Aspiration Biopsy Of Thyroid Nodules Research Articles

Current State and Future Perspective of Molecular Diagnosis of Fine-Needle Aspiration Biopsy of Thyroid Nodules

Current State and Future Perspective of Molecular Diagnosis of Fine-Needle Aspiration Biopsy of Thyroid Nodules

Current State and Future Perspective of Molecular Diagnosis of Fine-Needle Aspiration Biopsy of Thyroid Nodules

Fine-needle aspiration biopsy (FNAB) is the most sensitive and specific tool for the differential diagnosis of thyroid malignancy. Some limitations of FNAB can be overcome by the molecular analysis of FNAB. This review analyzes the current state and problems of the molecular analysis of FNAB as well as possible goals for increasing the diagnostic rate, especially in the indeterminate/follicular lesion cytological group. Twenty publications were evaluated for the diagnostic material and assay systems used, the type, and the number of mutations screened. Sensitivity, specificity, and false-negative and false-positive rates were calculated for all publications. Testing for a panel of somatic mutations is most promising to reduce the number of indeterminate FNAB. A mean sensitivity of 63.7% was achieved for indeterminate lesions. However, there is a broad sensitivity range for the investigation of mutations in the indeterminate lesions. Therefore, additional molecular markers should be defined by mRNA and microRNA expression studies and evaluated in FNAB samples of thyroid carcinomas without known somatic mutations, and especially for the many benign nodules in the indeterminate/follicular lesion fine-needle aspiration cytology category. This approach should improve the differential diagnosis of indeterminate/follicular lesion FNAB samples. Testing for a panel of somatic mutations has led to an improvement of sensitivity/specificity for indeterminate/follicular proliferation FNAB samples. Further methodological improvements, standardizations, and further molecular markers should soon lead to a broader application of molecular FNAB cytology for the differential diagnosis of thyroid nodules and to a substantial reduction of diagnostic surgeries.

Factors affecting inadequate sampling of ultrasound-guided fine-needle aspiration biopsy of thyroid nodules

The aim of this study was to evaluate the overall ultrasonographic features and clinical factors that contribute to inadequate sampling in ultrasound-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules. From April 2008 to December 2008, 4077 US-FNABs in 3767 consecutive patients were reviewed. We evaluated the clinical, ultrasound and pathological features of patients and analysed the association between these features and inadequate samples. We also compared inadequate sample rates according to the experience of the performing doctor. The inadequate sample rate was 16·1% (654/4077). Univariate analysis revealed an association between inadequate samples and cyst dominancy, macrocalcification and benign pathology of the nodule. The inadequate sample rate was also higher in the inexperienced group than in the experienced group. In multivariate analysis, cyst dominancy and macrocalcification of a nodule were significantly associated with inadequate samples in the experienced group. Cyst dominancy and macrocalcifications in thyroid nodules, inexperience of the performing doctor and benign pathology were factors associated with high inadequate sample rates of US-FNAB in thyroid nodules.

BRAF analysis by fine needle aspiration biopsy of thyroid nodules improves preoperative identification of papillary thyroid carcinoma and represents a prognostic factor. A mono-institutional experience

The current preoperative diagnosis of a thyroid mass relies on microscopic evaluation of thyroid cells obtained by fine needle aspiration biopsy (FNAB). More recently, FNAB has been combined with molecular analysis to increase the accuracy of the cytological evaluation. In this mono-institutional prospective study, we evaluated whether the routine introduction of BRAF testing in thyroid FNAB could help ameliorate the preoperative recognition of papillary thyroid carcinoma (PTC) in "suspended" or malignant cytological categories. Moreover, we investigated the prognostic role of the BRAFV600E mutation in PTC. BRAFV600E analysis was performed in thyroid FNAB from 270 patients classified into one of five cytological categories THY1, THY2, THY3, THY4, THY5. All subsequently underwent thyroidectomy±node dissection, from October 2008 to September 2009 in our Department. For each cytological category, we considered the definitive histological diagnosis of PTC and the presence of the BRAFV600E mutation. In 141 patients with a final tissue diagnosis of PTC, we correlated the presence of BRAFV600E with gender, age, histotype, TNM, size of the lesion, extracapsular extension, node metastases and multifocality. The prevalence of the BRAFV600E mutation, among PTCs at final tissue diagnosis, was 69%. It improved the FNAB diagnostic accuracy from 88% to 91%. The BRAFV600E mutation was correlated with older age, classical variant of PTC, advanced stages in patients > 45 years. BRAFV600E testing could play a role in improving the diagnostic accuracy of FNAB for PTC, representing a useful adjuvant tool in presurgical characterization of thyroid nodes in particular cases. There is an association between the BRAFV600E mutation and some clinico-pathological characteristics of PTC.

