial for triaging patients for either clinical follow-up or surgical management. Cancer (Cancer Cytopathol) 2007. © 2007 American Cancer Society.The current results indicated that FNA provides an accurate diagnosis of thyroid malignancy. The 6 diagnostic categories were beneficial for triaging patients for either clinical follow-up or surgical management. Cancer (Cancer Cytopathol) 2007. © 2007 American Cancer Society.
IJRAR(www.ijrar.org)International journal of research and analytic reviews , 2021
Background: Goiter is one of the major health hazards of Bangladesh and their incidence increases with advancing age. Any abnormal swelling in the neck is readily noticed and adversely affects on the look of the person. It also concern regarding the possibility of malignancy. Methods: Comparative cross-sectional study between fine needle aspiration cytology , frozen section and histopathological examination in solitary thyroid nodule (Total 100 patients) who underwent a thyroid surgery, conducted at Combined Military Hospital, Dhaka from December 2011 to November 2012. Sensitivity, specificity, and accuracy calculated for both fine needle aspiration cytology and frozen section. Result: Total 26 (26 %) malignancies were detected in histopathological examination out of 100 patients. On frozen section evaluation 18 of the 26 (69.2%) malignancies could be diagnosed. Out of 8 missed cases on frozen section, 4 cases were papillary micro carcinomas. The other 4 cases were follicular carcinoma where capsular and vascular invasion could not be demonstrated on frozen section. No false positivity was reported with frozen sect ion while false negativity was seen in 4 cases. Fine needle aspiration Cytology was able to detect only 12 out of 26(46.1%) malignant cases where as 20 were labeled as suspicious and 4 showed inadequate cellularity. Sensitivity, specificity and accuracy of frozen section was reported to be 81.8%, 100% and 95.4% respectively as compared to 60%, 100%, and 89.4% of that of fine needle aspiration cytology. Conclusion: Frozen section evaluation remains a useful tool, complimentary to fine needle aspiration cytology. Frozen section can be avoided when the fine needle aspiration cytology is consistent with benign or malignant, but could be of value when fine needle aspiration cytology result is reported as suspicious or inadequate and in diagnosis of unsuspected nodule found at surgery.
Turkish Journal of Pathology, 2010
Amaç: tiroid nodüllerinin tanısında ince iğne aspirasyon sitolojisi-İİAs doğru, ucuz ve spesifik bir ilk tanı yöntemidir. Ancak, yetersiz ve kuşkulu tanı alan olgular problem yaratmaktadır. bu olgularda gereksiz bir geniş cerrahi girişimin önlenmesi için genellikle intraoperatif tanı yöntemi uygulanmaktadır. Çalışmamızda, tiroid nodüllerinin tanısında İİAs ve intraoperatif tanı yöntemi uygulamanın duyarlılık, özgüllük ve tanısal doğruluğunun değerlendirilmesi amaçlandı.
Cancer, 1991
From 1980 to 1988 the authors examined by fine needle aspiration biopsy (FNAB) 4609 patients with solitary thyroid nodules or multinodular goiters. A total of 5605 "cold" thyroid nodules were evaluated and classified, on the basis of the cytologic findings, as malignant, follicular lesions (probably malignant and probably benign) and benign. Then the authors compared the preoperative cytologic findings with the postoperative histologic results in 827 nodules from patients who underwent surgery. In the 805 thyroid nodules in which an adequate cytologic specimen was obtained, false-negative results were 2.3% and false-positive findings were 1.1%. By comparing cytologic and histologic diagnoses, preoperative FNAB resulted in the ability to accurately assess the risk of cancer in a thyroid nodule; since 250 nodules were identified as malignant, the risk of a "cold" thyroid nodule being cancer was 4.46% in this series. Cancer 672137-2141,1991.
2006
Objective The purpose of this study is to evaluate the role of fine-needle aspiration (FNA) and intraoperative frozen section (FS) in the management of thyroid nodules at our institution. Methods An 8-year retrospective chart review was conducted on all patients who had undergone FNA for a thyroid nodule with subsequent thyroid surgery and intraoperative frozen section. The positive predictive value