Fine-Needle Aspiration Biopsy of Thyroid Nodules: Comparison of Diagnostic Performance of Experienced and Inexperienced Physicians

To determine whether a difference exists in terms of obtaining adequate cytologic samples from ultrasound-guided fine-needle aspiration cytology (US-FNAC) between experienced and inexperienced physicians in a tertiary referral center. In a prospective design, all patients with thyroid nodules of at least 10 mm in diameter were referred for US-FNAC tissue sampling as a part of their diagnostic work-up. Between May 2006 and September 2009, 997 euthyroid patients with 1,320 thyroid nodules were referred for US-FNAC by the attending endocrinologist (experienced physician) or 1 of 2 endocrinology fellows (inexperienced physicians). Of the 1,320 nodules, 713 biopsy specimens were obtained by the experienced physician and 607 were obtained by the inexperienced physicians. Nodule size was significantly larger in the endocrinologist's group of patients than in the fellows' group of patients (17 mm versus 14 mm, respectively; P<.001). The inadequacy rate of the US-FNAC procedures performed by the experienced physician (22 of 713 thyroid nodules or 3.1%) was significantly lower than for those performed by the inexperienced physicians (102 of 607 thyroid nodules or 16.8%) (P<.001). We conclude that, with increasing operator experience, the number of inadequate cytologic specimens generated by US-FNAC procedures is substantially reduced. This limits both direct and indirect costs and also minimizes the risks of possibly unnecessary surgical procedures.

Repeat US-guided Fine-Needle Aspiration Biopsy of Thyroid Nodules: Some Clarifications Are Needed

HomeRadiologyVol. 257, No. 1 PreviousNext CommunicationsLetters to the EditorRepeat US-guided Fine-Needle Aspiration Biopsy of Thyroid Nodules: Some Clarifications Are NeededXiao-Ying Qiu, Xiao-Ming Fan , Jian-Yi HanXiao-Ying Qiu, Xiao-Ming Fan , Jian-Yi HanAuthor AffiliationsDepartment of Ultrasound, People’s Hospital of Zhejiang Province, 158 Shangtang Rd, Hangzhou 310014, People’s Republic of China e-mail: [email protected]Xiao-Ying QiuXiao-Ming Fan Jian-Yi HanPublished Online:Oct 1 2010https://doi.org/10.1148/radiol.100953MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1 Kwak JY, Koo H, Youk JHet al.. Value of US correlation of a thyroid nodule with initially benign cytologic results. Radiology 2010;254(1):292–300. Link, Google Scholar2 Gharib H, Papini E, Valcavi Ret al.. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 2006;12(1):63–102. Crossref, Medline, Google Scholar3 Ross DS. Diagnostic approach to and treatment of thyroid nodules. I. In: Rose BD, ed. UpToDate. Wellesley, Mass: UpToDate, 2005. Google Scholar4 Gharib H. Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clin Proc 1994;69(1):44–49. Crossref, Medline, Google Scholar5 Layfield LJ, Cibas ES, Gharib H, Mandel SJ. Thyroid aspiration cytology: current status. CA Cancer J Clin 2009;59(2):99–110. Crossref, Medline, Google Scholar6 Papini E. The dilemma of non-palpable thyroid nodules. J Endocrinol Invest 2003;26(1):3–4. Crossref, Medline, Google ScholarArticle HistoryPublished online: Oct 2010Published in print: Oct 2010 FiguresReferencesRelatedDetailsRecommended Articles Sonographic Evaluation of Pediatric Thyroid NodulesRadioGraphics2017Volume: 37Issue: 6pp. 1731-1752Diagnostic Performance of Practice Guidelines for Thyroid Nodules: Thyroid Nodule Size versus Biopsy RatesRadiology2019Volume: 291Issue: 1pp. 92-99Diagnosis and Management of Small Thyroid Nodules: A Comparative Study with Six Guidelines for Thyroid NodulesRadiology2016Volume: 283Issue: 2pp. 560-569Diagnostic Performance of Five Adult-based US Risk Stratification Systems in Pediatric Thyroid NodulesRadiology2022Volume: 305Issue: 1pp. 190-198Assessment of American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) for Pediatric Thyroid NodulesRadiology2019Volume: 294Issue: 2pp. 415-420See More RSNA Education Exhibits Impact of ACR-TIRADS in Lesions Submitted to Fine Needle Aspiration: Experience in 1000 CasesDigital Posters2019Evaluating the Feasibility of ACR-TIRADS Classification System for Pediatric Thyroid Nodules Digital Posters2019The Good, the Bad, and the Ugly: A Case-based Review of the Ultrasonographic Evaluation of Thyroid Nodules According to the 2017 ACR-TIRADS ConsensusDigital Posters2019 RSNA Case Collection Papillary Thyroid CarcinomaRSNA Case Collection2022TI-RADS 5 - Papillary Thyroid CarcinomaRSNA Case Collection2022ACR TI-RADS TR5RSNA Case Collection2021 Vol. 257, No. 1 Metrics Altmetric Score PDF download

Enlarged Benign-Appearing Cervical Lymph Nodes by Ultrasonography Are Associated with Increased Likelihood of Cancer Somewhere Within the Thyroid in Patients Undergoing Thyroid Nodule Evaluation

Benign-appearing cervical lymph nodes (CLN) are easy to assess during an ultrasonography (US) evaluation for a guided fine-needle aspiration biopsy of a suspicious thyroid nodule, but their clinical significance regarding thyroid cancer risk is not known. Non-malignant-appearing nodes may be an indicator of early malignancy in the thyroid. We hypothesize that there is an increased prediction of thyroid cancer when benign-appearing enlarged CLN (ECLN) > 1 cm in any dimension are present during an US evaluation of thyroid nodules. A review of 269 consecutive patients' charts sent for thyroid nodule assessment that underwent thyroidectomy was conducted to compare ECLN, with the presence of thyroid cancer during an ultrasound-guided fine-needle aspiration biopsy of the thyroid nodule. Surgical excision pathology confirmed all abnormal cytology reports. From the final 265 charts reviewed, 213 had benign thyroid pathology and 52 had thyroid cancer. Sex, number, and size of the biggest thyroid nodule were not different between groups. Patients with cancer were on average 10 years younger and had higher thyroid-stimulating hormone (TSH) values (p < 0.003) as well as a 10-fold increase in enlarged non-malignant-appearing lymph nodes than their peers without cancer. The presence of ECLN had an 82% sensitivity, 90% specificity, and a 68% positive predictive value for thyroid cancer. There was also an 80% negative predictive value when enlarged lymph nodes were not present. In 8 of the 37 (21.6%) patients with malignancy and ECLN, the primary dominant thyroid nodule was negative on cytologic evaluation, but malignancies were confirmed on surgical specimen, in contralateral nodules on the same side as the ECLN. These nodules were mostly subcentimeric, ranging from 0.2 to 1.14 cm and were not biopsied due to their inconspicuous appearance. After multiple logistic regression analysis, enlarged lymph nodes had a 53.8 odds ratio for cancer (20.49-141.33, p < 0.01). Discovering the presence of ECLN in routine assessment of thyroid nodules is an easy and fast surveillance technique that increases the predictive value in diagnosing thyroid cancer, especially when the enlarged lymph nodes are on the same side as the thyroid nodule.

Detection of Papillary Thyroid Carcinoma by Analysis of BRAF and RET/PTC1 Mutations in Fine‐needle Aspiration Biopsies of Thyroid Nodules

Activating mutations of the oncogene BRAF or rearrangements of the tyrosine kinase receptor RET are observed in up to 80% of papillary thyroid carcinomas (PTCs). The predominant BRAF V600E mutation has not been detected in benign thyroid tissue so far, so consequently, this assumedly pathognomonic alteration is qualified to improve the preoperative diagnosis of PTC. Two hundred ninety preoperatively harvested fine-needle aspiration biopsies (FNABs) underwent routine cytologic assessment. BRAF V600E mutation analysis was performed by mutation-specific PCR using the same cell material; a hybrid-specific RT-PCR assay was used for detection of RET/PTC1 rearrangements. Detected genetic alterations were verified by direct sequencing. Definitive histopathology was obtained in 93/290 lesions following surgery of the respective thyroid nodule. While cytology alone diagnosed 13/30 malignancies (22 PTCs, 4 FTCs, 1 MTC, 1 UTC, 2 metastases), five additional malignancies were identified by supplementary mutation analysis. Cytology classified eight FNABs as benign, while postoperative histology demonstrated a thyroid malignancy (6 PTCs, 1 FTC, 1 metastasis). In four of these eight cases, the genetic analysis detected a BRAF V600E mutation or a RET/PTC1 rearrangement. Classifying both suspicious and malignant FNAB results as positive cytology results, supplementary genetic testing increased the overall sensitivity of FNAB from 70.4 to 85.7%, the positive predictive value (PPV) from 59.4 to 64.9%, and the negative predictive value (NPV) from 84.0 to 91.3%. Supplementary mutation analysis of RET and especially of the BRAF V600E mutation in FNABs is a fast and probably cost-effective assay in routine diagnostic setting. Mutation analyses of PTC-specific genetic alterations improve the preoperative identification and prognostic assessment of thyroid malignancies and therefore enable an optimized surgical strategy.

Fine-needle aspiration biopsy for thyroid nodules: a clinical and pathological study of 782 patients

Objective To evaluate clinical application of thyroid fine-needle aspiration biopsy (FNAB) and its diagnostic value.Methods FNAB was performed for 782 cases during 2005-2009 at China-Japan Friendship Hospital,Beijing and their clinical pathological data were retrospectively analyzed.Cytopathological diagnoses by FNAB were classified as unsatisfactory,benign,atypical cellular lesions,follicular neoplasm,suspicious malignancy and definite malignancy.Results of thyroid cytological and histological examinations of 76 patients with subsequent thyroidectomies were compared to those with FNAB to evaluate its diagnostic accuracy.Results Of 782 FNAB specimens,74.4 % (582/782) were classified as benign,2.6 % (20/782) as malignant,5.6 % (44/782) as follicular neoplasm,3.2 % (25/782) as atypical cellular lesion,2.9% (23/782) as suspicious malignancy and 11.3 % (88/782) as unsatisfactory.Among 76 patients with thyroidectomies,65.8 % of them (50/76) were histologically diagnosed as benign lesion,28.9 % (22/76) as definite malignancy and only 5.3 % (4/76) as benign follicular adenoma.Agreement between FNAB cytological diagnoses and histologically confirmed diagnoses for benign lesion and malignancy was 16/16 and 16/17,respectively.Conclusion FNAB is a reliable diagnostic method for evaluation of thyroid nodules. Key words: Thyroid nodule; Biopsy,fine-needle; Pathology,clinical

Biopsy of Thyroid Nodules: Comparison of Three Sets of Guidelines

The purpose of this study was to compare the results with three sets of guidelines for fine-needle aspiration biopsy of thyroid nodules. A total of 1,398 nodules confirmed with fine-needle aspiration biopsy or surgery were included in the study. We compared the diagnostic value of three sets of guidelines for ultrasound findings that should lead to fine-needle aspiration biopsy of a nodule. According to the Kim criteria, a nodule should have at least one of the following findings: marked hypoechogenicity, irregular or microlobulated margins, microcalcifications, or length greater than width. According to the Society of Radiologists in Ultrasound, biopsy should be performed on a nodule 1 cm in diameter or larger with microcalcifications, 1.5 cm in diameter or larger that is solid or has coarse calcifications, and 2 cm in diameter or larger that has mixed solid and cystic components, and a nodule that has undergone substantial growth or is associated with abnormal cervical lymph nodes. According to the American Association of Clinical Endocrinologists, a hypoechoic nodule with at least one additional feature, such as irregular margins, length greater than width, and microcalcifications, should be biopsied. For all nodules, the diagnostic accuracy of the Kim (area under the receiver operating characteristic curve [Az]=0.868) and American Association of Clinical Endocrinologists (Az=0.850) criteria was greater than that of the Society of Radiologists in Ultrasound criteria (Az=0.551). The number of nodules for which fine-needle aspiration biopsy was recommended (25.6%) was smallest with use of the American Association of Clinical Endocrinologists criteria, and the smallest number (7.3%) of missed malignant lesions was associated with use of the Kim criteria. The results did not change for the subgroup with nodules larger than 1 cm. The Kim and American Association of Clinical Endocrinologists criteria are more accurate than the Society of Radiologists in Ultrasound criteria. The American Association of Clinical Endocrinologists guidelines are recommended for achieving high specificity, and the Kim criteria may be chosen for higher sensitivity.

Fine-Needle Aspiration Biopsy of Thyroid Nodules: Experience in a Cohort of 944 Patients

The objective of our study was to determine the likelihood of malignancy in thyroid nodules and the risk of a nondiagnostic fine-needle aspiration biopsy (FNAB) on the basis of the demographic characteristics of the patients and sonographic features of the nodules. Between January 2002 and November 2007, 2,338 ultrasound-guided thyroid, thyroid bed, and cervical lymph node FNABs were performed at a tertiary referral center. Entry criteria for our retrospective study were adult patients who underwent thyroid nodule FNAB and had previously undergone diagnostic sonography. From previous reports for 944 thyroid nodules (739 nodules in women and 205 nodules in men), four sonographic features were recorded: longest dimension, morphology, presence of microcalcifications, and presence of lymphadenopathy. The final diagnosis of each nodule was classified as benign, malignant, or nondiagnostic on the basis of surgical pathology when available and cytology otherwise and was analyzed for correlation with individual sonographic features and combinations of features. The prevalence of malignancy and of nondiagnostic FNAB in this study was 11.0% and 11.8%, respectively. Statistically significant (p < 0.05) findings in malignant nodules were younger patient age (< or = 45 years; odds ratio [OR], 1.54) and solid nodule morphology (OR, 2.38). The significant predictors of a nondiagnostic-quality FNAB were older patient age (> 75 years; OR, 1.95) and a nodule > or = 10 mm (OR, 1.45). Adding information about the other evaluated ultrasound features did not lead to a significant result. Malignant thyroid nodules tend to be solid (86.5%). Patients older than 75 years showed a clearly increased risk of nondiagnostic FNAB, but to predict a higher risk of malignancy or of nondiagnostic FNAB using ultrasound remains difficult.

Clinical Efficacy of Fine-Needle Aspiration Biopsy of Thyroid Nodules in Males

It has recently been suggested that the use of fine-needle aspiration (FNA) biopsy of thyroid nodules in male patients is associated with an unacceptably high false-negative rate in the detection of thyroid malignancy. We hypothesize that FNA biopsy is an accurate preoperative tool for detecting thyroid cancer in men, and that false negative rates are significantly lower than recently reported. A retrospective database analysis was performed on all male patients who underwent thyroid surgery from May 1994 through January 2007 at a single institution. The results of preoperative FNA biopsies were compared with final surgical pathologic results. FNA biopsy results were reported as benign, malignant, inconclusive (i.e., follicular neoplasm), or nondiagnostic; final surgical pathology was reported as benign or malignant. Of 1205 patients who underwent thyroidectomy, 273 (23%) were male. Preoperative FNA biopsy results were obtained in 60% of these male patients and were read as benign in 45/165 (27%) patients, malignant in 47/165 (28%) patients, inconclusive in 66/165 (40%) patients, and nondiagnostic in 7/165 (4%) patients. In male patients with cytology reported as benign, 3/45 (6.7%) FNAs were determined to be malignant on final pathology. Our study determined that FNA biopsy of thyroid nodules in male patients has an acceptably low false-negative rate of 6.7% and is, therefore, an accurate and useful diagnostic tool. We recommend preoperative FNA biopsy for all male patients presenting with thyroid nodules as a standard of practice.

Comparison of cytological results obtained by repeated US‐guided fine‐needle aspiration biopsies of thyroid nodules: Focus on the rate of malignancy and diagnostic concordance

The debate still continues on the repeated fine-needle aspiration biopsies (FNABs) for thyroid nodule in clinical practice. In this study, we determined the rate of cytological change to malignancy and the diagnostic concordance of repeated FNABs when the same nodules were targeted under US-guidance. We retrospectively reviewed data for 187 thyroid nodules (173: twice, 14: three times) from 160 patients who underwent repeated US-guided FNABs, which were performed by one skillful radiologist targeting for the same nodules at a mean interval of 7.5 months. Their initial cytological findings were compared with second or third results and histopathologic follow-up. The initial FNABs findings of 187 nodules were unsatisfactory, benign, and indeterminate in 56, 52, and 79 cases, respectively. The rate of a second cytological diagnosis changed to malignancy was significantly higher in the unsatisfactory aspirates (10.7%; 6/56), when compared with those of the benign (0.0%; 0/52) or of indeterminate aspirates (3.8%; 3/79) (P = 0.022). However, there was no change to malignancy at third cytological findings of all 14 nodules. After the second US-guided FNABs, 30.8% (16/52) of the initially diagnosed as benign aspirates were reclassified as indeterminate, while 26.6% (21/79) of the initially diagnosed as indeterminate were reclassified as benign. In conclusion, to identify malignancies, repeated US-guided FNABs are recommended for thyroid nodules initially classified as unsatisfactory aspirates. However, although US-guidance is applied, a discrepancy might be unavoidable in the cytological interpretation of the nodules classified as benign or as indeterminate aspirates because of overlapping cytological criteria.

Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules: Comparison in Efficacy According to Nodule Size

The objective of this study was to compare the efficacy and procedure time of ultrasound-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules, according to the nodule size. US-FNABs of thyroid nodules performed between June 2007 and December 2007 were studied. We divided these patients into three groups according to the largest diameter of their nodules. Group A consisted of patients with thyroid nodules less than or equal to 5 mm, group B of patients with thyroid nodules greater than 5 mm and less than or equal to 10 mm, and group C of patients with thyroid nodules greater than 10 mm. We retrospectively reviewed the cytopathology results and complications in all three patient groups and measured the separate, total US-FNAB procedure time for each of 20 randomly selected thyroid nodules. US-FNAB was performed on 438 thyroid nodules in 253 patients. In groups A, B, and C, the adequacy rates from the first US-FNAB were 79.6% (90/113), 90.6% (125/138), and 95.2% (178/187), respectively. In groups A, B, and C, 113, 138, and 187 thyroid nodules in 100, 120, and 169 patients, respectively, revealed 59, 75, and 126 benign; 12, 11, and 9 suspicious for malignancy; 9, 32, and 29 malignant; 10, 7, and 14 inderminate for malignancy; and 23, 13, and 9 inadequate on the first US-FNAB. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were determined to be 85.7%, 100%, 100%, 94.9%, and 96.1% in group A; 97.7%, 100%, 100%, 98.7%, and 99.1% in group B; and 100%, 99.2%, 97.1%, 100%, and 99.4% in group C. The mean procedure times in groups A, B, and C were 2 minutes 33 seconds, 1 minute 50 seconds, and 1 minute 32 seconds, respectively. There were no significant patient complications in any of the three patient groups. US-FNAB of thyroid nodules smaller than 5 mm in maximum diameter was less successful, and the sensitivity was lower than those of nodules larger than 5 mm. We considered, however, that the sampling adequacy and efficacy of US-FNAB of thyroid nodules less than 5 mm in maximum diameter was satisfactory in our series and should be similar in other centers with similar characteristics to ours.

Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules: is it Necessary to Use Local Anesthesia for the Application of One Needle Puncture?

ObjectiveThis study was designed to evaluate the difference in the degree of patient pain for an ultrasound-guided fine-needle aspiration biopsy (USFNAB) of a thyroid nodule with one needle puncture with and without local anesthesia.Materials and MethodsA total of 50 patients participated in the study. We examined prospective patients who would undergo US-FNABs of two thyroid nodules (larger than 10 mm maximum diameter), which were located in separate thyroid lobes. For one of these thyroid nodules, US-FNAB was performed following the administration of local anesthesia; for the other nodule, no anesthesia was administered. The application of anesthesia was alternatively administered between patients (either prior to the first US-FNAB procedure or prior to the second procedure). For all patients, the degree of pain during and after each US-guided FNAB was evaluated according to a 4-category verbal rating scale (VRS), an 11-point numeric rating scale (NRS) and a 100-mm visual analogue scale (VAS).ResultsThe mean maximum diameters of thyroid nodules examined by US-FNAB with the use of local anesthesia and with no local anesthesia were 13.6 mm and 13.0 mm, respectively. There was no significant difference in nodule size (p > 0.05) between two groups. For the VRS, there were 27 patients with a higher pain score when local anesthesia was used and four patients with a higher pain score when no local anesthesia was administered. Nineteen patients had equivalent pain score for both treatments. This finding was statistically significant (p < 0.001). For the NRS, there were 33 patients with a higher pain score when local anesthesia was used and 10 patients with a higher pain score when no local anesthesia was administered. Seven patients had an equivalent pain score for each treatment. This finding was statistically significant (p < 0.001). For the VAS, there were 35 patients with a higher pain score when local anesthesia was used and 11 patients with a higher pain score where no local anesthesia was administered. Four patients had an equivalent pain score for both treatments. This finding was also statistically significant (p = 0.001).ConclusionIn our study, patient pain scales were significantly lower when no local anesthesia was used prior to US-FNABs of thyroid nodules as compared to when local anesthesia was administered. Therefore, we believe that when one needle puncture is used, US-FNAB should be performed without administering local anesthesia.

Fine‐needle aspiration biopsy of thyroid nodules as a possible source for molecular studies: Analysis of RNA obtained from routine cases

Thyroid nodules are frequent in clinical practice and fine-needle aspiration biopsy (FNAB) is widely used for its evaluation, but approximately 20% of the cases are diagnosed as indeterminate for malignancy. Aspirates from thyroid nodules can be used for ancillary methods, but molecular techniques are not routinely applied to these specimens. Forty-six consecutive, routinely performed, FNAB of thyroid nodules were evaluated for the feasibility of applying RT-PCR method. RNA was extracted from 1 of 3 fresh residual samples and analyzed to determine its pureness, integrity, and concentration. Cellularity was adequate in all 46, except one, specimens analyzed, scored as 0, 1+, 2+, 3+, and 4+ in 1, 10, 14, 9, and 8 cases, respectively. Thirty-three nodules measured less than 1.5 cm. Cytological diagnosis was positive for malignancy in 3 cases, indeterminate for malignancy in 3, most probably benign follicular lesion in 7, negative for malignancy in 32, and suggestive of benign follicular lesion in 1. Good quality RNA was successfully isolated in 45/46 (97.8%) samples, with an average RNA concentration of 14 ng/microl and detection of B2M mRNA in 97.7% (44/45). There was no significant correlation between RNA concentration and nodule size or specimen cellularity. In conclusion, molecular analysis using individual, residual samples of thyroid nodules aspirates is feasible and could be employed for molecular preoperative studies in the future, adding elements for final cytological diagnosis of indeterminate cases, without altering the routine procedure.

Galectin-3 immunodetection on large needle aspiration biopsy of thyroid nodules

Galectin-3 immunodetection on large needle aspiration biopsy of thyroid nodules

Unsatisfactory Consequences from Fine-Needle Aspiration Biopsy of Thyroid Nodules

ThyroidVol. 18, No. 5 Editorials and CommentaryUnsatisfactory Consequences from Fine-Needle Aspiration Biopsy of Thyroid NodulesAngela M. Leung and Alan P. FarwellAngela M. LeungSearch for more papers by this author and Alan P. FarwellSearch for more papers by this authorPublished Online:8 May 2008https://doi.org/10.1089/thy.2008.0067AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Unsatisfactory Consequences from Fine-Needle Aspiration Biopsy of Thyroid Nodules." , 18(5), pp. 491–492FiguresReferencesRelatedDetailsCited bySuperficial Aspiration TechniqueLow Nondiagnostic Rate for Fine-Needle Capillary Sampling Biopsy of Thyroid Nodules1 December 2013 | Journal of Ultrasound in Medicine, Vol. 32, No. 12Percutaneous Laser Ablation of Cold Benign Thyroid Nodules: A 3-Year Follow-Up Study in 122 Patients Roberto Valcavi, Fabrizio Riganti, Angelo Bertani, Debora Formisano, and Claudio M. Pacella9 November 2010 | Thyroid, Vol. 20, No. 11Is fine-needle aspiration cytology for thyroid nodules a routine and safe procedure? A series of emergency cervicotomies following FNAC23 July 2010 | Langenbeck's Archives of Surgery, Vol. 395, No. 7Alterations in Serum Thyroid–Related Constituents After Thyroid Fine-Needle Biopsy: A Systematic Review Stergios A. Polyzos and Athanasios D. Anastasilakis28 February 2010 | Thyroid, Vol. 20, No. 3Adequacy and Diagnostic Accuracy of Aspiration vs. Capillary Fine Needle Thyroid Biopsies15 September 2009 | Endocrine Pathology, Vol. 20, No. 4Clinical complications following thyroid fine-needle biopsy: a systematic reviewClinical Endocrinology, Vol. 71, No. 2Perchlorate: a cause for iodine deficiency?Environmental Chemistry, Vol. 6, No. 1 Volume 18Issue 5May 2008 InformationCopyright 2008, Mary Ann Liebert, Inc.To cite this article:Angela M. Leung and Alan P. Farwell.Unsatisfactory Consequences from Fine-Needle Aspiration Biopsy of Thyroid Nodules.Thyroid.May 2008.491-492.http://doi.org/10.1089/thy.2008.0067Published in Volume: 18 Issue 5: May 8, 2008Online Ahead of Print:April 21, 2008PDF download

Fine needle aspiration biopsy of thyroid nodules: Cytohistological Correlation

OBJECTIVE: Fine-needle aspiration biopsy (FNAB) currently is the main procedure for distinguishing benign from malignant thyroid nodules. The aim of our study was to assess the accuracy of FNABs in our hospital by comparing the cytological and histological diagnosis. METHODS: We performed a prospective study including 321 patients with thyroid nodules admitted to St. Marina Hospital from January 2004 to December 2006. Clinical and US data, TSH, FT3, FT4, anti-TPO, cytological and histological findings were evaluated. RESULTS: FNABs were performed in all 321 cases, 290 of them were women and 31 men; mean age 52,9 years. Cytological evaluation considered 67,3% of FNABs as benign, 15,6% as suspicious, 4,7% as malignant and 12,4% as inadequate sample. 88 of the patients underwent thyroid surgery. The comparison between cytological and histological findings showed that 99,1% of cytologically benign nodules were histologically confirmed, as well as 100% of the malignant lesions. 89,5% of the cases classified as suspicious on FNAB turned out to be benign on histology and 10,5% were malignant. The discrepant cases were 2 false-negative results, which had a cytological diagnosis of nodular hyperplasia and turned out to be a medullary carcinoma. Our results showed a sensitivity of 88,2% and a specifity of 100%. CONCLUSION: Thyroid FNAB is an accurate and cost-effective preoperative tool for selection of patients who would benefit from surgery. Scripta Scientifica Medica 2008;40(1):39-42

The frequency of malignant disease in cytological group of suspected cancer (ultrasound-guided fine-needle aspiration biopsy of nonpalpable thyroid nodules)

Fine-needle aspiration biopsy is the most important procedure for differentiating benign thyroid nodules from malignant ones. Traditionally, findings of fine-needle aspiration biopsy are divided into four categories: nondiagnostic, benign lesions, suspected cancer, and malignant lesions. Group suspicious for cancer largely involves follicular neoplasms as well as lesions with cytological features of malignancy. The purpose of this study was to establish the value of ultrasound-guided fine-needle aspiration biopsy in the diagnosis of nonpalpable thyroid cancer and to assess the frequency of malignant disease in the group of suspected cancer. A total of 184 patients with nonpalpable thyroid nodules (less than 1.5 cm in diameter) were examined by means of ultrasound-guided fine-needle aspiration biopsy. Patients were included in the study based on sonographic findings implicating possible malignant nature of nodules. RESULTS. During 1997-2002, 204 ultrasound-guided fine-needle aspiration biopsies of thyroid nodules were performed; findings were nondiagnostic in 5.9% of cases. In 59.8% of cases, cytological examination revealed benign lesions; in 11.8%, suspected cancer; and in 22.5%, malignant lesions. Eighty-five patients underwent subsequent surgery with histological examination of specimens obtained. In 45 cases, cytological diagnosis of malignant or suspected thyroid cancer was confirmed by histological examination after surgery. We conclude that ultrasound-guided fine-needle aspiration biopsy has a high accuracy in the diagnostic evaluation of nonpalpable thyroid nodule with cytological features of malignancy. However, fine-needle aspiration biopsy is not effective diagnostic method for differentiating benign thyroid nodules from malignant ones in follicular neoplasm group.